Inspection on 12/05/06 for Coombe Road (82)

This inspection was carried out on 12th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Coombe Road (82) 02/08/07

Coombe Road (82) 24/11/05

Coombe Road (82) 26/07/05

Coombe Road (82) 01/09/04

Coombe Road (82) 20/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Coombe Road (82) 82 Coombe Road Croydon Surrey CR0 5RA Lead Inspector Lee Willis Key Unannounced Inspection 12th May 2006 09:15 Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Coombe Road (82) Address 82 Coombe Road Croydon Surrey CR0 5RA 020 8681 8078 020 8681 8078 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) londonroad@tiscali.co.uk Milbury Care Services Limited Michael Luganda Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: 82 Coombe Road is a residential care home that is owned by Milbury Care Services an organisation that specialises in providing personal support for up to eight younger adults with moderate to severe learning disabilities. Michael Luganda, who has been the homes registered manager since November 2003, remains in operational day-to-day control. This detached Victorian property is set back from a main road in a residential suburb to the South East of Croydon and is less than two miles from the centre of town. The local tram service stops just outside the home making it easy for residents, their gusrts and staff to access central Croydon, with its wide variety of local shops, cafes, pubs, and banks. The property is built over three stories and comprises of eight single occupancy bedrooms; a main lounge; separate dinning area with a conservatory attached, large kitchen, laundry room, top floor office, and staff sleep-in room. There are sufficient numbers of toilet and bathing facilities located throughout the home near service users bedrooms and communal areas. The garden at the rear of the property is mainly laid to lawn and is well maintained. The home ensures prospective service users and their reprensentatives are provided with copies of the homes Statement of purpose, residents Guide and contracts which all contain information about what services and facilities on offer; the range of fees charged, which currently stands at between £48,000 - £56,000 p.a.; and the homes most recent CSCI report. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the evidence gathered at the pre-fieldwork stage and the actual site visit, the home is judged to have substantially more strengths than weaknesses. There are no significant weaknesses in areas relating to the health and safety of people using the service. Furthermore, most key National Minimum Standards are almost met, although there are areas of particular concern that will require improvement through a mandatory action plan. The Commission is confident the providers will acknowledge these shortcomings and be able to resolve them in a timely fashion. The unannounced site visit to the home was carried out over five and a half hours between 9.15am and 2.45pm on Friday 12th May 2006. During which time two service users, the homes registered and deputy managers, a support worker, and a visiting Drama Therapist, were all spoken with at length. One service user met helped the inspector complete a ‘have your say’ survey about their experiences of life in the home. The manager was also asked to fill out a Pre-Inspection Questionnaire and Equalities survey. The remainder of the site visit was spent examining the homes records and touring the premises. No additional visits have been carried out by the CSCI in respect of this service in past twelve months and the one incident of alleged abuse, which was investigated under the Local Authorities vulnerable adult protection procedures, was unsubstantiated. What the service does well: The one service user spoken with at length was very positive about their experience of life at the home and all the others met seemed to be well cared for and quite content. The one service user who helped fill out a questionnaire about the home said they felt the ‘best thing’ about living at 82 Coombe Road was going clothes shopping with staff. The home has developed innovative ways of helping prospective and existing residents understand what facilities and services they can expect to receive by providing them with illustrated guides about the home. The environment is pleasantly decorated and ensures the service users have a safe place in which to live. The home is also well maintained and routine repair work is now generally dealt with in a timely fashion. The garden at the rear of the property is particularly well maintained and the patio furniture and a large swing seem to be very popular with certain residents. Residents also seemed to have confidence in the staff that care for them and were benefiting from the fact that the home has experienced relatively low Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 6 levels of staff turnover in the past year. Finally, the manager’s approach to arranging staffing levels is very flexible and clearly based on the service users needs and preferences. For example, on Friday afternoons, an additional fourth member of staff is always employed to ensure service users who choose can participate in a community-based outing each week. What has improved since the last inspection? Where weaknesses have emerged in the past the providers have generally acknowledged these shortfalls and managed them well. The Commission accepts the manager’s comments that over the years he has demonstrate an ability to take the service forward and continually improve it. The homes new deputy manager, who has a wealth of experience working with vulnerable adults with learning disabilities, is also a welcome addition to the team. In the past six months the residents guide has been reviewed and updated accordingly to reflect any changes in provision and generally made far more ‘service user friendly’. The homes arrangements for ensuring all medication held on service users behalves is handled safely in accordance the Royal Pharmaceutical Society guidance, which includes its administration, storage, recording, and disposal, have also significantly improved in the last six months. Since the homes last inspection a new ground floor shower outlet has been installed to improve the number of bathing facilities strategically placed around the home. Furthermore, some progress has been made toward converting one of the homes spare bedrooms into a new sensory room that will provide much needed stimulation for those residents with higher needs. The Commission over the next few months will monitor progress on this matter closely. Finally, sufficient numbers of the homes current staff team have now attended ‘approved’ training courses to up date their existing physical intervention knowledge and skills. All staff spoken with at length, including the new deputy manager, were acutely aware that these techniques should only be used as a very ‘last resort’ after all other attempts to deescalate a potentially aggressive incident had been exhausted. There have been a relatively low number of incidents that have challenged the service in the past six months and on no occasions have staff used physically intervention techniques. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 5 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home has produced an up to date residents guide that ensures prospective service users and their representatives have the vast majority of information they need to make an informed choice about whether or not to move in. Sufficiently robust arrangements are in place to ensure no prospective service users are admitted without their unique aspirations and needs being thoroughly assessed to determine whether or not the placement is capable of meeting their needs. Each service user and their representatives are provided with written and costed contracts, which clearly tells them about the service they will receive, although not all of these have been signed as proof that they all agreed with their terms and conditions of occupancy. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 10 EVIDENCE: The home helps prospective residents to understand the service by providing them with a Statement of Purpose and Residents guide which sets out clearly what the homes objectives, ethos, and the services and facilities it offers. The Guide is precise in what the prospective resident can expect and gives a good detailed account of the quality of the accommodation, qualifications and experience of staff, how to make a complaint, and recent CSCI inspection findings. A copy of the homes most recent CSCI report was conspicuously displayed on a notice board in the entrance hall. All residents are given a copy of the Guide and one service user met said they keep a copy in their bedroom. The Guide is continually updated to reflect any changes in provision and was last reviewed in August 2005. The format remains very service user ‘friendly’ and is illustrated with all manner of colourful photographs, pictures and symbols, which meets the capacity of all the residents who may wish to read it. However, the Guide does not contain any comments from residents about their experiences of living at 82 Coombe Road. Documentary evidence was available on request to confirm the registered manager had received a copy of the homes most recent admissions needs assessment undertaken by their Care Manager prior to the referral being accepted. Residents are provided with a statement of their individual terms and conditions of occupancy, which gives basic information on what residents and their representatives can expect to receive for the fees they pay. Not all the contracts sampled at random had been signed as written proof that the service users and their representatives had been consulted about their terms and conditions of occupancy, which needs to be rectified. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 10 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home develops and agrees with each service user an individual care plan, which ensures they each receive personal and health care support based on their unique needs. Overall, suitable arrangements are in place to ensure service users have opportunities to be consulted on, and participate in, all aspects of life in the home, although the minutes of all residents meetings held in the home should be recorded. EVIDENCE: Each resident has a Care plan that has been agreed with them and the three inspected at random considered all aspects of the service users unique personal, social, and health care needs. Each of these plans had been formally reviewed in the past six months and up dated accordingly in response to any changes. These reviews had involved each of the service users and where applicable their key relatives, advocates, Care managers, keyworkers and the Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 12 homes manager. The one support worker met said they were always invited to attend the care plan review of the service user they key worked. One service user said they regularly had one-to-one meetings with their designated keyworker to up date their care plan. The manager insisted that residents meetings take place on a regular basis although no documentary evidence by way of minutes that were less than six months old could be located during the site visit. It is considered good practice that all the meetings held in the home are minuted to proof staff consult and encourage service users to get involved with all aspects of life in the home, including its day-to-day running. One resident met said that are regularly invited to attend staff meetings. Care plans also included assessments that set out in detail any action to be taken to minimise identified risks. One resident remarked that staff always supported them to go out shopping for new clothes, which was her favourite pastime. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The homes arrangements for ensuring service users have sufficient opportunities to maintain and develop their practical life skills are currently inadequate and need to be improved in order to help service users achieve greater independence. Progress continues to be made with regard the variety of social, cultural and recreational activities the residents can participate in, which in the main are well managed, although there is significant room for improvement in this area, especially with regards the service users with ‘higher’ needs who require greater input. Residents generally receive a healthy, well balanced and varied diet according to there assessed needs and preferences, although more could be done to cater for all the service users diverse culturally needs and also make it easier for service users to read the menus. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 14 EVIDENCE: The homes new deputy manager stated that some progress had been made to enable one resident who had expressed an interest in cooking at home to develop their practical life skills further, as recommended in the homes last CSCI report. The resident confirmed that they had recently given their keyworker list of ingredients to buy to make a dish they had learnt at college. The new deputy seemed very keen to help this particular individual develop their cooking skills and said there this aspiration should be encouraged. The deputy has agreed to include this personal goal in the individuals care plan, along with any practical support they would require to achieve it. Three care plans sampled at random all contained specific information about each residents spiritual needs. The homes activities book revealed that since the turn of the year one service user was being supported by their keyworker to attend Sunday services at a local church approximately once a month. The service user was met during the course of the visit and said the reason they did not go to church every week was because sometimes they decided they did not always feel like going. Residents are given the opportunity to take part in a variety of activities both within the home and in the wider community. As previously mentioned one service user spoken with at length said they look forward to attending cooking classes at a local college and the deputy said another service user had recently enrolled on a basic reading and writing course. Two other service users regular attend sessions at a local day centre. Having arrived around midmorning it was positively noted that a number of residents were already engaged in a number of recreational activities in the home. On resident was busy writing a letter in the conservatory, another was relaxing on a large swing in the garden, and several others were just relaxing in the main lounge. Furthermore, it was pleasing to note on the duty roster that a fourth member of staff is always employed across the day on Fridays to ensure residents can go out together on a group activity in the wider community. On the day of this site visit the deputy said plans had been made for several service users to go to the local cinema to see a matinee showing. All these positive comments notwithstanding staff met during the site visit, which included the homes registered and new deputy manager, a support worker, and visiting Drama therapist, all aged that although significant progress had been made by the home in recent years to improves its activity base, they also believed their was still someway to go to meet the needs of all the homes residents, especially those with higher needs. During a tour of the premises it was noted that one of the homes spare bedrooms had been cleared out in preparation to convert it into a new sensory facility. It is recommended the new deputy manager and longstanding Drama therapist might wish to Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 15 liaise with one another, and possibly involve an occupational therapist, before any decisions are taken about the design and layout of the new sensory room, and what to include in it. Furthermore, it is recommended that more information is made available to residents and staff about what events and recreational activities are happening in the area. The home works to open visiting arrangements and one resident met said they were not aware of any restrictions on times their family and friends could visit them. The manager said it is an expectation that visitors’ call ahead to say when they will be coming to ensure there loved one is at home. One resident met said they regularly go and stay with relatives and have tea at their boyfriend’s house. This individual went onto to say that they often had their boyfriend over for a meal and could entertain them in private if they wished. The homes visitors book is available in the entrance hall, which all guests are expected to sign and date on arrival. During the course of the site visit all the staff on duty were observed interacting with the service users in a very friendly and respectful manner. The one service user spoken to at length said staff always treated them well and that they got on well with their new keyworker. There is an expectation that service users should be encouraged to take greater responsibility for the day to running of the home and be supported to carry out certain household chores. During the site visit a member of staff was observed politely encouraging one service user to tidy up the dinning room table after they had finished breakfast. The one service user met said staff often helped them to tidy up their bedroom. The one service user said they liked the meals they were served at the home. The deputy manager said the majority of the service users were normally happy to eat the meals published on the menus, although one individual would often vote with their feet and throw their food straight into the bin if they did not like it. When this happens the deputy said an alternative choice of meal is always offered. The homes weekly menu was conspicuously displayed on the notice board and provided service users with two alternative choices of main meal each day. However, unlike the homes new Residents Guide it was not available in a particular service seer friendly format and may help some service users have a better understanding of its use if it is illustrated with some explanatory photographs, pictures or symbols, for example. One service user said they regularly go shopping with staff to buy food they eat. It was positively noted that with the regular inclusion of Ackee Swordfish and goat curry on the menus the culturally specific needs of the homes only black British Caribbean service user were being well catered for. However, it was also noted that no Central American style meals were available on the menus, despite one of the services users being of Hispanic origins. It was unclear whether or not this particular individual would like Central American style food because they had spent most of their life living in the USA. It was therefore Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 16 agreed that more should be done to ascertain this particular individuals dietary preferences and find out if they and the rest of the group might like to eat Central American food on a regular basis. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. The home has sufficiently robust arrangements in place to ensure the health care needs of the service users are recognised and met, but the service is still not clear when incidents need to be referred to external agencies. Sufficiently robust systems are in place to ensure medication records are appropriately maintained and monitored to protect service users. EVIDENCE: On arrival one service user was seen to be wearing a matching t-shirt and shorts, which they said they had recently bought. They went onto to say that staff have advised them to wear something cool that day because it was going to be warm. The same individual went onto say that she liked shopping for make up and had recently had her hair dyed at a hairdressers in town. All three of the care plans examined in depth revealed that staff ensure service users regularly attend appointments with local health care professionals, including community based GPs, dentists and speech therapists. These plans contained a comprehensive overview of each service users general health care Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 18 needs, which are continually updated to indicate any changes. The homes accident book revealed that there had been three accidents involving service users in the past six months, although no one had sustained any major injuries or been admitted to hospital in that time. However, on closer examination of this record it became apparent that one of the entries referred to a significant incident involving one service user scratching another across the face and was clearly not an accident. The home was reminded in its last inspection report that the CSCI must all be notified without delay about the occurrence of any ‘significant’ incident that adversely affects their health and welfare of the service users, and the event recorded on the appropriate form in accordance with the homes incident reporting procedures. Records are kept of all medicines received, administered, and returned to the dispensing pharmacist by the home and no recording errors where staff had failed to sign for medicines handled were noted on the three Medication Administration sheets sampled at random. These records accurately reflected the current medication stocks held by the home on service users behalves, which are securely stored away in a locked metal cabinet in the office. Protocols for the safe use of ‘as required’ (PRN) medication were also available on request which set out clearly when and how staff should give this type of medication. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. The home has sufficiently robust arrangements in place to ensure service users have access to an effective complaints procedure, have their legal rights protected and so far as reasonable practicable, are protected from abuse. EVIDENCE: The service has a complaints procedure that is up to date and is available in a number of formats to enable anyone associated with the service to complain or make suggestions for improvement. The complaints procedure is widely distributed and copies are included in the residents guide and pinned to the notice board in the dining room. One service user met said they felt staff always listened to their point of view and they knew they could speak to their keyworker or the manager if they were unhappy with anything at the home. The homes complaints log revealed that no formal complaints or informal concerns had been made about the homes operation in the past six months. Training of staff in the area of protection is regularly arranged by the Home and certificates of worthiness were available on request as documentary evidence to show that all the homes permanent staff team have recently attended annual refresher courses in the appropriate use of Non-Violent Crisis Intervention techniques. Only the manager and his new deputy need to up date theirs and arrangement have been made for this to happen in the next few months. Progress n this matter will be assessed at the homes next inspection. The new deputy manager and a support worker met during the site visit were both very aware that they had a duty of care to protect service users Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 20 rights and that approved physical intervention techniques must only be used as a ‘last resort’ when all other de-escalation strategies have failed. No vulnerable adult protection referrals have been made or service users physically restraint in the past six months because of a lack of incidents, rather than a lack of understanding when such events should be reported to external agencies. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 & 30 Quality in this outcome area is good. This judgement has been made using all the available evidence including a site visit to this service. Overall the physical design and layout, which is currently well maintained, enables the service users to live in a safe and comfortable environment, although the rather worn out leather sofas in the lounge and some of the storage units in the kitchen have seen better days and should be replaced in time. EVIDENCE: The home was very clean, pleasantly warm, and free from any offensive odours at the time of arrival. The French windows in the main lounge and conservatory doors were all open at the time, which made the home feel very airy, bright, and fresh. The garden at the rear of the property is extremely well maintained and the patio furniture and swing seem to be very popular with some of the service users who spent most of the morning relaxing in or around this space. As mentioned in a previous section the new deputy manager has already commenced work on converting one of the homes spare bedrooms into a new sensory room. Progress on this matter will be assessed at the homes next inspection. The manager said Milbury Cares maintenance department Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 22 have improved their response times for dealing with routine maintenance issues. During the course of this inspection two handy men arrived to repair a damaged toilet handle and shower outlet. As no action has been taken to replace the rather worn out leather sofas in the main lounge as recommended in the homes previous CSCI report the providers are required to supply the Commission with a action plan detailing when they intend to replace these items. Many of the units in the kitchen have also seen ‘better’ days and the providers should start considering plans to replace them, especially those units with either missing or loose doors. The temperature of water emanating from a first floor bath nearest the staircase was noted to be a safe 40 degrees Celsius at 13.00. There remains a choice of bathing facilities, which includes showers and baths, and sufficient numbers of toilet facilities located conveniently close to service users bedrooms and communal areas. Since the homes last inspection a new shower outlet has been installed ion the ground floor. All three of the bedrooms viewed with the services users consent were decorated and furnished to a good standard, felt warm, and looked very personalised, with all manner of home entertainment equipment, pictures, photographs and other personal belongings noted. Both the homes most recent admissions said they liked their bedrooms, which contained everything they needed. The homes washing machine is capable, of washing clothes at appropriate temperatures and also has a sluice facility. No laundry needs to be taken through areas where food is stored, prepared, or eaten and the separate utility room walls and floors are readily cleanable. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using all the available evidence including a site visit to this service. In the main sufficient numbers of suitably competent and qualified staff are employed on a daily basis to ensure the individual needs of the service users are met, although there are still some areas which need attention. Service users also benefit from being supported by staff who receive regular supervisions with suitably qualified senior members. EVIDENCE: Staff take there time to deal with service users question and the manager and new deputy were both observed using a form of Makaton sign language to communicate with one service user in their preferred mode of non-verbal communication. As previously mentioned a support worker also said the NonViolent Crisis Intervention training they recently attended enabled them to have a better understanding of individual service users physical and verbal aggression behaviour as a way of communicating their needs, preferences, and frustrations. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 24 Staff training records revealed that 50 of the homes current team have now achieved a National Vocational Qualification in care (Level 2 or above) to meet this National Minimum Standards training targets for support workers. The number and names of the staff on duty at the time of this site visit matched the entries on the duty roster for both the morning and late shifts, which were both adequate to meet the assessed needs of the service users. As previously mentioned the managers have a flexible approach to planning the rotas and have found creative ways of making sure additional staff are on duty at certain times to ensure many of the service users can enjoy regular group outings. The home has experienced relatively low levels of staff turn over in the past six months and consequently only one new senior member of staff, who was already working for Milbury in another of their care establishments in the area, has been since Novemeber’05. The new deputy managers staff records were not inspected on this occasion as they have already been seen during a site visit to the other care home. The new deputy has a lot of experience supporting vulnerable adults with high needs and is keen to continue improving the number and variety of opportunities service users have to engage in stimulating activities both at home and in the wider community, especially as they now longer employer an in-house activities coordinator. The service recognises the importance of training, and in the main delivers a programme that meets the service users needs. The manager said that sufficient numbers of his current staff team had received training in fire safety, first aid, basic food hygiene and the safe handling of medication in a residential care setting. Documentary evidence by way of certificates of attendance of the aforementioned course were made available on request in respect of three support workers who either on duty or would be that day. One member of staffs basic food hygiene training expired last year and arrangements for everyone who handles food in the home to up date their food hygiene knowledge and skills must be put in place if it was received over three years ago. Furthermore, staff who have not received any equal opportunities or person centred care planning training must attend the necessary courses. The homes staff team consists largely of individuals from black or black British Caribbean or African ethnic origins. The manager acknowledged that while the diverse ethnic backgrounds of his current staff was quite reflective of the area it did not accurately the ethnic origins of the service users currently residing there, the majority of whom are white British. The manager has agreed to be mindful of this ethnic and cultural imbalance when he next recruits. Two staff files inspected at random both contained documentary evidence to show they had each received three formal supervision sessions with a suitably qualified senior member of staff in the past six months, in line with this standard. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is poor. This judgement has been made using all the available evidence including a site visit to this service. The service users benefit from living in a reasonably well run home which a suitably qualified, experienced and competent individual manages. Furthermore, sufficiently robust arrangements are in place to ensure, so far as is reasonably practicable, the health, safety and welfare of service users, their guests and staff are promoted and protected. However, the homes self-monitoring arrangements for assuring quality, which should be based on seeking the views of service users, their representatives and staff, remain inadequate. Without the results of quality assurance surveys undertaken by the providers being published or the minutes of staff meetings being recorded then service users, their representatives, and other interested parties including the CSCI, are unable to assess fully how successfully or not the service has been in achieving its stated aims and objectives. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 26 EVIDENCE: The registered manager has achieved a National Vocational Qualification in management and care – Level 4 and has well over two years experience of working with adults with learning disabilities in a management capacity. The manager said he continues to have the same line amanger who although not directly involved in the day to day managing of the home is always available to offer advice and support as and when requested. The manager also said staff meetings are held at least once every to months or so and he planned to hold another on 19th May 2006. However, none of the minutes that should have been taken at these staff meetings were available post 2005. The home has Equal opportunities and racial harassment/bullying policies in place that the providers have kept under constant review. These policies referred to Britain’s most up tom date anti-discrimination legislation, (e.g. Race Relations, Sex, and Disability Discriminations Acts). The providers continue to carry out unannounced monthly inspections of the home and compile a written report of their findings, which they forward to the Commission to comply with this standard. However, it was concerning to note that the results of the providers own quality assurance system which should be based on seeking the views of service users and their representatives were had still not been published for all the relevant parties, including prospective new service users and the CSCI to read. The Commission accepted that because of matters beyond the providers control last year (2005) they were unable to publish the results of their quality assurance surveys, but cannot see why very little attempt has been made to address this on going issue which has dragged on for well over a year. The London Fire and Emergency Planning Authority last visited 82 Coombe Road in January 2006 and issued five requirements for the service to address in a timely fashion. All these shortfalls were followed up and it was positively noted that all had been addressed within the timescales set, including reviewing of the homes emergency plan; carrying out of periodic testing of the homes fire alarm and emergency lighting by a suitably qualified engineer; the weekly testing of the green override box and automatic realise mechanism fitted to the front door; and the adjusting of all fire doors to ensure they all self closed fully into their respective frames. The fire alarm system was tested during the site visit, was clearly audible throughout the house, and can be heard from the staff sleep in room. Records showed the system is tested on a weekly basis. A support worker met was very clear about her fire safety responsibilities, said they regularly participated in fire drill practises, and knew what to do in the event of the fire alarm being sounded. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 27 Up to date Certificates of worthiness were available on request as proof that suitably qualified engineers periodically test the homes gas installations, electrical system, portable electrical appliances, and fire extinguishers, in accordance with health and safety Regulations. All food in the fridge was correctly stored and fridge/freezer temperatures regularly monitored and recorded, in line with environmental standards. Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 2 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 2 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 3 X 3 2 1 X X 3 X Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 29 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(c) Requirement Timescale for action 01/07/06 2. YA11 3. YA19 4. YA28 They or their representatives must sign each service users statement of terms and conditions of occupancy. 12(1)(b) (3), Service users who express an 15(1) & interest in developing their 16(2)(h) practical life skills must be given the opportunity to purse this aim and the support they require to achieve this personal goal recorded in their care plan. 37(1) The CSCI must be notified in writing and without delay about the occurrence of any ‘significant’ incidents that adversely affect the health and welfare of the service users. Previous timescale for action of 15th January 2006 not met. 23(2)(g) The providers must establish a time specific action plan to replace all the rather worn out leather sofas in the main lounge. Previous recommendation not considered. DS0000028482.V293707.R01.S.doc 01/07/06 01/06/06 01/09/06 Coombe Road (82) Version 5.1 Page 30 5. YA35 18(1) & 19, Sch 2.4 6. YA35 18(1) & 19, Sch 2.4 7. YA38 18(1) (2) 8. YA39 24(2) Sufficient numbers of staff must receive training in equal opportunities and up date their basic food hygiene. Documentary evidence of this training must be available for inspection on request. Sufficient numbers of staff should receive person centred care planning training. Recommended in CSCI’s last two reports, but no action taken. All staff meetings must be minuted and these records made available for inspection on request. The results of any stakeholder surveys/satisfaction questionnaires undertaken by the providers to ascertain service users, their relatives and professional representatives views about the quality of the service received must be published on an annual basis as part of an effective quality assurance system. Previous timescales for action of 1st November 2005 & 1st March 2006 not met. Warning letter served regarding repeated failure to comply with Regulation. 01/09/06 01/09/06 01/06/06 01/09/06 Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA1 YA7 YA13 YA14 YA17 Good Practice Recommendations The Residents guide should contain the resident’s views about their experiences of life at 82 Coombe Road. Service users meetings should be held at more regular intervals (i.e., at least one every two months) and the minutes always recorded. Information about local event and activities should be more predominantly displayed on the homes notice board for all to view. The homes new sensory room should be suitably resourced with advice sought from appropriate professionals regarding how best to design and equip the new facility. The homes published menus should be available in a more service user-friendly formats suitable for the people for whom the home is intended (e.g. photographs, pictures, symbols ect). The culturally specific dietary preferences of all the service users, who come from a wide range of ethnically diverse backgrounds, should be taken into account when planning the weekly menus. The providers should consider upgrading the kitchen and replacing many of its damaged storage units. The manager should be mindful of the cultural and ethnic imbalance that currently exists between his staff team and the service users when he next recruits. 6. YA17 7. 8. YA28 YA33 Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Coombe Road (82) DS0000028482.V293707.R01.S.doc Version 5.1 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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