CARE HOME ADULTS 18-65
2 Crebor Street London SE22 0HF Lead Inspector
Lisa Wilde Unannounced 29th July 2005, 10:00am 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 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 Stationary 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. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service 2 Crebor Street Address London SE22 0HF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8693 3822 020 8693 8198 Odyssey Care Solutions for Today Ms Tracy Anne Crockford CRH Care Home PC Care home only 5 Category(ies) of LD Learning Disability registration, with number PD Physical Disability of places SI Sensory Impairment 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 14 October 2004 Brief Description of the Service: The home is registered to provide a residential care service for five people with learning disabilities. There are 5 single rooms. The home is made up of two houses converted to make one unit. It is located in a residential area of East Dulwich, close to public transport routes and local facilities, which include pubs, shops, restaurants and a post office. The home aims to provide support for the service users in any area of their daily lives to ensure that service users quality of life is maximised as well as enabling them to participate fully in the daily life of their home and community. The home is one of several homes run by the voluntary organisation Odyssey whos vision statement says that they are working towards “ A society where a learning disability is not a barrier to somebody’s perceived value or ability to make a meaningful contribution” . 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over one day in July 2005. The manager was not at the service so the inspection was done with the deputy manager, staff and all five service users. What the service does well: What has improved since the last inspection?
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 6 This was the first inspection of this home by the current inspector so it is more difficult to say what as improved. There were no requirement made last time and the recommendations had been met because now staff record where they are going with service users so that everyone knows where everyone is and a new bin had been bought for one of the bathrooms. What they could do better:
The Service User Guide is not in a language or form that could be understood by the service user group at this home and it does not include some of the areas required by the standard meaning that service users and their families are not provided with all the information they need to make an informed choice about where to live and whether they are being offered everything that they should be. The home must get better at making sure that their information can be understood by a wider group of people who may want to live at the home. Generally the needs of prospective service users are assessed prior to them coming to the home even when they accept an emergency placement. However, the home cannot show that they are completely meeting service users’ needs when they accept a short term emergency placement into this long term home without giving sufficient regard to the current service users’ needs. The home must make sure that current service users’ lives are not disrupted by bringing people into the home who are only planning to be there a short time. The home is not completely protecting service users from harm or abuse with regard to looking at the CRB checks of agency staff and they must make sure that they see the forms of all staff not just the CRB number so that they can make a judgement about any convictions or cautions that staff may have. The only area where the home was not comfortable was that currently the radiators are being used too often and the home is sometimes too hot because the home does not have a working clothes dryer so the home must buy a new clothes dryer as a priority. Training is needed for staff in the specific disability issues of the current service users such as autism, to make sure the staff fully understand their needs. Service users are about to go through a period of change when both managers leave and the home may not be as well run during this period. The organisation must put in place a plan to manage the change effectively. Although a lot of work is done in the area of monitoring and seeking out what the service users want at this home, the service users’ views and the views of their families do not underpin the review and development process. The home must do more work to make sure that they ask service users and their families what they think of the service every year and make sure that the home tries to improve the service based on their views.
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3 & 4 Service users and their families are not provided with all the information they need to make an informed choice about where to live and whether they are being offered everything that they should be. The home cannot show that they are completely meeting service users needs when they accept a short term emergency placement into this long term home without giving sufficient regard to the current service users’ needs. When a non-emergency placement is made to the home the person would have the opportunity to come and look round the home and undertake trial visits as they choose so that they can gradually get used to the home and decide if they want to live there before they fully move in. EVIDENCE: Some of the current service users at this home cannot read or write; however, the home is registered for learning disabilities and it is possible to draw up a service user guide in a language and format that could be understood by some people from those groups who may wish to use this home e.g. by using pictures, video and language that is more simple. (See Requirement 1) The Service User Guide does not cover the required areas of the numbers of places provided; the relevant qualifications and experience of the staff; key contract issues of occupancy and termination; fees charged, what they cover and fees for any ‘extras’; service users’ (or their families’) views of the home
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 10 and a copy of the complaints procedure and information about how to contact the local CSCI office and local health and social services. (See Requirement 2) There has been one admission to the home since the last inspection. This was an emergency placement, with the intention being that they would only remain at the home for a few months. The deputy manager said that this placement had actually worked out well but there had been no real choice given to the home as to whether this person was to come to the home or not. Given the long-term nature of this home and the service users it is not appropriate for it to be used as a short-term placement for emergency situations. (See Requirement 3). The assessment process in this situation had been different given that the person needed to move to the home quickly. There had been no opportunity for that person to ‘test drive’ the home but the manager said that in other circumstances there would always be opportunities for a gradual move in. The deputy manager stated that given the nature of recent placement the home were given enough information to make an assessment of need. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 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 standard(s) 7, 8 and 9 Service users at this home are given information so that they can make their own decisions as far as possible. They are asked about what they want each day and they are supported to do things as they choose, which includes taking reasonable risks. EVIDENCE: The deputy manager described the processes by which staff aim to consult with service users. There are staff charts to tell service users which staff are on duty. There are pictures of chores to be undertaken on the walls of the kitchen so that service users can take part each day. Food choices are offered, the inspector saw this happening on the day of the inspection. Service users are asked about their activities and are able to express if they do not want to do anything. On the day of the inspection two service users were on work placements with staff and three service users were in the lounge looking at photos and doing jigsaw puzzles. Throughout the inspection the inspector saw staff consulting, giving information and allowing service user to make decisions. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 12 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 standard(s) 11, 12, 13, 14 and 15 Service users have individual lives within this home and can come together as they choose. They go out into the local community and undertake a range of activities as a group and on their own with staff support. They are supported to have jobs of they choose and are supported to meet their family and friends both locally and further afield. EVIDENCE: As mentioned above the service users were undertaking different activities on the day of the inspection. Some of them told the inspector that they get to do what they want to do. The inspector saw the weekly programmes for the service users and saw a mix of activities including day centres and individual things such as job placements, shopping and internet cafes. The deputy manager stated that two service users use the internet and that they used to be able to have access to it on the home’s computer but this had been stopped when the management of the home changed over from Southwark Social Services to Odyssey. Service users do not have their own computer and the deputy manager felt that although they do go out to internet cafes they would enjoy and benefit from a computer in the home, especially as they had been used to having access in the home previously. (See Recommendation 1).
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 13 The current service users do not have much family but the deputy manager described how staff support service users to maintain access to those family they do have and friends in the local area. All service users have been or will be going on holiday this year. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19 Staff understand the needs of the service users group and are aware of when they cannot meet those needs and must access professional specialist support which means that service users emotional and physical needs are being met. EVIDENCE: Staff and the deputy manger showed awareness of the current service users health needs and the inspector was satisfied that staff could identify when hey needed to access additional professional support. Service users are linked into local GPs and health services and specialist support is offered on an individual basis. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 15 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 standard(s) X Both these standards were assessed as met at the last inspection. However the home is not completely protecting service users from harm or abuse with regard to looking at the CRB checks of agency staff. EVIDENCE: The only issue that was raised during this inspection with regard to abuse was that the agency worker on shift on the day of the inspection had brought a CRB number with her but not her CRN form. This means that the home could not see if she had any previous convictions or cautions and make a judgement as to whether those convictions or cautions were relevant to working at the home. (See Requirement 4) 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29 and 30 This home is comfortable and homely. Service user rooms are large enough and suit individual lifestyles. Communal areas are well decorated and the whole home was clean and hygienic on both days of the inspection. The only area where the home was not comfortable was that currently the radiators are being used too often and the home is on occasion too hot because the home does not have a working clothes dryer. EVIDENCE: The home is comfortable and decorated in a homely manner. Service users bedrooms are personalised to their own tastes and at the last inspection the manger confirmed that they meet the size requirements of the standards. The toilets and bathrooms in the home ensure that privacy and dignity are maintained and currently the service users do not need any specialist adaptations or equipment as they do not have mobility issues. On the day of the inspection the home was clean and hygienic. There had been a previous requirement with regard to one service users bathroom that stated that it needed to be refurbished. The deputy manger had understood this to mean that a new bathroom suite was to be bought as the current suite was old fashioned and somewhat institutional. The bathroom had been retiled but the organisation was not willing to pay currently for any
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 17 further refurbishment. On this inspection the service user said that he was happy with his bathroom and didn’t mind the colour. The deputy manager said that compared to other en-suite bathrooms in the home it was particularly dull. (See Recommendation 2) Currently the dryer is broken and there have been some difficulties in acquiring a replacement. Staff are using the radiators to dry clothes and the home on occasion is to hot. (See Requirement 4). 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 35 Generally service users benefit from a fully trained, experienced and skilled staff team although training is needed in one area to make sure that the staff fully understand the needs of the current service users. EVIDENCE: Staff and the deputy manager showed awareness and understanding of the individual service users needs throughout the inspection. Staff receive basic training in statutory issues and then further training in more specialist areas such as values and principles of care and attitudes to disabilities. The deputy manger said that currently staff do not receive specific training in issues such as Autism and that this would be of benefit. (See Requirement 5) All staff receive induction and foundation when they start employment and then begin the NVQ Level 2 or 3 in Care. There was an agency worker on duty on the day of the inspection undertaking her first shift and she had been though an induction with the deputy manager in emergency and basic issues and this induction had been recorded. The agency worker said that she felt that she had received enough information to safely do the shift. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 39 Currently the home is well run because the managers have been at the home a long time and understand the needs of the service and how the home should meet those needs. Service users are about to go through a period of change when both managers leave and the home may not be as well run during this period if the organisation does not put in place a plan to manage the change effectively. Although a lot of work is done in the area of monitoring and seeking to find out what the service users want at this home, the service users views and the views of their families do not underpin the review and development process. EVIDENCE: The current manager and deputy at the home have been at the home for a long time and on previous inspections have established that they are fully qualified and able to manage this service. However the manager will be leaving the service in the week following this inspection and the deputy manager will be leaving at the end of the year. The organisation’s plan is for the deputy manager to act-up into the post of manager. The deputy manager evidenced his competence and ability to manage the service during this inspection
2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 20 however the inspector was concerned that both long term managers will be leaving at around the same time and this will have a significant impact on this long term service user group. The deputy manager did not know what the plan was to recruit to either the deputy post or the manager post. (See Requirement 6) The home doesn’t conduct annual reviews with the service users but does complete quarterly returns to the borough organisation that report on identified indicators. There is a local business plan for the home. The home does not use an externally accredited quality assurance systems that focuses on the views of service users and the home does not conduct an annual review of the views of family and other stakeholders. (See Requirement 7 and Recommendation 3) The inspector and the deputy manager discussed further ways that reviews could be made more useful for service users and information could be gathered. (See Recommendations 4 and 5) 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 3 3 x Standard No 22 23
ENVIRONMENT Score x 2 Standard No 24 Score 2
Version 1.20 Page 21 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 3 x
Score 25 26 27 28 29 30
STAFFING 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x 3 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 x x Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x x x 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 22 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 YA1 Regulation 5 Requirement The Service User Guide must be drawn up in a format that can be understood by more people from the service user groups for which the home is registered i.e learning disabilities. The Service User Guide must cover all areas required by Regulation 5 and Standard 1. The Registered Persons must ensure that the current service users needs are taken into account when new referrals are considered for the home and short-term emergency placements must be throughly risk assessed with those needs born in mind. The Registered Individuals must ensure that they see all the CRB forms for any agency staff to allow them to make judgements about any convictions or cautions they may have received. The Registered Manager must ensure that a new dryer is bought as a priority. The Registered Individuals must ensure that staff receive training in the specific disability issues of Timescale for action 31/11/05 2. 3. YA1 YA2 5 12 (1) (a) 31/11/05 31/08/05 4. YA23 13 (1) (6) 31/08/05 5. 6. YA24 YA35 16 (2) (f) 18 (1) (c) (i) 31/08/05 31/12/05 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 23 7. YA37 18 (1) (a) 8. YA39 12 (1) (3) & 24 (3) the service users at the home such as autism.. The Responsible Individual must 14/09/05 ensure that the Commission is provided with the plan to recruit to the manager and deputy post at the home which includes plans to ensure that the new management have opportunity for a thorough handover from the current deputy manager. The Registered Manager must 31/12/05 ensure that an annual survey (or other form of annual audit) of service users families and other stakeholders takes place that then feeds into the annual review of the service and the local business plan. 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 YA14 YA24 YA39 YA39 YA39 Good Practice Recommendations The Registered Individuals should consider acquiring a computer with internet access for the service users to use in the home. The Registered individuals shoud consdier refurbishing and redecorating the olive coloured ensuite bathroom to bring it to the standard of other bethrooms in the home. The Responsible Individuals should consider investigating and employing a professionally recognised quality assurance tool within the home. The Registered Manager should ensure that the monthly keyworksession/activity reviews are collated and made part of the service users annual reviews. The Registeerd Manager should consider using a video camera in the home to record service users thoughts and views, that can be taken into their review meetings and made part of an ongoing review process. 2 Crebor Street G52-G02 S60238 CreborStreet V220889 290705 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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