Inspection on 04/01/06 for Garden House

This inspection was carried out on 4th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garden House 29/01/07

Garden House 08/09/05

Garden House 18/03/05

Garden House 21/10/04

Garden House 03/02/04

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

CARE HOME ADULTS 18-65 Garden House 127, Friary Road London SE15 5UW Lead Inspector Ms Lynn Hampton Unannounced Inspection 4th January 2006 5:20 DS0000007092.V266321.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 DS0000007092.V266321.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. DS0000007092.V266321.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Garden House Address 127, Friary Road London SE15 5UW 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) 0207 732 0208 0207 277 6043 rosemarie.mitchell@lk.leonard-cheshire.org.uk Leonard Cheshire Mr Kevin Parkes Care Home 10 Category(ies) of Learning disability (10) registration, with number of places DS0000007092.V266321.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 Adults, male or female with learning disabilities, some of whom may be over 65 years old. Date of last inspection Brief Description of the Service: Garden House provides care for ten people with learning disabilities who have lived together for a number of years. The home is located in a residential street in Peckham close to public transport routes. There are shopping and leisure amenities within walking distance in Peckham, which includes a fitness centre, swimming pool, library and cinema. The residents are encouraged to be part of the community, using the local facilities, and are supported to do so by staff. The property consists of three terraced houses that are interconnected. The building is in keeping with the other properties in the area. The bedrooms are located on the ground and first floor of the home, with two communal lounges and kitchen facilities on the ground floor. There is a good sized garden to the rear and on street parking is available. The home is managed by Leonard Cheshire - South East London Learning Disability Homes, and the building is owned by a housing association. DS0000007092.V266321.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place during the evening of a weekday, Thursday 4th January 2005, and lasted over four hours. During the visit the inspector met four care staff. A range of documents was examined and a tour of the building took place. The inspector met and spent time with nine of the ten current residents, most of whom were articulate and able to express their views on the service provided at the home. The inspector discussed a range of issues arising from the inspection with the manager, in a telephone conversation following the inspection visit. What the service does well: Service users receive support that is appropriate to their needs, and action is taken when their needs change. Multi-disciplinary reviews take place, and risk assessments are undertaken. Personal support is provided in a way that meets service users’ needs and preferences, and staff are conscientious in promoting their health and well being. Administration of medication is of a good standard. The ageing, illness and death of service users are handled with respect. Service users have opportunities and support to enable them to maintain appropriate lifestyles both within and outside the home. This includes having meaningful activities, and support in forming and maintaining friendships. They reported that they feel listened to and respected, and they had no complaints about the home. Meals are of a good standard, and provide choice and variety. The house is decorated and furnished in a homely style, and provides a clean and safe environment that meets their individual needs. One service user has requested that his carpet and curtains are replaced. Interaction between staff and service users was observed to be warm and appropriate. Staff have access to training and are experienced. Consistency of care is promoted by ensuring that regular, permanent staff are used. Service users benefit from a well-run home, and systems are in place to safeguard their best interests. DS0000007092.V266321.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. DS0000007092.V266321.R01.S.doc Version 5.1 Page 7 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 DS0000007092.V266321.R01.S.doc Version 5.1 Page 8 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): These standards were not assessed at this unannounced inspection visit. EVIDENCE: At the previous inspection visit (September 2005), standards 1, 2 & 5 were assessed and found to be met. DS0000007092.V266321.R01.S.doc Version 5.1 Page 9 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, 9 Service users receive support that is appropriate to their needs, and action is taken when their needs change. Multi-disciplinary reviews take place, and risk assessments are undertaken. Recording of this was inconsistent, however, and would benefit from review and improvement. Requirements made in the report of the previous inspection visit, concerning these matters, remain in force. EVIDENCE: A Requirement was made in the report of the last inspection that the Registered Person must ensure that the system to monitor progress towards care planning goals is strengthened, by ensuring that monthly summaries are completed regularly. Also that the Registered Person must ensure that an audit of residents’ files is conducted to ensure documents are dated, signed and currently relevant. DS0000007092.V266321.R01.S.doc Version 5.1 Page 10 The inspector looked at a number of files and tracked the care of one resident who had complex needs. From observation of practice and talking to staff, there was evidence that the resident receiving caring and appropriate support, and that consultation with a range of health and care professionals had taken place. However, this was not always well or clearly documented in his case file records. Some guidelines were undated, and there were different versions of guidelines in different files, which could lead to confusion (especially where there has been a change in health care and support needs, as was the case for the user whose files were checked). There was evidence of reviews of goals, and updates in progress in some files, but there were some gaps. There were records of periodic reviews, and risk assessments, and details of health appointments, but the inspector found that information was spread over different files or sections – there was no single section that contained a complete record of all the essential information or guidelines on the individual concerned. Some case files had made greater progress than others in ensuring that all monitoring sheets and records were reviewed, dated, and signed. Issues around the organisation of files, reviews and updating of records were discussed with staff on duty as well as with the manager (in a telephone call after the inspection). It was reported that a system was to be implemented, whereby supervisors were to discuss this in meetings with staff on a monthly basis from the beginning of the New Year. Also, Person Centred planning was to be introduced to the home, and staff had had some training on this. It was discussed with the manager that the range and content of files available were in need of review, and that residents could benefit from outcomes-based planning and practice, linked with improving the clarity and consistency of recording in a way that will reflect changing needs. Previous Requirements remain in force, and this will be the focus of inspection at the next inspection visit. DS0000007092.V266321.R01.S.doc Version 5.1 Page 11 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, 17 Service users have opportunities and support to enable them to maintain appropriate lifestyles both within and outside the home. This includes having meaningful activities, and support in forming and maintaining friendships. Meals are of a good standard, and provide choice and variety. EVIDENCE: At the time that the inspection started, most of the residents were having their evening meal, which consisted of pasta with sauce and vegetables, and fruit or yoghurt for dessert. A choice of drinks was made available. The food looked appetising and well prepared. One resident was being supported to prepare his own meal (salmon and potatoes) as part of his programme of activities. DS0000007092.V266321.R01.S.doc Version 5.1 Page 12 Residents have individually tailored programmes of activities, which are varied and imaginative. One resident had been out to a day centre, and another had been to her work placement. During the evening, residents were able to choose how to spend their time. Some sat together in one lounge watching a film; one was supported by a member of staff to complete a jigsaw; one chose to do puzzles. A member of staff offered to accompany residents to the pub, and two people went out for part of the evening. Residents that the inspector spoke to confirmed that they were happy at the home, and enjoyed the activities and opportunities available. One had a number of pen pals that staff helped her to keep in touch with. Residents each had a range of personal items in their rooms, which reflected their tastes and interests. These included hobbies (such as sewing, music or model boats), and pictures of friends and holidays. Each resident had been on individual holidays, which they were involved in choosing and planning, with support from staff. They confirmed that they were helped to keep in touch with friends and family, that visitors were welcome, and that parties and social events took place. DS0000007092.V266321.R01.S.doc Version 5.1 Page 13 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, 21 Personal support is provided in a way that meets service users’ needs and preferences, and staff are conscientious in promoting their health and wellbeing. Administration of medication is of a good standard. The ageing, illness and death of service users are handled with respect. EVIDENCE: During the inspection, staff were making arrangements to get medical attention to a resident who had returned from a hospital appointment feeling unwell. The staff acted conscientiously and with concern for the resident’s welfare. The GP surgery would not send anyone out to see him, and it was arranged for a member of staff to accompany him back to the hospital. Additional staff cover was arranged for the home to cover the evening shift. The member of staff reported back to the home at intervals, and it took several hours for the resident to be seen in the A&E department. Staff on duty expressed concern about how the resident had been sent home from the earlier appointment, and about the difficulty in getting a speedy response when concerns were noted. Following the inspection, the manager informed the Commission of action that was being taken to ensure that the resident was not discharged inappropriately, that a Discharge meeting would be held, and also that the multi-disciplinary team was involved in reviewing and planning for the person’s long-term care. The situation was being handled thoughtfully and with the best interests of the user being taken into account. DS0000007092.V266321.R01.S.doc Version 5.1 Page 14 Health Action plans are on files, which are written in the first person and clearly set out each service user’s needs in this area. Administration of medication was observed, which was of a good standard. Most medication is supplied to the home in a monitored dosage system. There were no gaps in records of administration. A Requirement was made in the report of the last inspection that the Registered Person must ensure that handwritten entries on medication administration records accurately reflect the prescriber’s instructions. Records of medication were checked during this inspection and it was found that this Requirement is met. A further Requirement was made that the Registered Person must ensure that the lists of homely remedies reviewed to ensure that they are current and agreed by the GP. The manager reported that he has been in touch with the GP, but has not yet had received information back. This Requirement is only partly met, and remains in force. DS0000007092.V266321.R01.S.doc Version 5.1 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 the following standard(s): 22, 23 Service users feel listened to and respected. Residents had no complaints. EVIDENCE: Residents confirmed that they knew how to make a complaint, although they did not have any. They said that staff were approachable, and that they could talk to them if they had any concerns. A Requirement was made in the report of the last inspection that the Registered Person must ensure that an audit of residents’ property lists is undertaken to ensure that they are complete. Staff on duty confirmed that they had been given forms on which to record residents’ property, but that this had not yet been completed. This Requirement is only partly met, and will remain in force. DS0000007092.V266321.R01.S.doc Version 5.1 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 the following standard(s): 24, 25, 27, 28 Service users live in a homely, clean and safe environment, which meets their individual needs. EVIDENCE: The inspector had a tour of the building, and three residents showed her their bedroom. The building is made up of three small houses that have been adapted to connect on the ground floor. There are two large lounge areas, giving residents a choice of sitting area and T.V to watch. The main lounge has a dining area, with a serving hatch between it and the large kitchen. The ground floor also has a laundry room, staff office, store room, and a toilet. Two residents’ bedrooms are on the ground floor, being used for people with mobility problems. The remaining bedrooms, and a number of toilets and bathrooms, are on the upper floor. All areas seen were decorated in a homely and domestic style, with furnishings and decorations being chosen by residents for their individual rooms. Most areas seen were clean, with few repairs needed. However, one resident pointed out that one edge of his carpet needed to be secured, and the curtains in his room were marked and a bit creased. The resident requested that these were replaced, which was conveyed to staff (see also Conduct & Management of the Home). DS0000007092.V266321.R01.S.doc Version 5.1 Page 17 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 Service users benefit from support by trained and competent staff. Consistency of care is promoted by ensuring that regular, permanent staff are used. EVIDENCE: Examination of the rotas showed that there is a minimum of three staff on duty during the day, with two staff from 9 p.m., who also sleep-over on site. The rota is laid out to ensure that additional staff are on duty during peak times, to meet residents needs (for example, to escort them to activities). Recent recruitment has taken place, which enables the rota to be covered largely by permanent staff. Few Bank or Agency staff are used, which promotes continuity of care. Interaction between staff and residents was observed to be warm and appropriate. Residents that the inspector spoke to confirmed that they felt able to approach staff and talk to them if they had any problems. A Requirement was made in the report of the last inspection that the Registered Person must ensure that CRB documentation of staff recruited since the last inspection is available for inspection. The manager confirmed that this was in place, although it was in his locked office at the time of the inspection (and therefore not checked by the inspector. This Requirement is considered met but will be checked at the time of the next inspection visit. DS0000007092.V266321.R01.S.doc Version 5.1 Page 18 DS0000007092.V266321.R01.S.doc Version 5.1 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 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, 40, 41. Service users benefit from a well-run home, and systems are in place to safeguard their best interests. Clarification is needed on who pays for replacements of fittings (carpets and curtains). EVIDENCE: A Requirement was made in the report of the last inspection that the Registered Person must ensure that the CSCI is informed about the range of matters covered by regulation 37. A range of critical incidents had been notified to the Commission since the time of the last inspection, and the manager has appropriately consulted and liaised with inspectors about specific changes to residents’ health. During the evening, two residents had a disagreement, which led to a short heated exchange. Staff quickly intervened to calm the situation, and one member of staff ensured that the incident was recorded appropriately. This Requirement is met. However, the inspector was unable to inspect other records of critical incidents, as these had been locked in the manager’s office. The manager later reported that this was not usually the case, and the file had been locked away accidentally. Incident reporting will be checked in more detail at the next inspection visit. DS0000007092.V266321.R01.S.doc Version 5.1 Page 20 There was evidence that the home is well managed. Staff confirmed that they had appropriate induction when they started working at the home, had regular supervision and support, as well as access to training. Those that the inspector spoke to during this inspection confirmed that they felt that the home had a clear focus on user-centred practice. There is good morale, and management were accessible and approachable. Handover between staff changing shifts is of a good standard, with information being shared on each service user. Records are completed on daily activities covering seven areas (personal care; medication; activities, etc), which ensures a comprehensive and clear handover is given. A Requirement was made in the report of the last inspection that the Registered Person must ensure that staff have access to guidance about which items are paid for by residents and which by the home. The manager reported that this had been raised for discussion in staff meetings, and the specific issue that had been noted in the last inspection had been addressed. This Requirement is met. However, it was noted that a resident mentioned to the inspector that he would like new carpet and curtains, as his current ones were stained or worn. This was raised with staff, who said that the resident would have to pay for the items. The inspector queried whether such items would normally come within reasonable renewals and repairs, which would be the responsibility of the landlord. This is to be investigated, and clarification of responsibility for furnishing and equipment is to be clarified on residents’ contracts. See Requirements. Records are kept of expenditure of money held on behalf of residents. These itemise every amount spent, with receipts kept, and a running balance is signed by two staff, with evidence of periodic checks and signatures by the manager or Deputy. This provides clear accounting that is easily tracked. DS0000007092.V266321.R01.S.doc Version 5.1 Page 21 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 3 3 X 3 2 X X DS0000007092.V266321.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 YA6 Regulation 15(2)(b) Requirement Timescale for action 01/04/06 2. YA6 15(1) 3. YA20 13(2) 4. YA23 13(6) The Registered Person must ensure that the system to monitor progress towards care planning goals is strengthened, by ensuring that monthly summaries are completed regularly. Partly met (previous timescale 1/1/06) The Registered Person must 01/03/06 ensure that an audit of residents’ files is conducted to ensure documents are dated, signed and currently relevant. Within timescale at the time of this inspection visit. The Registered Person must 01/03/06 ensure that the lists of homely remedies reviewed to ensure that they are current and agreed by the GP. Partly met (previous timescale 1/1/06) The Registered Person must 01/03/06 ensure that an audit of residents’ property lists is undertaken to ensure that they are complete. Partly met (previous timescale 1/1/06) DS0000007092.V266321.R01.S.doc Version 5.1 Page 23 5. YA41 12(1)(a) The Registered Person must clarify who is responsible for the costs of repairs and replacements in respect of carpets and curtains in residents’ bedrooms, and ensure that this information is clearly stated in service users’ contracts. Once clarified, the manager must make arrangements to replace or repair the carpet and curtains of the resident referred to in this report. 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000007092.V266321.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000007092.V266321.R01.S.doc Version 5.1 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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