Inspection on 08/09/05 for Garden House

This inspection was carried out on 8th September 2005.

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 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

Garden House 29/01/07

Garden House 04/01/06

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 Alison Pritchard Unannounced Inspection 8th September 2005 15:40 DS0000007092.V254203.R01.S.doc Version 5.0 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.V254203.R01.S.doc Version 5.0 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.V254203.R01.S.doc Version 5.0 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.V254203.R01.S.doc Version 5.0 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. 18th March 2005 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, the amenities include 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 which 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.V254203.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over five hours in September 2005. The inspection methods included talking to all of the residents, discussions with the deputy manager of the home, a tour of the communal areas of the building, examination of records and observation of care practices. A second visit was made to the home in early November 2005 to examine records of staff recruitment and the management of residents’ finances. This was carried out on an announced basis and with the assistance of the registered manager of the home. the findings of that visit are also reported. What the service does well: What has improved since the last inspection? What they could do better: Overall the home is well managed but some areas need to be improved so that the standards are met. In particular, residents’ files need to be better organised and maintained, including regular monitoring of care plan goals. Staff need further guidance on the items for which residents’ finances may be used so that withdrawals from their funds are not made in error. The registered manager has agreed to take action to ensure that, if appropriate, money is refunded to the resident involved. DS0000007092.V254203.R01.S.doc Version 5.0 Page 6 Staff need to be sure that the medication administration sheets are accurately completed. An immediate requirement was made about this and a senior manager from Leonard Cheshire confirmed within the time-scale that this has been met. The CSCI had not been properly informed of the range of matters covered by regulation. All the necessary recruitment documents need to be available for inspection. 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.V254203.R01.S.doc Version 5.0 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.V254203.R01.S.doc Version 5.0 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): 1, 2, 5 The information available for prospective residents includes most of the information required. It is written in a manner which is accessible to current and prospective residents. EVIDENCE: The service user guide has been written in plain English and in symbol format so that it is accessible to prospective residents. Although there have been no recent admissions to the home, the policy of the managing organisation is to obtain assessments for potential residents prior to their admission. Residents have been issued with statements of terms and conditions and one such document was seen on a resident’s file. DS0000007092.V254203.R01.S.doc Version 5.0 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, 7, 8, 9, 10 Residents would benefit if the system to monitor progress towards care planning goals were strengthened. A system to conduct regular audits of files would be useful in ensuring that residents benefit from the recording and monitoring systems in the home. EVIDENCE: Each of the residents has a key worker who is responsible for the care plan and will contribute to the review system. The organisation plans to introduce the person centred planning approach to care planning. Goals were identified as part of the care plans, but on one of the files examined the last monthly summary completed was dated May 2005. This does not allow timely monitoring of goals. Some documents on care plan files were undated, others were wrongly filed and some were in need of review to assess their current relevance. A system to conduct regular audits of files would be useful in ensuring that residents benefit from the recording and monitoring systems in the home. DS0000007092.V254203.R01.S.doc Version 5.0 Page 10 Residents confirmed that they have input into the running of the home through attending residents’ meetings which are held each month, attending care planning meetings and day to day discussion with staff. The managing organisation has a risk management policy and new forms for its implementation are to be introduced. Risk assessments were seen on residents’ files and were judged appropriate to their needs. Information about residents is kept securely and with regard for their confidentiality. The organisation is registered under the Data Protection Act as required. DS0000007092.V254203.R01.S.doc Version 5.0 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, 16, 17 Residents are able to join in a wide range of suitable activities in the community and at home. The meals in the home offer choice, variety and they are appropriate for the residents’ cultural background. EVIDENCE: The majority of the residents follow a range of activities. One of the residents has a less well developed activity programme as a result of particular needs and has been referred to a specialist team for people with learning disabilities. Several of the residents had been on holiday over the summer period and other holidays were planned. There had been a number of day trips organised by the home. on the day of the inspection the residents had taken part in a range of activities including going to a sailing club, to a city farm, shopping, visiting family members, and doing household chores. Regular activities include attendance at adult education classes, day centres, a city farm and membership of a sailing club. In addition the residents use the local facilities such as the local shops and cinema. Within the home the residents follow a number of interests, including music, craft work, watching TV, helping to prepare meals and having massages. DS0000007092.V254203.R01.S.doc Version 5.0 Page 12 Some of the residents have close relationships with family members and friends. The home supports residents to make and receive visits and the deputy manager said that all necessary checks have been carried out. Warm greetings were observed between residents and staff who had not seen each-other for a while. Residents, in the main, spoke positively about staff and how they get on together. Residents said that they were happy with the meals provided in the home, that they helped to choose them and could choose to assist with their preparation. The menus showed that a range of food is provided including fresh items and that the menu changes to reflect residents’ preferences and tastes. DS0000007092.V254203.R01.S.doc Version 5.0 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 Residents have benefited from the commitment that the home has shown to meeting their health care needs. Staff need to make sure that medication administration records are completed accurately. EVIDENCE: Three residents who were asked said that they were happy with the way that they are looked after. It was seen on the file of one of these residents that their preference was noted regarding the gender of staff providing personal care. Routine appointments with health care professionals such as opticians, dentists and the GP had been attended appropriately. There has been careful attention to the health care needs of residents. One of the residents was going to have a minor operation on the day after the inspection which is likely to improve the quality of her life. Another resident has particular health care needs which are increasing with age. The home had worked in conjunction with a multidisciplinary team to ensure that the person’s needs can be met in the home and that his best interests are met. The home also ensured that the CSCI was appropriately informed and consulted. Throughout the process the home demonstrated care and commitment to meeting the needs of the resident. DS0000007092.V254203.R01.S.doc Version 5.0 Page 14 It was found that instructions on a medication administration record which had been hand written by staff did not reflect the prescriber’s instructions. This was the subject of an immediate requirement to be met by 5pm on the day after the inspection. Evidence was provided by the registered person, within the timescale specified, that the requirement had been met. Staff received training in medication issues in July 2005. One resident had a list of homely remedies noted but this had not been reviewed for some years. It is required that this is updated and those of other residents reviewed to ensure that they are current. DS0000007092.V254203.R01.S.doc Version 5.0 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 The complaints, adult protection and whistle-blowing policy contribute to the protection of the residents. EVIDENCE: Residents asked about these matters could all identify someone that they would raise issues of concern with, and expressed confidence that their worries would be dealt with. There have been no complaints made since the last inspection in March 2005. The home has an adult protection procedure and there is a whistle-blowing procedure. An audit must be carried out to make sure that all residents have completed property lists. There are safe procedures in place for checking residents’ finances, these involve daily and weekly checks internally and external audits. (see also standard 41 below). DS0000007092.V254203.R01.S.doc Version 5.0 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, 28, 30 Residents have benefited from improvements to the decorative state of the building and are looking forward to further redecoration and refurbishment. EVIDENCE: The ground floor of the home is accessible to wheelchair users. Refurbishment and redecoration has begun and a new kitchen has been fitted. Further refurbishment is planned throughout the home. There are two large living rooms in the home allowing choice for residents, and for different activities to go on. One of the living rooms has a large dining table for communal meals. There is an adequately sized garden to the rear of the home and this has recently been tidied and improved. The premises were clean and odour free at the time of the Inspection. Laundry facilities are suitable for the needs of the home. DS0000007092.V254203.R01.S.doc Version 5.0 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): 31, 32, 33, 34, 35, 36 There are enough well trained staff who know the residents well to make sure that consistent care is provided. The systems to recruit staff are safe and protect residents. Staff are well supported and supervised. EVIDENCE: There is a clear staff structure in the team which consists of the registered team manager and a senior support worker and support workers. The two senior staff share management tasks including staff supervision. Each staff member has a job description which clearly lays out their responsibilities and to whom they are accountable. Staff have been issued with copies of the GSCC code of conduct. There is an induction programme in place which includes training in specific issues deemed essential for the home. These include health and safety, key working, vulnerable adults issues and infection control. Staff are required to undertake training to achieve NVQ 2 or above and the programme to achieve this is underway. At the time of the inspection there were four staff on duty until 8pm and then there were to be two staff on duty, providing sleep-in cover, overnight. This staffing level is suitable for the needs of the residents. Overnight there was a male and a female member of staff on duty, thus allowing same gender care to be offered to all residents. DS0000007092.V254203.R01.S.doc Version 5.0 Page 18 The staff team is mixed consisting of six women and six men. There were no vacancies at the time of the inspection. There is a low turnover of staff at the home and residents benefit from the consistency that this allows. When bank or agency staff are used efforts are made to ensure that they are used regularly so that there are few changes for residents. In order to facilitate this temporary staff are sometimes employed on short term contracts. Recruitment records showed that safe practices are followed in accordance with the regulations. Although there was evidence that all staff have had CRB checks undertaken, those of recently recruited staff were not available for inspection as required. There is a supervision and appraisal system and records showed that staff are adequately supported and effectively managed. DS0000007092.V254203.R01.S.doc Version 5.0 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, 39, 41, 42, Residents benefit from effective management systems. The use of residents’ money needs to be reviewed to make sure that it is spent appropriately. The CSCI needs to be informed of incidents to which regulation applies. Health and safety matters are well managed in the home. EVIDENCE: The manager of the home has been registered under the Care Standards Act since October 2004. The indications of this inspection were that the home is well run, with a pro-active approach to staff management in the interests of the residents. A range of people carry out visits to the home as required by regulation 26 of the Care Homes Regulations. The reports of the visits show that staff and residents’ views are sought and points for action are identified. Copies of the reports are sent to the CSCI. Record keeping was in generally good order although it was found that the CSCI had not been informed of some incidents as required by regulation 37 of DS0000007092.V254203.R01.S.doc Version 5.0 Page 20 the Care Homes Regulations. The range of the regulation and the issues covered were discussed with the registered manager who agreed to ensure that this is addressed in future. Examination of records relating to residents’ finances showed that residents are encouraged to be involved and the organisation does not hold appointeeship for any of the residents. A random check of one resident’s financial records showed that he had been paying for items which the manager stated were more appropriately covered by a part of the home’s general budget. The manager agreed to follow up this issue and to ensure that any money owed to the resident was repaid. Records showed that health and safety matters are managed well in the home and no problems were noted during the inspection. Staff receive training in a range of health and safety issues, including moving and handling, first aid and fire safety. DS0000007092.V254203.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 4 Standard No 37 38 39 40 41 42 43 Score 3 3 3 x 2 3 x DS0000007092.V254203.R01.S.doc Version 5.0 Page 22 no Are there any outstanding requirements from the last inspection? DS0000007092.V254203.R01.S.doc Version 5.0 Page 23 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 YA20 Regulation 13(2) Timescale for action The Registered Person must 09/09/05 ensure that handwritten entries on medication administration records accurately reflect the prescriber’s instructions. The Registered Person must 01/01/06 ensure that the system to monitor progress towards care planning goals is strengthened, by ensuring that monthly summaries are completed regularly. 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. The Registered Person must 01/01/06 ensure that the lists of homely remedies reviewed to ensure that they are current and agreed by the GP. The Registered Person must 01/01/06 ensure that an audit of residents’ property lists is undertaken to ensure that they are complete. The Registered Person must 01/01/06 ensure that staff have access to guidance about which items are paid for by residents and which by the home. The Registered Person must 01/12/05 ensure that CRB documentation of staff recruited since the last inspection is available for inspection. DS0000007092.V254203.R01.S.doc Version 5.0 Page 24 Requirement 2 YA6 15(2)(b) 3 YA6 15(1) 4 YA20 13(2) 5 YA23 13(6) 6 YA41 12(1)(a) 7 YA34 19(1)(b) 8 YA41 37 The Registered Person must 01/12/05 ensure that the CSCI is informed about the range of matters covered by regulation 37. 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.V254203.R01.S.doc Version 5.0 Page 25 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.V254203.R01.S.doc Version 5.0 Page 26 - 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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