Inspection on 28/07/06 for Garrards Road 25

This inspection was carried out on 28th July 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 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 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garrards Road 25 08/09/09

Garrards Road 25 02/09/08

Garrards Road 25 09/01/08

Garrards Road 25 02/05/07

Garrards Road 25 12/01/06

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

CARE HOME ADULTS 18-65 Garrards Road 25 Streatham London SW16 1JS Lead Inspector Sonia McKay & Vashti Maharaj Unannounced Inspection 28th July 2006 08:45 Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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 Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garrards Road 25 Address Streatham London SW16 1JS 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) 020 8696 6773 020 8696 6773 Caretech Community Services Ms Caroline Mordi Care Home 12 Category(ies) of Learning disability (12), Physical disability (6) registration, with number of places Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 2006 Brief Description of the Service: Garrards Road is a residential care home registered to provide care and accommodation for twelve people with a learning disability aged between 18 and 65 years. The home is set in it’s own grounds facing a large park with lido. Ramps and handrails are available at the entrance to the ground floor. It is conveniently located for public transport and for local shopping areas. The home is divided into three units. All are self-contained with separate entrances to each. The ground floor is for six people with physical disabilities with varying degrees of learning disability. The first floor offers accommodation to four people with a learning disability and other complex needs such as mental health difficulties. The second floor offers accommodation to two service users with learning disabilities. The home has use of a vehicle and employs a support worker/driver to assist with the numerous journeys back and forth to the various day services/activities attended. Prospective service users are given a copy of the Service Users guide that gives information about the home and the services provided. A copy of the most recent CSCI inspection report is available in the home on request. Fees range from £1395.00 to £1750.00 per week and depend on the individual care needs of each service user. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out in ten hours over one day. It involved talking with the registered manager, support staff on duty and seven of the service users. Records relating to individual care arrangements, training and health and safety were examined and there was a tour of the premises. The registered home manager completed a pre-inspection questionnaire to provide the CSCI with current information about service users, staffing and the services provided. Three placing authority social workers and three health professionals involved in the care of three service users were also contacted by telephone for their views of the service provided. What the service does well: What has improved since the last inspection? What they could do better: The records of planned health and social care, and individual aims and goals must be updated regularly and there must be better assessment and record keeping of any risks posed to service users. Staff must be better trained in meeting the specific and complex needs of some of the service users and more staff must attain a vocational qualification in providing care. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 6 There must be better assessment of the type of support that each person needs with managing their finances and increased safeguards for protecting service users from financial abuse. The ground floor unit, which is designated as accommodation for service user with a physical mobility need, is not fully accessible. More must be done to ensure that service users who use wheelchairs have full access to communal areas and appropriate furniture and equipment. 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. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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 Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have the information they need to make an informed choice about moving to the home and an opportunity to visit and test drive the service before making a decision to move in for a trial period. There is a need to increase the information about fees that is provided to prospective service users in the service users guide and for more detailed contracts. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. These documents were reviewed in January 2006. The Service users Guide also contains a section for service user induction to the home training. The manager described the process for assessing the needs of individuals referred to the service. Care Tech request a copy of the local authority community care assessment and care plan and any supporting evidence in the form of specialist assessments. The home manager and senior staff then visit the prospective service user and complete a comprehensive care needs assessment. Prospective service users are then given an opportunity to visit the home to experience life in the home and to get to know the service users and staff. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 9 These visits can include joining the current service users for meals and also staying overnight. The prospective service user can then move in for a trial period. Contracts do not provide sufficient detail about client fee contributions towards placement costs and what these contributions cover. The information provided to service users must be revised in accordance with recent changes in the Care Homes Regulations of 2001 that are due to come into force in September 2006. The service users guide and associated individual contracts must provide greater detail relating to the standard package of services provided. The terms and conditions (including fee levels) that apply to key services (both personal care and food) and the payment arrangements (service user contribution/local authority contribution) must be stipulated. The guide must also state whether the terms and conditions (including fees) would be different in circumstances where a service user’s care is funded, in whole or in part, by someone other than the service user (See recommendation 1) Occupancy contracts do not stipulate the bedroom to be occupied under the agreement. (See requirement 1) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 10 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, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there are good standard templates for written information that allow for the inclusion of the views and personal preferences of service users, the plans and risk assessments must be revised to reflect current need, risk and short, medium and long-term goals and all documents must be reviewed regularly. EVIDENCE: Each service users planned care is documented as their Individual Support Requirements. These plans are written in the first person, for example, How I want staff to assist me and How I dont want staff to treat me. The areas covered in these plans include brief but salient information about: • Preferred sleep patterns and any support needed • Personal care • Continence needs • Communication • Nutrition • Daytime activities Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 11 • • • • Household chores Mobility needs Religious and cultural needs Relationships and emotional support There is more detailed information about support needs from relevant specialists in some cases. For example, one service user has specific support needs and behaviours around food. This is not mentioned in the Individual support requirement. Professionals involved commented that there has been some difficulty in implementing recommendations on occasion. It would be useful if there were a reference to the more detailed support plan in place. (See recommendation 2) The service user has autism and quite challenging behaviour. Key staff are meeting with care management and health professionals regularly to develop appropriate support guidelines and a more structured week of activities, whilst a day service specifically for people with autism is arranged. The local authority care manager confirmed that although there had been difficulties in the initial stages of the placement, there is better communication with the health professionals involved and care arrangements are improving by having regular multi-disciplinary meetings. A visual planner of the service users daily activities is available in the service users bedroom and specific behaviour support recommendations are in place. Information about short, medium and long-term goals is not readily available and a service user said that she was not sure what her future plans are. Goals from recent internal and external reviews are not reflected in the support plans in some cases. There is a company policy for the key worker to complete a monthly summary of support provided and to review support plans with the service user each month. This has not happened in some cases. (See requirement 2) Service users need and receive varying levels of support to make decisions. Three service users have been referred for support from a local advocacy service. There is evidence that service users as a group make decisions about activities and menu choices. Observation of interaction between staff and service user provided evidence that service users are encouraged to make decisions where possible. Some service users have significant communication needs and in some cases cannot communicate verbally. There is insufficient information in the homes own communication support plans about how these service users are/could be supported to make day-to-day decisions, for example, use of photographs, visual planners and objects of reference. (See recommendation 3) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 12 Service users receive varying levels of support with managing their finances. The reasons for and nature of the support provided is not documented or reviewed. (See requirement 3) Risk assessments are in place to demonstrate how service users can be supported to lead their lives safely and manage identified risks. However, staff described risks that are not documented. It is not clear whether all required risk assessments are in place as a risk audit tool is not in place. For example, one service user has eaten vegetation. There is no specific risk assessment relating to the risks that this presents. (See requirement 4 & recommendation 4) Confidential records about service users are now stored securely, as required in the previous inspection report. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users take part in a range of appropriate activities, are part of their local community and can maintain relationships with family and friends. Service users are encouraged to take responsibility for some household chores; however, the physical limitations of the current kitchen do not allow full access for people who use wheelchairs. Service users are offered a healthy diet. EVIDENCE: Service users are involved in a variety of daytime activities; these include attending day centres, supported employment training, shopping, daytrips and one-to-one activities with staff. As the home opened recently none of the service users have yet enrolled for any college courses. A masseuse also visits one service user at home on a regular basis. One service user said, I like going to the disco and dancing! Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 14 There is a house vehicle and a member of the support team is employed as a support worker/driver. One service user was out with staff shopping for food for her birthday party. The mother of another service user was visiting to take her daughter out for the afternoon. There are outings to places of interest. Recent trips have included the London Eye and Brighton. There are also trips to leisure resources such as the park, a disco, swimming pools, bowling and social clubs. Service user can maintain their friendships and relationships whilst living in the home. Some service users also spend time with their relatives. One service user recently enjoyed a holiday to Greece and, being able to access the community independently, was preparing to visit her family using public transport. Another service user was looking forward to a holiday with his family in Kent and a trip to Thorpe Park theme park. There are televisions and music centres in the communal lounges, and many service users also have televisions and music centres in their bedrooms. Some service users enjoy spending time or playing football in the large front garden and there is also a small trampoline. The cultural and spiritual needs of individual service users are recorded although the steps taken to address them are not recorded in some cases. (See requirement 2) Staff were observed to spend time and interact well with service users and to readily engage in conversation. Meals are served in the dining areas on each of the three floors. Records indicate that service users choose a range of dishes. Breakfasts are individually chosen and some service users are encouraged to prepare these meals themselves. One service user said, My favourites are our soup and macaroni cheese. Staff explained that the service user, who is from Trinidad, enjoys Caribbean style soups and dishes. The ground floor kitchen food preparation areas and dining tables are not fully accessible to service users who use wheelchairs. Service users cannot sit with their wheelchairs under the table and have to sideways if they wish to sit in the dining area. This is not suitable or safe. (See requirement 5) An occupational therapist has assessed the needs of one of the service users who uses a wheelchair and has made recommendations around encouraging the service user to prepare some meals for him self and the kitchen equipment needed to enable independent food preparation. On the day of the inspection the service user prepared his own breakfast at a small breakfast bar, but as Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 15 the kitchen is not accessible the opportunities for skills development are limited. (See recommendation 5) Service users assist with chores to the best of their ability and most are involved in either household or personal shopping. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 16 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 poor. This judgement has been made using available evidence including a visit to this service. There is evidence that service user receive personal support in the way that they prefer although more should be done to ensure that staff are providing support in the way that is required. Physical healthcare needs are generally well met, but are inadequately recorded in some cases. Although there is evidence that service users receive their medicines regularly, quality in this area is poor overall as there are issues with recording and stock control that could put service users at risk. EVIDENCE: Service users require varying levels of support with maintaining their personal hygiene from full support to verbal prompting. Personal support is provided in private, either in bedrooms or in bathrooms and each service user has a written personal care guideline detailing the nature of support required. A female member of staff is on duty at night on the ground floor, as recommended in the previous inspection report. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 17 There is a designated key worker system in place and on occasions when additional staff are required they are supplied via an agency or a bank system. All service users are registered with a local GP practice and each service user has an individual Health Action Plan in place. Service users are encouraged to own and complete these documents with support from staff. This is good practice. There is evidence that advice is being taken in regard to specialist support from physiotherapists, occupational therapists and speech and language therapists and some adaptations, equipment and communication tools are already in place. However, feedback from some of the professionals involved indicates that there are sometimes problems in implementing some of the recommendations and guidelines that they have provided. (See recommendations 2 & 7) Physical health outcomes are generally good. Service users see the GP regularly, although appointments with health professionals are not well documented in some cases. Staff had to check the communal diary to provide evidence of appointments in some cases and templates available to record the outcomes of these appointments are not always used correctly. This is poor practice, as it does not provide an accurate and permanent record of the healthcare provided to each service user. One service user gained a significant amount of excess weight so a referral was made to a dietician. A speech and language therapist was also involved and the service user is now eating independently which she was unable to do when she moved into the home. One service user uses an oxygen mask at night. A requirement was made in the previous inspection report for clear guidance and staff training in the use of this equipment. Day staff on duty were unfamiliar with the equipment and said that only night staff used it. All staff should know how to use this equipment and a care plan should be developed around use, operation and maintenance of the equipment, where to get replacements and the care of masks. (See requirement 6) There are lists of health care contacts, but they are not fully completed in some cases. For example, the names and contact details of opticians, dentists and other therapist involved are not readily available. (See recommendation 7) Service users receive their medication regularly, however there are issues with recording and stock control. A separate report will be supplied listing areas for improvement. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Service users are confidant to make complaints and all complaints are investigated thoroughly. Service users are not protected from financial abuse. EVIDENCE: The service users guide document encourages service users to make complaints and states that the manager and key worker will discuss how this is done with each service user. One service user was clear about how to make a complaint and whom she should talk to, to do so. The record of complaints examined indicates that detailed records are kept of any complaint made, the actions taken to investigate and the findings of the investigation. There have been seven complaints. The regional manager investigated each complaint thoroughly. The finding of the investigations conclude that: • Three complaints are not upheld • Two complaints are partially upheld • Two complaints are upheld The investigation reports make constructive recommendations to prevent reoccurrence. Staff training in abuse awareness is available, although there are a number of new staff and it is not clear whether all staff have yet received this training. (See recommendation 11) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 19 Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing). There are inadequate procedures for safeguarding vulnerable adults from financial abuse. Two service users, who are supported by staff to manage their finances, have recently lost large amount of money from their bank accounts. A police investigation and adult protection procedures, co-ordinated by the local authority, are pending. Systems in place for checking and monitoring of money and valuables held in safekeeping are inadequate. An immediate requirement was issued on the day of the inspection. The registered manager provided the CSCI with an interim report on increased protection until a full financial review could be conducted. The regional manager will undertake the review. (See requirements 7 & 8) Observations of staff interactions with one service user, who has behaviours that are quite challenging at times, provide evidence that some newer staff may not have a clear understanding of the appropriate use of physical intervention. A member of staff gripped the wrist of one service user firmly to prevent him moving from a garden chair and was observed to hold his shoulders. Although the physical intervention was not aggressive there is no guideline in place for this type of physical intervention/restraint. This is unacceptable. The manager was notified of this inappropriate physical intervention immediately. (See requirement 9) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 20 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, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the large home is clean, spacious and well furnished, it is not fully accessible to service users with a physical disability. EVIDENCE: The large home is divided into three separate units. Each unit is self-contained and offers individual spacious bedrooms with en-suite bathrooms that are well decorated and furnished. There is ramped access to the ground floor entrance and a large front garden. Temporary ceiling tracks are available in three bedrooms. Although it appears that some appropriate equipment is supplied to meet the specialist needs of current service users, an occupational therapists assessment of the premises is not available. (See requirements 10 and 11, and recommendation 8) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 21 The kitchen, dining area and laundry room on the ground floor are not fully accessible to service users currently living there. This is not in keeping with the stated purpose of the ground floor unit. (See requirement 10) Bathrooms on the ground floor are suitable for people with mobility needs and walk-in showers, shower chairs and a parker bath are available. There is water damage to some of the bath side panels on the first floor, which are made of a material that is not water resistant. (See recommendation 9) The first floor unit is poorly ventilated with little airflow. It was a hot day and the temperature on this floor was unacceptable. Service users and staff spent the majority of the day in the garden to keep cool. (See recommendation 10) The interior of the property is tastefully decorated throughout, with coordinated colour schemes and the home is clean and hygienic. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 22 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, 34 & 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst there is evidence of ongoing training there is a need to ensure that staff training is linked to the specific needs of the service users and for all staff to attain a vocational qualification. EVIDENCE: Staff duty rosters provide evidence that a sufficient number of staff are on duty on each floor of the home. There are seventeen care staff. Three members of staff have an NVQ level 2 or above and four staff are currently undertaking this qualification. All staff are enrolled on LDAF (Learning Disabilities Award Framework) training and a file containing all current training certificates is maintained. A range of training is available although there is a need to analyse current training needs and to develop a training plan for 2006-2007. (See requirements 12 and 13 and recommendation 11) Feedback from health professionals indicates that staff would benefit from training that is focused on the needs of individual service users and skills development. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 23 The CSCI Provider Relationship Manager examines staff recruitment records twice each year. The records were last audited in April 2006. This audit provides evidence that all staff have enhanced criminal records checks in place and POVA First checks are taken up if necessary. A number of recommendations were made and progress in implementing these recommended actions will be examined at the next audit. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 24 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, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced and quality assurance systems are in place. There is a need to develop a plan for the home based on the views of and outcomes for service user. Systems are in place to promote health and safety in the home. EVIDENCE: The home benefits from the competencies and skills of the registered manager who has experience at a senior level and has successfully completed a CMS (Certificate in Management studies) and an NVQ at Level 4. The organisation has a quality assurance system in place. An independent assessor has completed two audits of the service provision. The reports of these inspections are detailed and result in meaningful recommendations for improvement. Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 25 Quality assurance must include stakeholder and service user surveys and an annual development plan, based on a system of planning-action-review that reflects the aims of the service and outcomes for service users must be put in place. (See requirement 14) Staff conduct regular health and safety checks each month. The LFEPA (London Fire & Emergency Planning Authority) carried out an inspection of the premises on 15 August 2005 and deemed arrangements to be in accordance with Fire Precautions (Workplace) Regulations. Fire evacuation procedures and a building floor plan are displayed. Fire evacuation drills are held regularly and the outcome of the drills recorded. Fire detection equipment is tested each week, and the fire fighting and detection equipment is also professionally tested on a regular basis. The annual gas appliance safety test was conducted on 26/07/06. Records of tests conducted on the small electrical appliances and the mains electrical circuitry is not available. (See requirement 15) Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 26 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 1 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 2 28 2 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 X 2 X X 2 X Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 27 Yes 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 12(5) Requirement The registered person must ensure that contracts with service users contain the National Minimum Standard of information. This must include the rooms to be occupied under the agreement. The registered person must develop and agree with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The registered person must document the nature of support that each service user requires to manage their finances. These arrangements must provide adequate protection from financial abuse and must be reviewed regularly or when needs change. The registered person must ensure that risks presented to service users are appropriately assessed and actions taken to DS0000065068.V305401.R01.S.doc Timescale for action 30/11/06 2. YA6 15 31/10/06 3. YA7 15 31/10/06 4. YA9 12 13 30/09/06 Garrards Road 25 Version 5.2 Page 28 minimise risks where possible. 5. YA17 YA29 13 23 12 The registered person must ensure that dining tables are of a type that is suitable to service users who use wheelchairs. The registered person must ensure that staff receive training and instructions on how to support service users using specialist equipment. Previous timescale of 01/03/06 not met. The registered persons must ensure that service users are protected from financial abuse. Immediate requirement. The registered manager has provided evidence that immediate action was taken to reduce the risk of financial abuse until a full review of financial arrangements and checks is conducted. The registered persons must ensure that there are adequate safeguards and procedures in place in regard to the support provided to service users to manage their financial affairs and to safeguard their money and valuables. The registered persons must ensure that physical intervention is used only as a last resort by trained staff in accordance with Department of Health guidance, protects the rights and best interests of the service user and is the minimum consistent with safety. The registered persons must ensure that the ground floor kitchen and laundry room are suitable for stated purpose; accessible, meet service users’ individual and collective needs in a comfortable and homely way; and have been designed with DS0000065068.V305401.R01.S.doc 31/10/06 6. YA19 31/10/06 7. YA23 16(2)(l) 12(1) 12(4) 28/07/06 8. YA23 12 30/09/06 9. YA23 12 13 31/08/06 10. YA24 YA28 YA29 23 16 31/12/06 Garrards Road 25 Version 5.2 Page 29 reference to relevant guidance. 11. YA29 23 16 The registered person must ensure the provision of environmental adaptations and disability equipment necessary to meet the home’s stated purpose and the individually assessed needs of all service users. The registered persons must ensure that staff have the competencies and qualities required to meet service users’ needs and achieve Sector Skills Council workforce strategy targets within the required timescales. A staff training needs analysis and training plan for 2006-2007 must be supplied to the CSCI Southwark office. The registered person must ensure that staff are enrolled for National Vocational Qualification training at level 2 or above. The registered person must ensure that an annual development plan is formulated, based on a systematic cycle of planning-action-review, reflecting aims and outcomes for service users. The registered person must supply the CSCI Southwark office with evidence of professional safety testing of the mains gas appliances, the small electrical appliances and the mains electrical wiring. 31/12/06 12. YA32 YA35 18 31/10/06 13. YA35 YA32 18 (1) c 31/10/06 14. YA39 24 31/10/06 15. YA42 24 31/10/06 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 DS0000065068.V305401.R01.S.doc Version 5.2 Page 30 Garrards Road 25 1. YA1 YA5 2. YA6 3. 4. YA7 YA9 5. YA16 6. YA19 YA18 7. 8. YA19 YA29 9. 10. YA27 YA24 11. YA32 YA35 The registered persons should revise the service users guide and service user contracts to ensure that the additional information required by changes in legislation (coming into force on 1st September 2006) are added. The registered person should make reference to any specialist assessment information in place in the Individual Support Requirements so that staff are made aware of any specific support needs or current guidance available elsewhere in records. The registered persons should develop specific communication and decision making support plans for service users with limited verbal communication skills. The registered person should develop a risk audit tool that enables staff to methodically assess risks posed to service users and tracks current risk assessments and review dates. The registered persons should seek advice on making the kitchen area and kitchen equipment (worktops, sinks, taps, cupboards, aids for eating and drinking, dining tables and cookers) more accessible to service users who use a wheelchair. The registered persons should consider ways in which the advice and recommendations of healthcare professionals can be better communicated to all members of the team. For example, read and sign documents, regular discussion and key worker feedback sessions. The registered persons should ensure that the lists of healthcare contacts are kept up to date for each service user. The registered person should ensure that an occupational therapist or other suitably qualified therapist completes an assessment of the premises, and that any recommendations made be responded to. The registered person should replace damaged bath side panels with panels made of a suitably water resistant material. The registered persons should seek professional advice on increasing the airflow through the first floor unit to prevent high temperatures on hot days and to make the unit a more comfortable living area. The registered person should ensure that all staff attain a vocational qualification (at NVQ level 2 or above) and are trained in accordance with the stated aims of the home and the specific needs of the service users. Training should include: • Makaton • Autism • Challenging behaviour DS0000065068.V305401.R01.S.doc Version 5.2 Page 31 Garrards Road 25 • • • • Non verbal communication Active support training Equal opportunities Adult protection and abuse awareness Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 Page 32 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 Garrards Road 25 DS0000065068.V305401.R01.S.doc Version 5.2 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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