Inspection on 08/09/09 for Garrards Road 25

This inspection was carried out on 8th September 2009.

CQC found this care home to be providing an Adequate service.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garrards Road 25 02/09/08

Garrards Road 25 09/01/08

Garrards Road 25 02/05/07

Garrards Road 25 28/07/06

Garrards Road 25 12/01/06

Extracts from inspection reports are licensed from CQC, this page was updated on 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Garrards Road 25 Streatham London SW16 1JS Lead Inspector Sonia McKay Key Unannounced Inspection 8 & 9th September 2009 09:30 th Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Garrards Road 25 DS0000065068.V376954.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 6775 020 8696 6773 Caretech Community Services Post Vacant Care Home 12 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD 2. Physical Disability - Code PD The maximum number of service users who can be accommodated is: 12 2nd September 2008 Date of last inspection Brief Description of the Service: Garrards Road is a residential care home registered to provide care and accommodation for twelve people with a moderate to severe learning disability aged between 18 and 65 years. The home is set in it’s own grounds facing a large park with a 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 and varying degrees of learning disability. The first floor and second floors are separate but are staffed by one team. These floors can provide care and accommodation for six people with a learning disability and other associated conditions. Prospective residents 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 Commission inspection report is available in the home on request. Fees currently range from £1125.00 to £1577.06 per week and depend on the individual care needs of the person using the service. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out over two days. Medication was examined by a Specialist Pharmacy Inspector. The methods used to assess the quality of service being provided were: • • • • • • • • • • • Talking with the home manager Looking at the ‘Annual Quality Assurance Audit’ completed by the home manager (this document is sometimes called an ‘AQAA’ and it provides the Commission with information about the service) Talking to staff on duty during the inspection Talking to four of the seven residents Talking with a relative and an advocate A tour of the communal areas of the premises Looking at records about the care provided to two of the residents Looking at records relating to recent staff recruitment and training Looking at the way medicines are handled by staff in the home Looking at issues that the Commission has been notified about since the last inspection and how they were handled Completed surveys were received from five members of staff The Commission would like to thank all who kindly contributed their time, views and experiences to the inspection process. What the service does well: A member of staff said that the home did well by helping empower service users to participate in activities. Getting choices and preferences in what they like to do, for example, cinema trips and eating out. Also helping residents to plan and go on holidays. Another member of staff said We make sure service users get the right kind of care and support they need. The service users guide is accessible and contains useful information, with pictures and photographs about living in the home. A new resident said, I really like it here, dont want to leave. I feel safe here. Staff are brilliant. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 6 Residents enjoy a range of activities and they have been supported to go on holidays this year. A resident said a holiday away with her key worker had been Perfect, and she is arranging another trip soon. A relative gave positive feedback about the home, thinks the staff are good and she knows what to do if she has any concerns. What has improved since the last inspection? What they could do better: The home must confirm that it can meet the needs of any prospective resident by sending them a letter indicating the outcome of the pre-admissions assessment. There are care plans in place but they do not cover an appropriate range of needs or reflect the current situation in some cases. There is a need for a more meaningful review of care plans and better consultation with the residents themselves or their representative about these plans. There is also a need to better assess risks relating to activities of daily living so that people can take part in activities and not become de-skilled whilst living in the home. Many residents need staff support to have a fulfilling lifestyle and more should be done to understand and meet their individual cultural needs and choices. Residents should be more involved in choosing and preparing meals. Residents can generally receive the support they need to manage their personal care, although those that need staff assistance may have to wait longer, and this is not ideal. There are still concerns that there are not enough Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 7 staff on duty at certain times of the day, for instance during the mornings when people need assisted personal care. Residents get medical assistance when needed but staff must get better at developing plans for good preventative healthcare. Staff must also keep better records so that they know whether an appointment has been attended and what the outcome was. Medication is handled safely, although more staff need the specialist training required to administer one of the medicines in use. There is a staff training and development plan in place although induction training for new staff has not been done properly and there is inadequate evidence of thorough staff recruitment checks. Staff would also benefit from additional training in communication. We received the following comments from staff: • • • • • Staff should better understood their responsibilities and value the people we are looking after Staff should always speak English around service users and colleagues Staff need to work as a team and respect each other in a professional way Staff should be supported equally The home could get better by boosting the staff morale and strengthening the team spirit. Staff are not treated fairly and this does not help to move the home forward. Frequent changes in home management may have affected team morale which appears to be low. More should be done to ensure clear and fair leadership and good team working. The home still does not have a registered manager. Record keeping and environmental safety monitoring must also be improved. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The stated purpose of the home has changed and it no longer provides a service designated for people with challenging behaviour. This is reflected in a revised Statement of Purpose. The service users guide is accessible and contains useful information about living in the home. Some additional information should be included. The home must confirm that it can meet the needs of any prospective resident by sending them a letter indicating the outcome of the pre-admissions assessment. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. The Statement of Purpose was reviewed in September 2009 and it contains information as required. The stated purpose of the home has changed in that the first and second floor units are no longer designated for people with challenging behaviours. The Service Users Guide is produced in an ‘easy to read’ format, using plain English with photographs and pictures to make it more accessible to people Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 10 who may find ‘text only’ documents difficult to understand. The Service Users Guide is under review at the time of this inspection. Some additional information is needed in the guide. A copy of the most recent Commission inspection report is not added to the guide. We recommend that this be done to ensure that prospective residents and their families and friends have an independent view to consider when choosing a care home. A recent Caretech Quality Assurance report highlights the need to add information about the cost of any extras, for example, using the company mini-bus. This addition of this information is also recommended. There is a process for assessing the needs of individuals referred to the service. A Caretech resettlement officer requests a copy of the Local Authority care needs assessment and any specialist assessments available. If a vacant placement in a suitable CareTech service is identified, a CareTech resettlement officer then visits the person referred to complete an assessment of the persons care and support needs. There have been two admissions since the last inspection. I looked at records relating to one admission and there is evidence that the persons needs were assessed and they had opportunities for visits, including overnight stays, before admission. This gives the prospective resident an opportunity to see what the home is like before making a decision to move in for a trial period. As recommended in the last report, a set of initial care plans were put in place before the persons admission. However, these care plans do not cover the persons assessed needs in full. This is addressed in the next section of this report. There is a need to send prospective residents a letter at the end of the assessment. The letter must confirm whether the home can meet the persons assessed needs, as this is not done at present. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are care plans in place but they do not cover an appropriate range of needs or reflect current needs. There is a need for meaningful review and better consultation with the residents themselves or their representative. There is also a need to better assess risks relating to activities of daily living so that people do not become de-skilled whilst living in the home. EVIDENCE: I looked at sets of records for two people living on the ground floor of the home. Each resident has a key worker. The key worker has a responsibility to meet with the resident and help them to keep their affairs and paperwork up to date. The first person moved to the home in October 2008. There is a detailed assessment of need on file. The care plans in place do not cover all of the Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 12 areas of need identified in the assessment. For example, continence needs are not identified in a specific care plan. A personal care plan advises staff of the need for incontinence care but does not provide information about how often this should be done. The initial assessment says that continence aids should be changed every two hours as the person is unable to say when the pad needs changing. Staff on duty said that this is usually done every 3 to 4 hours. The communication plan identifies the need to use objects of reference to aid communication. This means showing the person an object to help them understand what you are saying, for example, showing a cup whilst offering a drink. The plan does not state what these objects are and staff on duty were not sure if they were being used. The plan should provide a reference list to aid staff consistency of support. The pre-admission assessment highlights a need to support the persons Indian culture. The cultural needs care plan is written in the first person and says I can fit into any religious or cultural setting. This gives staff no practical information about how culture needs can be supported and any opportunities to be provided. The care plans had been reviewed by the home manager on two occasions and no changes were made at either review. There are 41 pages of care planning information in a large file containing lots of other records. There is scant information on each page and all 41 pages must be read. This does not make the information easily accessible for staff reference. The care plan does not provide staff with clear instruction or practical information about how identified needs should be met. The care plans do not match the assessed needs of this person. This means that the residents needs are not being addressed properly and cannot be being met. There are a number of risk assessments on file. The information is more concise. The assessments cover an appropriate range of areas and have been reviewed regularly. The risk assessments are based on risks identified at a previous placement. I also looked at plans for a resident who moved to the home in April 2009. The resident can read and is able to communicate verbally but she said she has not seen or signed her care plans. The care plans have a space for the resident to sign their agreement to the plans and this section had not been signed on any of the plans. The resident said that she wanted to get in touch with an advocate but she did not know how. The home should provide her with this information. All residents should be provided with information, and if necessary, support to get in touch with advocacy services. We discussed her care needs and she disagreed with some of the care described as required in the plans. For example, a plan describes her as Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 13 needing staff to advise her when it is time to go to bed and to check on her at night to provide continence care. She said she needs neither as she is doing these things herself. A plan says she is self-medicating when she said she is no longer self medicating. A continence care needs plan is blank, continence needs are described in a personal care plan, albeit incorrectly. It is not clear whether her needs have changed. Again these plans have been reviewed by the home manager regularly and an entry of No change required added. There is a need for more meaningful review of the plans, with the resident involved, to ensure that current care and support needs are recorded accurately and any changes recorded. This must be done to ensure that the resident gets the right type of support at the right time. There is only one risk assessment on file for this resident, in regards to having a medication cabinet in the bedroom. There are no risk assessments around activities of daily living or self medication. It is noted that the resident was living independently before moving to the home. It is important that risks relating to all areas of self-care are properly assessed so that safer plans can be made for the resident to continue to use and develop her independent living skills, for example cooking. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 14, 15, 16 & 17. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a range of activities and they have been supported to go on holidays this year. Many residents need staff support to have a fulfilling lifestyle and more should be done to understand and meet their individual cultural needs and choices. Resident should be more involved in choosing and preparing meals. EVIDENCE: Each person requires staff support to go out in the community. The home has two house vehicles that are wheelchair accessible and a driver is usually on duty each day. This helps with transport to college and day services, as well as outings and shopping. The home is close to public transport links and high street shopping so a vehicle is not always needed. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 15 During the last inspection we noted that residents had not had an annual holiday. Holidays have been arranged and most people have been away for a short break. A resident said that a recent seaside holiday away with her key worker had been Perfect, and she is arranging another trip soon. During the course of the inspection residents were observed to be involved in a range of activities that included attending day services and shopping. Others were watching television or chatting together in the kitchen. Visitors are welcomed and residents can maintain relationships with family and friends by visits and telephone calls. One resident said she keeps in touch with her friends by telephone, letters and visits. A relative was visiting during this inspection. Another resident said she is in regular contact with friends by telephone calls and visits. Some residents need support from staff to help them to maintain their relationships, for example, they may need assistance to use the telephone, plan their social lives and engage in activities, both at home and out in the community. Monthly key worker reports say that one resident swims twice a week at a hydro pool. There is a letter from a relative thanking the staff for arranging a weekend home visit and a holiday. The resident has a communication care plan. I telephoned this residents Advocate and she considers the efforts made by the staff to keep the resident in touch with her family to be brilliant. She thought that the residents cultural needs could be better explored and taken into consideration in planning things like menus and activities. There is also a need to review the current daytime activities for this person as the resident attends a daycentre in another borough and the far distance may be a factor in the feedback from the daycentre staff that the resident is often dropped off late or does not attend at all. If regular attendence cannot be achieved, alternative daytime activities should be looked at and agreed with with the Placing Authority and the persons Advocate. Some residents may be, or may become, sexually active. Discussion with the home manager indicates that there is a need to consider appropriate safe sex advice and sex education. This should be discussed with local authority care managers and a referral to a suitable external specialist educational resource made. This would ensure that residents receive advice about relationships and safe sex. There are no set times for getting up or going to bed. Residents generally wake when they choose and/or are prompted to wake at a time suitable for their planned daytime activity. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 16 Residents move around the floor on which they are living freely, and some use the keypad security exit/entry system if they are able and if it is safe for them to do so. Residents are encouraged to take part in household chores such as cooking activities, shopping and tidying up their bedrooms. Meals are flexibly timed and are served in the dining areas on each of the three floors. Records indicate that residents choose a range of dishes. Breakfasts are individually chosen and some residents are encouraged to help to prepare these meals. Records show that meals are nutritionally balanced and reflect a range of cultural needs. Residents who find it harder to communicate their choices could be shown pictures or photogrpahs to help them to choose. Food stocks were ample and contained fresh produce that was stored and labelled correctly. A record is kept of what each person eats. Staff cook the meals in each of the three kitchens (one on each floor of the home). Residents who commented said that the meals are fine. Although, one said the portions could be bigger and there is sometimes not enough meat. The main kitchen appliances (cooker, sink and fridge) are not accessible to people who use wheelchairs, so the kitchen is not suitable for physically disabled people who want to cook independently. Poor accessibility limits the opportunities for people to take part in cooking activities and develop their cooking skills. Advice has been sought from an occupational therapist on how kitchen accessibility can be improved for people using wheelchairs, although progress in providing greater accessibility is limited to providing dining tables and a worktop of the correct height and a microwave oven. There is a television and music centre in the communal lounge. There is no internet access. Some residents have their own televisions in their bedrooms. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can generally receive the support they need to manage their personal care, although those that need staff assistance may have to wait longer, and this is not ideal. Residents get medical assistance when needed but staff must get better at developing plans for good healthcare. Staff must also keep better records so that they know whether an appointment has been attended and what the outcome was. Medication is handled safely, although more staff need the specialist training required to administer one of the medicines in use. EVIDENCE: Some residents are able to maintain their own personal care and hygiene with just advice or reminders from staff. Others need full staff support with bathing and dressing. The residents seen during this inspection were dressed appropriately. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 18 Individual personal care routines are recorded in a specific care plan. There is ceiling tracking and an assisted bathroom on the ground floor as people have a physical disability. Staff are busy as most residents need full assistance and this requires two members of staff to be done safely. I noticed that one resident did not get up and dressed till after 11.00 am. Staff on duty said that the resident liked to get up late but it was clear that staff were too busy to get him up any earlier, even if he had wished. Another resident said that there are too few staff on duty in the mornings and she often has to wait too long to be assisted with personal care and using the toilet. I looked at personal care plans for two people living on the ground floor. One had a good plan in place that encouraged independence and asked staff to remind the resident about checking hot bath water temperatures. Other parts of the care plan are less accurate (continence care) and it is not clear how independent the resident is. The second persons personal care plan is sufficiently detailed. I looked at the written plans the home has in place to help to keep residents healthy. One resident does not have a completed health action plan. This means that staff are not helping her to plan her preventative healthcare and make appropriate appointments for routine health screenings and check ups. I spoke with the resident and she has moved into the home and kept her old GP as she wished. There is a brief record of the healthcare appointments she has attended whilst living in the home. Another resident has a health action plan in place although it is not clear from the records whether she has attended some of the appointments made, for example, a cervical smear test. This resident needs assistance with making decisions about healthcare and there are copies of best interests meetings in regards to the need for dental treatment, which is being arranged at a local hospital. The resident has seen a dentist regularly, has had a flu jab and has seen a GP when staff notice any health related symptoms and make an appointment. There is evidence that staff seek medical attention for people when they are sick, either via the GP or hospital emergency services. However, more must be done to help residents to plan preventative healthcare and to improve the records of the outcomes of healthcare appointments attended. We inspected medication records, medication storage areas, staff training, and care plans relating to medication. Medication is being managed well at the home. Staff do not administer medication until they have been trained and assessed as competent. Examination of records and medicines in stock show that the medication policy is being followed and residents are kept safe. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 19 We spoke with a new resident who has been living at the home for 2 months, their medicines are supplied in a dossette box by the pharmacy and staff provide support for them to take medicines. This resident was happy with the support provided. A care plan says that she is still self-medicating. The care plan must be amended to reflect changes, as they occur. All residents now have individual lockable medication cupboards in their rooms, which is an improvement. The temperature is checked and recorded on a regular basis. Recordings indicate that medication is stored within safe temperature limits. There are also lockable medication storage areas to store medicines to be returned and excess medication. All prescribed medications are in stock. All medication administration records are up to date with no gaps in recording. Records or medicines received and returned are kept, which show that all medicines kept on behalf of residents can be accounted for. Staff carry out justified stock checks of tablets regularly; these checks are recorded and also provide evidence that medicines are used correctly. There were a very small number of receipt quantities missing this month; this had already been picked up by the homes internal checks so no requirement has been left. Examination of medication stored in blister packs correlated with records of medication administration, indicating that medication is being administered correctly and at the correct time. There are no controlled drugs requiring separate controlled drugs storage at the home although adequate storage is available if they are prescribed. One controlled drug is kept which legally does not require separate controlled drugs storage however CQC guidance says it is good practice to record it in a controlled drugs register. This is used in emergency situations for seizures, and is kept locked in residents rooms as this is where it is most likely to be needed. Storage arrangements are safe. A recommendation has been made regarding using a controlled drugs register. One resident aims to be more independent with taking her medication. At the last inspection, it was noted that the medication for her is left in a medication pot on a bedside cabinet in an open bedroom for up to two hours before being taken. This was not safe practice, and a requirement was made. The home has taken good action, and put in place a comprehensive protocol for this resident to ensure medicines are not left out unattended. One resident experiences seizures. There are two types of emergency medication prescribed. One that is taken orally and an older type that has to be administered rectally by staff. Both medications are in stock because not all Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 20 staff have been trained to administer the new medication. A requirement was left at the last inspection that staff must all be trained to administer the new medication because this is an option that better preserves the residents dignity. At this inspection, two members of staff have been trained to use the new medication, and training for other staff is due to take place before the end of the year. We were told that one of these two members of staff is always on duty or available, however this requirement will remain as there may be occasions when both staff are unavailable for example, for leave or illness. Good guidelines are in place on one floor for the use of ‘As Required’ medications, especially those used for agitation. The guidelines are brief on the other floor; however examination of records show that these medicines are not being used excessively, and have only been used once or twice this year. It is recommended that more detailed guidelines for “as required” medicines are place for all residents. Over the counter remedies for minor ailments such as headaches are still not kept in stock, although the GP has now signed an authorization letter allowing the home to keep them if they wish to do so. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is evidence that the service is listening to residents and acting on their complaints and concerns. Potentially abusive situations are recognised and the managers take the correct action to protect residents. The records should be better so that there is better evidence of how complaints have been investigated and what the outcome is for the complainant. EVIDENCE: The complaints procedure is satisfactory and it is available in a pictorial format, making it easier to understand. Residents who commented said that if they had a complaint they would raise it with the manager and staff. A relative said she knew what to do if she had any concerns and would talk to the manager or staff. Some residents attend ‘house’ meetings. These are opportunities for residents to talk about the home and raise issues or concerns, and for them to be discussed and resolved informally. There are two recorded complaints since the last inspection in September 2008. One is from daycentre staff who complained that a resident had been collected late by home staff. A series of emails is printed with this and these emails show that the complaint was substantiated, although records available Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 22 do not clearly indicate an outcome of the invetsigation. This must be addressed. Residents have made complaints that have resulted in safeguarding investigations, as the issues they raised have indicated possible abuse. These matters have been referred to the local authority (Lambeth) as required by safeguarding protocols. The provider has taken appropriate disciplinary action as necessary although the records kept in the home are inadequate and there is no indication as to whether the complainant was given feedback about what had been done. The managers should keep better records. Residents need assistance to manage their financial affairs and to look after their money. Each resident requires slightly different support based on the need to allow personal preference and as much independence as is safely possible. All money held in safe keeping is stored in a locked safe and the home manager has responsibility for holding the key. Staff have access to a petty cash system that gives them limited access to funds belonging to residents. Records are kept of both systems of safekeeping. Receipts are retained for any money spent on behalf of a resident or where staff support has been required. A spot check showed receipts were accurate and available as recorded. As required in the previous inspection report, valuable items and documents held in safekeeping are now recorded (cheque books and bank cards). A spot check of cash balances and associated records showed that the records are accurate. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally clean and tidy but more must be done to ensure environmental safety and accessibility. EVIDENCE: The home is situated in a residential area close to open space, shops, leisure facilities and public transport links. There is off road parking and a large garden. The home is divided into three units; each with it is own entrance. The units are situated on each of the three floors of the home. Each unit is staffed independently. There is ramped access to the ground floor entrance. It is noted that a waste pipe is overflowing onto the ramp. This is hazardous and will be even more Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 24 dangerous in freezing temperatures as the water will freeze and make the ramp slippery. This must be fixed. There is a large front garden, but there is limited access to this garden for people who use wheelchairs. Bathrooms on the ground floor are suitable for people with mobility needs and walk-in showers, shower chairs and a parker bath are available. Accessibility is an issue in the ground floor kitchen area. An Occupational Therapist assessed the premises and has produced a report identifying how the kitchen can be made fully accessible. Some improvements were made as a result, for example, the kitchen work surface is larger and accessible to people who use wheelchairs and dining tables are of an appropriate height for people who use wheelchairs. During the last inspection it was noted that an automated door providing access to the kitchen/diner was broken. A requirement was issued. This is now repaired. The first floor unit is poorly ventilated with little airflow; this causes high indoor temperatures on warm days that are uncomfortable for residents and staff. A recommendation from the previous inspections has not been implemented and is repeated in this report. The Local Authority Behaviour Support team have provided advice for how a resident can be assisted safely in the first floor kitchen and encouraged to become involved in the preparation of meals and snacks. This advice includes changing the type of cooker in use or fitting it with a protective cover (the cooker has ceramic plates). The middle floor kitchen has had some minor repairs and bedrooms on this floor have been redecorated. An ensuite bathroom had a bad smell at the last inspection and this has been addressed. Another bathroom is due for refurbishment. The second floor has a small kitchen. There is damage from smoke evident around the cooking area and ceiling. This was noted at the previous inspection and requirement issued. The requirement is repeated. The home manager said that the central heating has been repaired, as required in the previous inspection report. A broken window on the stairway to the top floor has also been repaired. The registered provider has recognised the need for staff on the first and second floors to have a confidential office area and a vacant bedroom is currently being used as an office. This means that the home does not currently Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 25 have the twelve bedrooms it is registered to have. There are currently only eleven bedrooms designated for the use of residents. The area manager attended the inspection and said that they are considering an alternative location for the office, in a large hallway area. During a tour of the premises I noted the following: • One ground floor resident has a badly stained carpet • A wet room drain cover is missing, this is trip hazard • There is damp damage in an en-suite bathroom on the ground floor • Some of the fire doors had missing intumesce strips and large gaps around the door that would allow smoke to travel easily through the building The area manager attended the inspection and quickly arranged maintenance staff to repair the fire doors. Internal health and safety checks of the environment should have picked up the faulty doors and missing drain cover, but did not. These internal environmental safety checks must be improved so that people are safe. Many repairs have been reported but not actioned. The company uses its own team of maintenance staff. Staff commented that repairs and maintenance issues are addressed too slowly. Staff have PPE (Personal Protective Equipment), such as gloves and aprons and there is a clinical waste contract for safe disposal of clinical waste. . Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are still concerns that there are not enough staff on duty at certain times of the day, for instance during the mornings when people need assisted personal care. There is a staff training and development plan in place although induction training has not been done properly and there is inadequate evidence of thorough staff recruitment checks. Staff would also benefit from additional training in communication. EVIDENCE: There are both male and female support staff working at the home. There are two teams, one for the ground floor and one for the first and second floors. Each team has a deputy manager and there is one overall home manager. The home also has an area manager and input from a non operational quality assurance officer. A resident said, Staff are brilliant! Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 27 Only four members of staff have achieved a vocational qualification in care (NVQ at level 2 or above). A further 20 of the staff team are currently undertaking the qualification. During the last inspection there was evidence that staffing levels were too low for the work that needed to be done. The staffing levels were increased. The resident population, and their needs, have changed and this means that the staffing levels are changing also. Some residents also have one to one staffing arrangements for specific needs and support. The ground floor is difficult to staff as residents need staff to assist the with personal care tasks, such as bathing. This means that a sufficient number of staff of the correct gender must be available at the right time. One member of staff is a driver and he is usually busy dropping people to daycentres and classes. At the last inspection we issued a requirement for the service to ensure that there are always a sufficient number of staff on duty. During this inspection it is clear that daytime staffing levels are increased (from 2 to 3 on the ground floor) but may still be too low at busy times, like in the morning. I recommend that staffing levels be reviewed on the ground floor. A staff-training programme is in place. I noted that the supervision matrix is rather long for such a small service. Support workers are supervised by senior support workers, seniors are supervised by the deputies and the manager supervises the deputies. As support workers have key working responsibilities it is important that they have an opportunity to discuss their role and get advice and support to develop their key working. A shorter matrix would keep managers better appraised of issues relating to each resident. This is recommended. I looked at records relating to recent staff recruitment. Recruitment is handled by a team at a head office who send the recruitment records to the home when a new member of staff is taken on. I noted that for one new member of staff there is no photograph, no record of a POVA check number and no information about references. This is unacceptable. I spoke with a new member of staff about her induction training. She said that she had been given an induction work book but had only completed two weeks of it with a deputy manager. The induction record is incomplete. This is unacceptable as it does not provide evidence that new staff have been given the necessary training and support that they need for them to do their jobs properly. Better induction is required. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 28 It is noted that some of the residents have communication needs and would benefit from a more communicative environment. Staff need training in sign language for people with a learning disability (Makaton) and broader communication skills training. This is recommended. We received the following comments from staff: • • • Staff should better understood their responsibilities and value the people we are looking after Staff should always speak English around service users and colleagues Staff need to work as a team and respect each other in a professional way. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Frequent changes in home management may have affected team morale which appears to be low. More should be done to ensure clear and fair leadership and good team working. The home still does not have a registered manager. Quality assurance systems have improved. Record keeping and environmental safety monitoring must also be improved. EVIDENCE: The new home manager has been in post for over twelve months but has yet to complete registration with the Commission. The service has no registered manager at this time. The home manager said he is in the process of applying. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 30 Comments from staff indicate that there is a need for team building and development work. For example, When staff are not happy and feel as though they are being bullied they dont get the right spirit to do their job and this can result in poor practices which lead to adult protection cases. We need to build the team spirit as at the moment there is no teamwork. And, The home could get better by boosting the staff morale and strengthen the team spirit. Staff are not treated fairly and this does not help to move the home forward. And, Staff should be supported equally. The area manager conducts regular visits to the service in accordance with Regulation 26. These are mini-inspections that provide the home manager with feedback about the running of the home. Copies of the reports are available in the home. There is a new Quality Assurance team in place and the home has been assessed recently. These assessment reports are more detailed and cover national minimum standards. This could be a useful tool for the home, which has struggled to meet minimum standards for a number of years. Records relating to care planning, risk assessement, recruitment, complaints and healthcare are inadequate and must be improved. Ensuring appropriate records are in place is a management responsibility. Ensuring the building is safe is also a management responsibility and monitoring must be improved to ensure that residents, staff and visitors are kept safe from fire and other hazards. Managers and staff would benefit from training in the new Deprivation of Liberty Safeguards because they must understand the implications for day to day service delivery and their responsibilities in ensuring that people are not deprived of their liberty unnecessarily. The home does not have email facilities, and professionals involved have often commented that communication could be improved or no one answers the telephone. Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 31 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 2 2 2 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 1 2 x X 2 X Version 5.2 Page 32 Garrards Road 25 DS0000065068.V376954.R01.S.doc 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 YA2 Regulation 14(1)(d) Requirement The home must confirm that it can meet the needs of any prospective resident by sending them a letter indicating the outcome of the pre-admissions assessment. The registered manager 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. Staff must enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service user’s individual Plan and of the home’s risk assessment and risk management strategies. Health care plans must be in place for all residents. DS0000065068.V376954.R01.S.doc Timescale for action 31/12/09 2 YA6 15 31/12/09 3 YA9 13(4) 31/12/09 4 YA19 12 31/12/09 Garrards Road 25 Version 5.2 Page 33 5 6 YA19 YA20 17 13(2) There must be a record of the outcome of all healthcare appointments. All staff must be trained to administer all prescribed medications (new medication for a resident who experiences frequent and prolonged seizures) A water leak must be repaired as it is discharging water onto the front door entrance ramp and this is a slip hazard. There must be better monitoring of the safety of the home environment, for example, regular checks on the integrity of fire doors. A missing wet room drain cover must be replaced to prevent falls. 31/12/09 31/12/09 7 YA24 23 30/11/09 8 YA24 23 30/11/09 9 YA24 23 30/11/09 10 YA35 18 30/11/09 All staff must receive structured induction training to Skills For Care Standards. Training must include training on the principles of care, safe working practices, the organisation and worker role, the experiences and particular needs of the resident group and any other requirements of the service setting. The registered person must ensure that there are records that show that the company operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. Areas of décor damaged by smoke and water must be repaired (ground floor, first floor DS0000065068.V376954.R01.S.doc 11 YA34 19 30/11/09 12. YA24 23 31/12/09 Garrards Road 25 Version 5.2 Page 34 and second floor). Although there is some progress, this previous requirement remains unmet. 13. YA24 2316 A kitchen on the first floor must be refurbished. Although there is some progress this previous requirement remains unmet. 31/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 Good Practice Recommendations A copy of the most recent Commission inspection report should be added to the guide. This should be done to ensure that prospective residents and their families and friends have an independent view to consider when choosing a care home. The cost of any extras, such as, the cost of using the company mini-bus, should be added to the guide. Residents should be advised of local and/or national advocacy services and peer support groups. Residents may want to find out more about safe sex and sex in general. This should be decided on an individual basis in conjunction with the resident and their local authority care manager and a referral to a suitable external resource made if necessary. There should be a register for Controlled Drugs. There should be clear guidelines for when all As Required Medications should be administered. There should be better records about complaints made, DS0000065068.V376954.R01.S.doc Version 5.2 Page 35 2 3 4 YA1 YA7 YA15 5 6 7 YA20 YA20 YA22 Garrards Road 25 any actions taken to investigate and the outcome. 8 YA29 The registered persons should change the type of cooker in use on the middle floor kitchen or provide a safety cover to prevent residents touching hot ceramic plates. The registered persons should takes steps to increase the ventilation on the first floor to prevent high temperatures on hot days and to make the unit a more comfortable living area. Staffing levels should be reviewed to ensure that there are a sufficient number of staff of the correct gender available to provide support with personal care, especially on the ground floor where people have greater physical needs. The supervision matrix should less complicated and should be reviewed to ensure that staff receive appropriate supervision and feedback about their key working role and performance. All staff should be confident that they understand the new Deprivation of Liberty safeguards. Staff and managers should have access to the internet and email. More staff should undertake a vocational qualification in care (NVQ at level 2 or above) and all staff involved in meal preparation should be trained in food hygiene. 9 YA24 10 YA33 11 YA36 12 13 14 YA35 YA37 YA35 Garrards Road 25 DS0000065068.V376954.R01.S.doc Version 5.2 Page 36 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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