Inspection on 09/01/08 for Garrards Road 25

This inspection was carried out on 9th January 2008.

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 no outstanding requirements from the previous inspection report, but made 10 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 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 08/07/2008.

CARE HOME ADULTS 18-65 Garrards Road 25 Streatham London SW16 1JS Lead Inspector Sonia McKay Unannounced Inspection 9th January 2008 10:00 DS0000065068.V352196.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 DS0000065068.V352196.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. DS0000065068.V352196.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 joanbone@caretech-uk.com Caretech Community Services Amanda Jane Turner Care Home 12 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places DS0000065068.V352196.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 May 2007 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 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 behaviours that challenge. There are currently four people living in this part of the home. 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 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. DS0000065068.V352196.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 over two days by one inspector. The methods used to assess the quality of service being provided include: • • • • • • • • • • • • Discussion with the registered manager Examination of the Annual Quality Assurance Audit document completed by the registered manager (this document is sometimes called an AQAA and it provides the Commission with information about the service) Discussion with people currently living in the home Observation of the care and support they receive Discussion with a visiting health professional Discussion with an advocate for one of the residents Discussion with staff working in the home A tour of the premises Examining records of the care provided to four of the residents Examining records relating to staff recruitment and training Examination of the way medicines are handled by staff in the home Consideration of the feedback from placing authority social workers, advocates and the registered provider, Caretech, who have been meeting regularly with the Commission and the Local Authority Safeguarding Adults Chair, since the last key inspection in May 2007 to monitor service safety and improvement The Commission would like to thank all who kindly contributed their time, views and experiences to this inspection process. What the service does well: Systems are in place to keep residents safe in their home environment. Prospective residents have the information they need to make a decision about whether the home is right for them and they have an opportunity to visit and ‘test drive’ the service before making a decision to move in for a trial period. Residents who are more able and can communicate verbally can make decisions about their everyday lives and life plans, and these decisions are respected where possible. Staff recruitment provides residents with adequate protection. DS0000065068.V352196.R01.S.doc Version 5.2 Page 6 The home is locates in a residential area and is close to service, shops, leisure facilities and public transport routes. There are opportunities for residents to attend college and work placements in the area and some residents are actively involved. People living in the home can maintain their close personal relationships and see their friends and family as they wish. Systems and environmental checks are in place to keep residents safe in their home. All bedrooms are single occupancy and most have en-suite bathrooms. What has improved since the last inspection? The registered manager is experienced and qualified and there is improvement in the management and monitoring of the service. The registered provider is doing more to assure that residents receive a quality service. There is progress in developing the team to better meet the needs of people with complex and/or challenging behaviour. There is improvement in the way that care plans and goals are documented, and person centred planning is in the early stages of development. Risk assessments provide staff with clearer information about keeping people safe and a wider range of risk areas have been considered. There is progress in developing the team skills in using the assistive communication techniques necessary to effectively communicate with and offer choice to people who are less verbal or able. Residents are happy with the food and improved facilities allow people to take part in some aspects of meal preparation. There is better information available to staff about how each person wishes and needs to be supported in maintaining their personal care. The registered provider and manager have worked to improve the levels of protection given to residents and staff are better trained to take appropriate action when abuse of any sort is suspected. There is progress in developing a training programme that is in accordance with the stated aims of the service. DS0000065068.V352196.R01.S.doc Version 5.2 Page 7 More staff are trained in assessing risk and in infection control. The handling of medication has improved and more is done to make sure that staff are adequately trained and competent. The manager is now registered with the Commission. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000065068.V352196.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 DS0000065068.V352196.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make a decision about whether the home is right for them and they have an opportunity to visit and ‘test drive’ the service before making a decision to move in for a trial period. There is also progress in developing the team to better meet the needs of people with complex and/or challenging behaviour. EVIDENCE: There is an informative Statement of Purpose and Service Users Guide. The Service Users Guide was reviewed in September 2007 and has been revised. It now has better information about the fees and what elements of care and support they are for, in accordance with recent changes in legislation, and as required in the previous inspection report. The guide is produced in an ‘easy to read’ format, using plain English with photographs and pictures to make it more accessible to people who may find ‘text only’ documents difficult to understand. The guides now also include the individual contract arrangements for each person living in the home. DS0000065068.V352196.R01.S.doc Version 5.2 Page 10 There is a process for assessing the needs of individuals referred to the service. Resettlement staff at the CareTech central office request a copy of the Local Authority care needs assessment, care plan and any specialist assessments. If the central office identifies a vacant placement in a suitable CareTech service, a CareTech resettlement officer and the home manager then visit the person referred and complete their own care needs assessment. The person referred is given an opportunity to visit the service to experience life in the home and to get to know the staff and residents. When a new person moves into the home there is a three-month trial period after which the suitability of the placement is reviewed. The Registered Provider agreed to restrict admissions to the home as part of an improvement strategy being monitored by the Commission and the local authority. This gave the new registered manager an opportunity to work on team training and development. Improvement was such that this voluntary embargo was lifted on the ground floor of the home in the later part of 2007; this allowed places to be offered to people with a physical disability. The Lambeth Learning Disability Partnership undertook an audit of the complex needs service in late 2006 and produced a report in January 2007. The report’s findings were that there were a number of areas where action was required. These included: the need for a consistent staff team; the need for staff support, training and supervision; the need for staff to understand challenging behaviour; the need to assess and manage risk appropriately; and, to implement individually tailored support and planning for each resident. A training and development plan is now in place to ensure that staff are appropriately trained to meet the needs of people who have more complex needs and behaviours that can be challenging. This team development is being monitored by The Lambeth Learning Disability Partnership who advise staff on how best to work with people who have complex psychological needs. The Partnership team are currently repeating the audit of the service’s capability of meeting the needs of people with challenging behaviour and complex needs. The findings of this audit will be shared with the Registered Provider, Caretech, and the Commission as part of overall monitoring of an improvement strategy. Initial feedback from a health professional conducting the audit indicates a level of service improvement. There has been one admission to the ground floor unit of the home since the last inspection visit. Examination of documentation available indicates that the person’s needs had been assessed appropriately before the placement was offered. There had also been an opportunity for the person to visit the service before making a decision to move in for a trial period. DS0000065068.V352196.R01.S.doc Version 5.2 Page 11 A placement review has taken place and a copy of the initial review meeting indicates that the placement is suitable. There is also evidence that the actions advised during the review are being progressed by the home manager and staff in the home. DS0000065068.V352196.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is improvement in the way that care plans and goals are documented, and person centred planning is in the early stages of development. Risk assessments provide staff with clearer information about keeping people safe and a wider range of risk areas have been considered. Residents who are more able and can communicate verbally can make decisions about their everyday lives and life plans, and these decisions are respected where possible. There is progress in developing the team skills in using the assistive communication techniques necessary to effectively communicate with and offer choice to people who are less verbal or able. EVIDENCE: Records and plans relating to two of the people living on the ground floor and of two of the people living upstairs were examined during this inspection. DS0000065068.V352196.R01.S.doc Version 5.2 Page 13 Each resident has a set of written plans and assessments that are put in place to enable staff to deliver care as required by the individual. There is progress in developing written plans that are centred on people’s strengths, needs and current goals. There is more information about people’s cultural and faith needs, as required in the previous inspection report. There is also evidence that the progress in achieving any identified goals is reviewed on a regular basis. Files containing these documents are better organised and current information is easier to find. This makes the information more accessible to staff on duty. Plans include individual support guidelines around a range of areas pertinent to the individual and their specific needs and lifestyles. There is also information about people’s likes and dislikes. A person centred plan is in the early stage of development for one resident on the ground floor and is described as ‘aspirational’ in review notes. However, discussion with the resident about her future plans indicates that some, including plans for overseas travel, are progressing well. The home manager said that there are also plans for a Caretech residents group to assist the provider in developing a more accessible and person centred system for planning care. This includes using computer software and photographs to make care planning documents more accessible to people with a learning disability. Some of the residents have an advocate. Advocates are involved in planning with and representing the views of individual residents in meetings and reviews. One of the advocates commented that things seem to have improved in the running of the home. The AQAA (Annual Quality Assurance Audit) notes that all residents are entered on the electoral role and can vote if they wish. Residents have ‘one to one’ time with their key worker each week and there are also residents ‘house’ meetings. The outcomes of these meetings are sometimes recorded. These meetings are an opportunity for people to be consulted about how things are going in their life and in the home. Observation of staff and resident interaction during this inspection indicates that staff offer choice around everyday decisions such as meals and local excursions. There is some progress in developing tools that aid consultation. With input and advice from professionals involved, a series of photographic journals are being developed to make it easier for residents to make choices about what to DS0000065068.V352196.R01.S.doc Version 5.2 Page 14 do each day, to understand the order of events and to know which staff will be on duty to provide support. This will benefit residents living in the home by increasing the opportunities for consultation and decision-making. People who live in the home receive varying levels of support with managing their personal finances. A requirement was made to ensure that the nature of the support required be fully documented. During the last inspection it was noted that initial drafts of each person’s financial support needs were in place, but were in need of further review and development. Individual financial arrangements are now properly documented and are reviewed with residents and placing authority social workers during placement review meetings. This ensures that there is consideration of balancing financial independence with a need for support and protection from financial abuse. To be an effective safeguard there must be ongoing review. During the last inspection it was noted that there was insufficient assessment of risk. A requirement was made for action to be taken. The home manager has reviewed the individual risk assessment documents in place for each resident, and additional assessments have been undertaken to cover the shortfalls identified during the previous inspection. There are assessments of the risks relating to each persons needs, lifestyle and support. This includes the assessment of risks relating to physical and emotional need, health conditions (including tissue viability), skills development, activities, behavioural support and moving and handling tasks. The risk assessments examined are comprehensive and have been subject to regular review. The requirement is therefore met. An overall risk assessment audit tool is not available. This would assist key staff by giving them a list of areas to think about when considering risks to individuals. Again, to be an effective tool in keeping people safe and promoting independence, there must be ongoing review of risk. (See recommendation 1) DS0000065068.V352196.R01.S.doc Version 5.2 Page 15 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): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are opportunities for residents to attend college and work placements in the area and some residents are actively involved. Staff support residents to engage and a variety of leisure activities and there is better planning for how this can be done safely. People living in the home can maintain their close personal relationships and see their friends and family as they wish. Residents are happy with the food and improved facilities allow people to take part in some aspects of meal preparation. The current facilities are not suitable for people who are able to cook independently, and provide current residents with limited opportunity for skills development. EVIDENCE: The seven people currently using this service are involved in a variety of daytime activities; these include attending day centres, college courses and supported employment training. DS0000065068.V352196.R01.S.doc Version 5.2 Page 16 Each person requires staff support to go out in the community. The home has two house vehicles that are wheelchair accessible to assist with transportation and a driver is usually on duty each day. Use of the vehicles has to be carefully planned to ensure that each resident attends planned appointments and activities. Staff support residents to take part in community based leisure activities that include swimming, trips to the seaside and other places of interest such as cinemas, pubs and clubs. The home manager said that holidays were not organised in 2007, because of a large amount of staff change during service improvements and restructuring. During the course of the inspection residents were observed to be involved in a range of activities that included attending a college course, personal shopping, going to an evening social club, garden games and watching television. Group outings are discussed and decided upon during residents meetings. A resident said, “ The best thing about living here is I can do my own thing. Chill out in my room or watch DVD’s”. The resident also uses the dial-a ride taxi service to go out to restaurants with a friend and is planning a holiday abroad. The resident is being encouraged to increase the amount of structured activity she undertakes and staff are assisting her to look at possible college courses. Another resident complained of being bored and wanting to move to a home where she could go out more often. Some residents have behaviours that challenge their community presence and staff working with people living on the top two floors must follow specific guidelines for using community facilities. This involves careful selection of venue and planning. It also involves effective communication, and ongoing assessment of risk and mood. There is evidence that staff are now selected with these skills in mind and there is a suitable training programme in place. During previous inspections it was noted that staff were anxious about community access and the possible dangers that residents and staff were exposed to. Feedback indicates that staff are now better trained and are becoming more confident. Residents visit their family and friends and their relatives also visit the home. People also keep in touch by telephone. Another resident said that he was looking forward to going away for the weekend to be with his family. Visitors are welcomed and some residents maintain relationships with family and friends by visits and telephone calls. DS0000065068.V352196.R01.S.doc Version 5.2 Page 17 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. Staff are working with day provision to accommodate some residents who have lengthy morning routines that sometimes make them late for their planned day service. 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. The majority of residents go out with the support of staff or a relative. A keypad door opening system provides additional security. Residents are encouraged to take part in household chores such as cooking, shopping and tidying up their bedrooms. During the inspection one resident was making herself some breakfast before going out to local shops with a member of staff. 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 prepare these meals themselves. Meals are nutritionally balanced and reflect the cultural needs of the residents accommodated. Food stocks were ample and contained fresh produce that was stored and labelled correctly. A record is kept of what each person eats, and for some this includes recording timely snacks, as part of a behaviour management strategy. A record is also kept of what people weigh. Residents are encouraged to eat healthy meals and appropriate advice is taken in regard to reduction diets where necessary. Residents who commented said that the food was “alright” or “good”. Another spoke of enjoying helping to bake cakes with staff. The ground floor kitchen/dining area has improved accessibility for people using a wheelchair. There is a larger accessible work surface. One resident said that this made it much easier for her to prepare food. Main kitchen appliances (cooker, sink and fridge) are not accessible to people who use wheelchairs, so the kitchen is not currently suitable for people who can cook independently. It also limits opportunity for the skills development of current residents. Advice has been sought from an occupational therapist on how accessibility can be improved, and the registered manager says that residents who are independent in this area will not be offered a place in the home until/unless accessibility is improved. DS0000065068.V352196.R01.S.doc Version 5.2 Page 18 The middle floor kitchen door was being kept locked by staff as a ‘safety’ measure. This was causing one resident to become anxious and all the more keen to gain entry. It also prevented the other resident from using the kitchen when he wished. The kitchen is now kept unlocked and this means that residents can go in and out of the kitchen at any time. This is an improvement. DS0000065068.V352196.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is better information about how each person wishes and needs to be supported in maintaining their personal care. Physical and emotional needs are being met, although more must be done to ensure that resident’s views are better integrated into the healthcare planning systems used by staff. EVIDENCE: Residents require varying levels of staff support to maintain their personal grooming. This ranges from full support to verbal prompting. Personal care is provided in private, either in bedrooms or in bathrooms. Staffing is planned to have both male and female staff are on duty to provide ‘same gender’ support. There are currently three female residents living on the ground floor and four males residents living upstairs. Guidelines for how each person wishes to be assisted with washing and bathing are in place. Observation and discussion indicate that residents receive DS0000065068.V352196.R01.S.doc Version 5.2 Page 20 appropriate with their personal care and dressing. Written plans for how personal care is to be given are more detailed, as required in the previous inspection report. This is an improvement, although it is noted that the finer details of a personal care routine for one new resident must be revised to ensure that known preferences are fully accommodated (guidance from a previous placement about the need to comb a persons hair during conditioning to prevent knots and discomfort had not been carried forward into the personal care plan). (See recommendation 2) One new resident has extensive physiotherapy needs that are currently being addressed at college. The staff in the home are expected to play an increasing role in assisting the resident to complete exercises. During the inspection it was noted that some staff were keen to assist the resident in this area and the resident was noted to be enjoying a period of hoisted suspension from her wheelchair with a cooling fan and a period of time relaxing on a large bean bag listening to music and interacting with staff. Other staff were less confidant and thought that physiotherapy was being done at college. This must be clarified so that the transition period is smooth and to ensure that the resident’s physiotherapy needs are being met. It is also important for staff to be trained and confident in each routine required. (See requirement 1) There is a designated key worker system in place, although changes in staffing have resulted in frequent changes. On occasions when additional staff are required they are supplied via an agency or a bank system. All residents are registered with a local GP practice and each resident has a document called a Health Action Plan. These are easy read documents that are more accessible to people with a learning disability. Residents are encouraged to own and complete these documents with support from staff. This is good practice. Documents seen are at different stages of completion. There is up to date contact information about who is involved in each person’s health care. Staff maintain a record of each persons healthcare needs and the outcomes of any appointments. These records are now better organised making it possible to track each persons healthcare. Records indicate that residents attend a range of health checks and hospital appointments. All are registered with a dentist and an optician. There is a need for better integration of the person centred health action plans with existing health planning and recording systems, to avoid confusion, replication or omission, and to ensure that the health action plans are subject to regular review. (See requirement 2) DS0000065068.V352196.R01.S.doc Version 5.2 Page 21 Each floor of the home has a lockable medication storage area. The temperature is checked and recorded on a regular basis. Recordings indicate that medications are stored within safe temperatures. During the last inspection a member of staff identified a problem with medications stock tallies on the first floor of the home. The home manager undertook an audit of ground floor stocks and records and also identified errors. The manager has since conducted regular justified stock checks and errors have reportedly reduced as a result. Examination of medication stocks and records on the ground floor of the home indicate that: • All prescribed medications are in stock • Medication Administration Records are up to date with no gaps in signature recording • Examination of medication stored in blister packs correlated with records of medication administration, indicating that medication is being administered at the correct time • Justified stock checks happen regularly and the results are recorded A requirement made in this regard is therefore met. There has been one significant error in medication administration by staff since the last inspection. A member of staff administered the wrong medication to a resident. Emergency advice was sought and the resident suffered no ill effects. This prompted a disciplinary investigation and a review of how ‘As Required’ medication is stored. It is noted that all of the information relating to the use of ‘As Required’’ medication is available, but it is not available on a single document in medication administration records. For example, some of the PRN (As Required) guidelines available in the medication administration records do not state the dose to be taken or the maximum number of doses to be taken in 24 hours. Copies of the guidelines that have been seen and signed by the GP are kept elsewhere. A list of staff trained to administer the PRN is held, but not in the medication administration file used on a day-to-day basis by staff. Information about the safe use of ‘As Required’ medications, when they are to be administered, who can authorise use (in cases of medication being used to manage challenging behaviour or anxiety) and who is trained to administer must be clearly and readily available in medication administration records to ensure resident safety. (See recommendation 3) It is also noted that the application of prescribed dressings that prevent skin damage for one resident with a physical disability are no longer being recorded in medication administration records. There are adequate supplies of the dressings available. The home manager investigated and found out that the DS0000065068.V352196.R01.S.doc Version 5.2 Page 22 use of the dressings was being recorded in daily notes instead. This is not ideal as it does not act as a prompt or accurate record of the days and times that the dressings are changed. (See recommendation 4) Staff do not administer medication until they have bee trained and assessed as competent. Evidence of individual training and competence is held on file, as required in the previous inspection report. Home remedies are not kept in stock. (See recommendation 5) DS0000065068.V352196.R01.S.doc Version 5.2 Page 23 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. 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. There is improvement in the way that the home responds to peoples concerns and complaints, although more must be done to ensure that people get feedback quickly. The registered provider and manager have worked to improve the levels of protection given to residents and to take appropriate action when abuse of any sort is suspected. EVIDENCE: There is a clear record of complaints made about the service. The home manager has maintained a central log and individual records of how each concern or complaint has been dealt with. This is an improvement as during the last inspection, not long after the manager joined the team, adequate records were not available. Requirements made as a result included a requirement for better record keeping and a summary of complaints information for the 12 months preceding the inspection. A summary was supplied but the registered manager was unable to find out how many complaints had been resolved. The complaints procedure is available in a pictorial format, making it easier to understand. Two residents who commented said if they have a complaint they are comfortable to raise the issues with the manager or staff. DS0000065068.V352196.R01.S.doc Version 5.2 Page 24 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. The AQAA (Annual Quality Assurance Audit) states that there have been twenty complaints in the last twelve months. Seven complaints have been upheld. Only 80 of the complaints have been resolved within 28 days. A sample examination of records relating to how a complaint is investigated indicates that the home manager takes appropriate action and provides adequate feedback to the complainant, although this has not always been achieved within the required 28 days. (See requirement 3) There have been six safeguarding adults investigations. During these investigations the registered provider has taken appropriate action to safeguard residents during the investigation by suspending staff if necessary. The outcomes of these investigations have included appropriate disciplinary proceedings against staff and dismissal in some cases. The Local Authority Safeguarding Adults team have provided the staff team with additional training in safeguarding vulnerable adults and have chaired regular meetings to monitor the improvement of the service. It is noted that although this still a large number of adult protection concerns, this is a reduction on the number in the twelve months preceding the last inspection. Comments from professionals indicate improved communication from the service and the home manager has been notifying the local authorities and Commission when an incident, allegation or accident occurs. Notifications have been made in a timely manner. Staff are trained in non-violent crisis intervention. There have been six incidents of challenging behaviour in the last twelve months when restraint has been used. Prior to the last inspection there were concerns from professionals that the staff training provided did not sufficiently focus on developing staff understanding of the function of behaviours in order to prevent them. A revised and increased training programme was then developed, and is still underway at the time of the inspection. Initial feedback from a health professional involved indicates that there is a marked difference in staff performance and evidence of progress. The staff team were described as “More understanding and responsive, with a better sense of why what they do is important. Their approach is more consistent. There is better planning going on and effective management of the service”. DS0000065068.V352196.R01.S.doc Version 5.2 Page 25 During this visit it is noted that individual arrangements to help protect resident from financial abuse have improved. Arrangements to safeguard the cash balances held on behalf of two resident were checked. All money held in safe keeping is stored in a locked safe and the home manager has responsibility for holding the key. Resident’s request cash and a record is kept of money taken. It is noted that valuable documents held in safekeeping are also accounted for and stored in the safe. This provides residents with adequate safeguard from financial abuse. An expensive personal item was lost/stolen from a resident. It is unclear when the item went missing (possibly during 2006). A police investigation was inconclusive and the registered provider has agreed to refund the cost of replacing the item (a laptop). Residents are now given appropriate assistance to safeguard their valuable property and to keep appropriate, up to date and sufficiently detailed inventories. DS0000065068.V352196.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 & 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, the ground floor communal kitchen and garden are not fully accessible to people with a physical disability. 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. During a tour of the premises it was noted that the home is clean and hygienic, with plenty of soap and hand towels available in bathrooms. Only one area of the home had an unpleasant odour. A bedroom has been damaged by a water leak from the roof and there is an unpleasant odour of damp. The occupying resident has moved to another vacant bedroom. DS0000065068.V352196.R01.S.doc Version 5.2 Page 27 The leak has been reported and the manager said that the bedroom would be repaired once the leak is fixed. There is ramped access to the ground floor entrance and a large, but poorly maintained, front garden that is not wheelchair accessible. This means that residents living on the ground floor who use wheelchairs cannot access the garden. 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 kitchen area. An Occupational Therapist assessed the premises and has produced a report identifying how the kitchen can be made fully accessible. Some improvements have been 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. An automated door providing access to the kitchen/diner is currently broken. This makes it impossible for residents to open the door. (See requirement 4) A copy of the Occupational Therapists report and action plan and progress report must be supplied to the Commission. (See requirement 5) 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. (See recommendation 6) The Behaviour Support team have provided advice for how a resident can be assisted safely in the 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). (See recommendation 7) One of the resident’s bedrooms on the first floor is unoccupied as there is a vacancy. The registered provider has recognised the need for staff to have a confidential area and the bedroom has been turned into an office for staff working on the first and second floors of the home. This means that the home does not have the twelve bedrooms it is registered to have. There are currently only eleven bedrooms designated for the use of residents. DS0000065068.V352196.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is progress in developing a training programme that is in accordance with the stated aims of the service, but more staff must attain a nationally recognised qualification in care. Staff recruitment provides residents with adequate protection. EVIDENCE: There are significant changes in the staff team. 15 members of the team have left employment in the home in the last twelve months. There has been emphasis on training the team members to understand and meet the needs of residents with complex and challenging needs. A training programme for the home now includes a range of training from the Local Learning Disabilities Partnership. The training undertaken by staff in November 2007 was to address skills and training shortfalls identified in an audit of the capability of the service in meeting the needs of people with a learning disability whose behaviour may be challenging to provision at times, autism and communication needs. DS0000065068.V352196.R01.S.doc Version 5.2 Page 29 Feedback from a health professional involved in assessing the capability of this part of the service is positive. “There is a marked difference. The team are more understanding and responsive. Team morale is better and team members have a better understanding of their roles and the importance of what they do”. The home manager provided up to date staffing information during the inspection. There are currently 19 support workers. Five have attained a vocational qualification in care at NVQ level 2 or above and four are currently working towards the award. The home manager is contacting the Caretech training team to look at how standards can be improved in this area. (See requirement 6) During the last inspection it was noted that many staff had not been trained in infection control and risk assessment. Training logs indicate that there is significant progress in these areas and the requirements are met. The staff team includes both men and women and is reflective of the cultural diversity of the resident group and local population. There are currently five staff vacancies, with cover supplied by bank staff. There is a record of when staff work. These records indicate that staff have routinely covered double shifts in recent months. This means their working day is too long for them to be effective, especially if they are also working the next day. (See recommendation 8) DS0000065068.V352196.R01.S.doc Version 5.2 Page 30 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. 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 registered manager is experienced and qualified and there is improvement in the management and monitoring of the service. The registered provider is doing more to assure that residents receive a quality service, although this is still at an early stage and must be developed. Systems are in place to keep residents safe in their home environment. EVIDENCE: The registered manager has experience in a similar care setting, an NVQ 4 and the Registered Managers Award (RMA). There are now two deputy managers, one for each unit of the service. DS0000065068.V352196.R01.S.doc Version 5.2 Page 31 Observation of a senior staff meeting indicates that there is effective management and leadership. Feedback from two people who visit the service indicates includes an improvement in staff morale and the effective management of the service. There is also a new area manager, who visits the service each month in accordance with Regulation 26, to monitor the service on behalf of the registered provider. Copies of the outcomes of these visits are supplied to the registered manager and to the Commission. The reports produced are adequately detailed. There is a new quality assurance team in place and quality assurance systems are being developed. The home manager said that all stakeholders are being contacted to provide feedback about the service as part of this process. A full quality assurance assessment is due for completion in 2007. The outcomes of the quality assessment must be supplied to the Commission. (See requirement 7) There are a range of appropriate health and safety checks in place. This includes the regular checking of the home environment and professional testing of equipment in use at the home. COSHH materials are stored securely (substances hazardous to health, like cleaning and laundry products). Staff receive induction training in safe working practices and there is health and safety policy and procedure in place to provide guidance. The home is also inspected by the environmental health department and the London fire and emergency planning authority. Work is underway to address issues raised in a recent environmental health check. Fire evacuation procedures are posted and a fire risk assessment and fire evacuation plan are in place. Environmental risk assessments are conducted annually. DS0000065068.V352196.R01.S.doc Version 5.2 Page 32 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 2 4 3 5 X 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 2 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 X 2 X X 3 X DS0000065068.V352196.R01.S.doc Version 5.2 Page 33 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 12(1) Requirement The registered person must clarify the current physiotherapy needs of a new resident. Any physiotherapy support required of home staff must be clearly detailed in a care plan and staff must be sufficiently trained to safely undertake them. The registered person must ensure that residents individual Health Action Plans are reviewed alongside other documents relating to healthcare planning and recording. The registered person must, within 28 days after the date that a complaint is made, or as short as period as may be reasonable in the circumstances, inform the person who made the complaint of the action (if any) that is to be taken. The registered person must ensure that residents are able to open the kitchen door. The registered person must supply the Commission with: • An Occupational Therapists assessment of the home conducted on July 2007 DS0000065068.V352196.R01.S.doc Timescale for action 29/02/08 2. YA19 12 15 31/05/08 3. YA22 22 29/02/08 4 5. YA29 YA28 YA29 YA28 23(2) 23 16 29/02/08 31/03/08 Version 5.2 Page 34 6. YA32 YA35 18 7. YA39 24 An update on progress in achieving better accessibility • A plan for how and when full accessibility will be achieved The registered persons must ensure that staff attain a national vocational qualification in care at NVQ level 2 or above. A training plan for how this will be achieved must be supplied to the Commission by The registered persons must supply the Commission with a copy of the quality assurance report when it is completed. • 31/03/08 31/07/08 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 YA9 Good Practice Recommendations 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 person should review pre-admission assessment information obtained for a recently admitted resident to ensure that all of the detailed personal care guidelines are transferred to the current care plan. The registered person should rationalise all of the information relating to the authorisation and administration of ‘As Required’ medications. This information should be in one document in the Medication Administration Records, so that it is readily available to staff. The registered person should record the use of prescribed skin dressings in the Medication Administration Records. The registered person should take medical advice about suitable home remedies, such as analgesics. The registered persons should takes steps to increase the ventilation on the first floor to prevent high temperatures DS0000065068.V352196.R01.S.doc Version 5.2 Page 35 2. YA18 3. YA20 4. 5. 6. YA20 YA20 YA24 7. 8. YA29 YA42 YA33 on hot days and to make the unit a more comfortable living area. 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 manager should ensure that staff duty rotas do not routinely include double shifts, unless this is an emergency or unless a member of staff is required to undertake a specific activity that requires consistent all day support. Staff should also be consulted about their willingness to work a long day or double shift. DS0000065068.V352196.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000065068.V352196.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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