Inspection on 09/05/07 for Garthowen

This inspection was carried out on 9th May 2007.

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

Other inspections for this house

Garthowen 01/10/07

Garthowen 14/11/06

Garthowen 16/05/06

Garthowen 06/01/06

Garthowen 14/06/05

Garthowen 28/01/05

Garthowen 06/08/04

Garthowen 12/02/04

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

CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Sarah Middleton Unannounced Inspection 9th May 2007 09:45 Garthowen DS0000022889.V334453.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 Garthowen DS0000022889.V334453.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. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road Chiswick London W4 4QP 0208 995 9702 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) www.together-uk.org Together Working for Wellbeing Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2006 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is registered for twelve service users with mental health problems. The London Borough of Hounslow is the main purchaser and has blocked purchased seven of the bed places. The home is owned and managed by Together Working For Wellbeing. The accommodation has nine single bedrooms on the first floor. There is a selfcontained flat on the ground floor and two flats on the second floor. Service users who are ready to move on to more independent living use the latter. The lounge is a designated smoking room. The dining room can be used as a quiet area in between meals. There are no lifts in the building so it is only suitable for service users with good mobility. Service users are expected to participate in cooking, looking after their own laundry and helping with some domestic tasks around the home. After a settling in period, service users are expected to become more involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support service users to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Fees range from £560-£650 per resident per week. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The term “service user” has been replaced and the term resident will be used throughout this inspection report and refers to the people living in the home. This was an unannounced inspection carried out as part of the regulatory process. The inspection visit was from 9.45am-6.30pm. The Inspector viewed samples of residents’ files, staff files and maintenance records. Two residents and one care manager completed surveys. In addition, three residents, two members of staff and one family member were spoken with as part of the inspection process. Any relevant comments have been included into this inspection report. The Registered Manager has now left his position. The Deputy Manager assisted with this inspection and she has been asked to be the Manager Designate from the 10th May 2007 on a temporary basis until the position is filled permanently. As the Deputy Manager had not started officially as the Manager Designate, in this report she will be referred to as the Deputy Manager. The home considers equality and diversity issues and addresses them through the every day running of the home. The home has continued to make improvements with the support from staff, the Area Manager and Deputy Manager. All five of the previous requirements were met at this inspection and eight new requirements were made from this inspection visit. All of the Key Standards were assessed. What the service does well: Staff support the residents to be independent and the aim of the home is to encourage residents to make decisions about their individual daily lives. The home has managed well with the changes that have been taking place over the past few months. The staff team are committed to supporting the residents in a positive way. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The Statement of Purpose needs to reflect the current staff team and type of home the service is. The Deputy Manager needs to update this document as and when circumstances change. All residents’ needs must be met by the home. The home currently has a few residents who need to move on to various new placements. The home must ensure that it is the most appropriate place for each resident. Food items need to be checked by staff so that food is covered and stored appropriately when it has been opened. Resident’s health needs must be met by the home and by relevant health professionals. If a resident’s primary need is no longer mental health and the specific health need cannot be met by the home, then the placement must be reviewed. Staff must only record and sign for medication when they have administered it and seen the resident actually take the medication. There are ongoing maintenance issues around various rooms of the home that need to be addressed. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 7 Staff employment files need to contain all the required information so that during an inspection, appropriate checks can be made to ensure residents are safeguarded by robust recruitment procedures. The training programme needs to be available and provide staff with the knowledge and skills they need to support residents. 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. Garthowen DS0000022889.V334453.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 Garthowen DS0000022889.V334453.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 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Statement of Purpose did not clearly reflect the type of home that could offer a place to a resident and thus was not informative or accurate for a prospective resident. Prospective residents’ are assessed prior to moving into the home to ensure the home can meet their individual needs. Prospective residents have opportunities to visit the home prior to moving in so that they can make a decision about the home. EVIDENCE: The Inspector discussed the Statement of Purpose with the Deputy Manager as it had not been updated to reflect the current staff team neither did it make it clear about the type of home it is. The Inspector was informed that the home offers rehabilitation to residents and is not viewed as a long- term home. This has been an ongoing issue as a few residents have lived in the home for several years and have not progressed to a stage where they can live in supported living accommodation or live independently. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 10 The Inspector spoke with the Deputy Manager regarding the home needing to be clear about its aims and objectives. The objective within the home is for residents to gain sufficient daily living skills to move on therefore this must be stated in the Statement of Purpose. A requirement was made for the Statement of Purpose to be updated. The Inspector viewed two pre-admission assessments on the most recently admitted residents. One pre-admission assessment was sketchy in the information it provided to the Inspector, however since then the Deputy Manager has developed a more detailed assessment and had used this new document when assessing another new resident. This new assessment viewed covered areas such as mental health needs, physical health needs, cultural and social needs, along with any identified risks. Where possible, the home seeks to obtain an up to date assessment and risk assessment from the referrer to gain as much insight into the resident’s needs. A decision is then made to arrange visits to the home. A resident spoken with confirmed to the Inspector that they had spent time visiting the home and meeting staff and other residents. Two new residents agreed that they had made the decision to move into the home and had felt included in the decision making process. Once the home accepts a referral and assessed the prospective resident, the home confirms in writing to the referrer and resident. The Inspector viewed copies of these letters offering the resident a place to live for the trial period. After approximately six weeks a review meeting is held, with all those concerned, to determine if the placement is to continue. Garthowen DS0000022889.V334453.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had not been pro-active regarding those residents who need to move on from the home. Supporting residents to move on would enable them to live in the most appropriate home that can fully meet their individual needs. Residents are involved and supported to make decisions about their lives. Risk assessments are completed and reflect the potential risks posed to the resident and others. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 12 EVIDENCE: The Inspector viewed a sample of care plans and these were up to date and had involved the resident throughout the development of the plans. The care plans encourage residents to consider the specific goals they wish to achieve and any support they might need to achieve these goals. Other areas then considered are residents’ health needs, including mental health needs, daily living needs, such as managing finances and social contacts. Residents are able to comment on their care plans and aims and objectives to ensure they are aware of how staff view their current needs. Those residents asked stated they had contributed to their care plans and were aware of the contents of their care plans. Overall care plans have significantly improved over the months with more detail for each resident’s individual needs. The Inspector discussed with the Deputy Manager the residents who have lived in the home for many years and are not gaining or developing any further skills that will enable them to move on to more independent accommodation. Discussions also took place regarding those residents who are not engaging in many of the meetings or activities. These residents need reviews and action taken to make firm decisions about their future. The Deputy Manager informed the Inspector that staff had discussed at meetings and reviews about moving some of the residents on from the home, but that some placing authorities have not made any firm decisions or taken any steps to act on the home’s request for alternative accommodation. As highlighted earlier in the report, the home supports residents in gaining independent skills that will assist them to live more independently. It must be recognised when the home is no longer meeting a resident’s needs or when the home is no longer suitable for a resident. A requirement was made for the home to support those residents needing to move on. The emphasis in the home is to encourage residents to make daily decisions and to be involved with the care and support being provided to them. Residents have daily meetings to discuss the chores, meals and activities for the day ahead and monthly community meetings are held where residents are able to contribute to the agenda and to the meeting. Various topics can be looked at during these meetings, such as the home, day trips or anything they wish to talk about. Where they are able to, residents manage their own finances and seek support from staff as and when they choose to. Resident’s decisions are respected and if residents choose to keep certain things private and away from family members the staff team respects these wishes. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 13 Risk assessments had been completed on the most recent admission into the home and overall these were comprehensive. Staff obtain as much information from reports, the resident, previous staff and family members. The risk assessments are reviewed on a regular basis and updated every six months or when there has been a change in resident’s needs. A checklist is initially completed looking at various possible risks, such as aggression towards others or themselves and then from this a more detailed risk management form is completed. This document uses ratings that are recorded as to whether a particular risk is a low, medium or high. The Deputy Manager regularly views each resident’s file, which includes care plans and risk assessments with the key worker, who is assigned to a resident. The key worker is responsible for maintaining these documents, to ensure relevant information is kept up to date. Garthowen DS0000022889.V334453.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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to take part in appropriate activities that are in both the home and community. Residents are able to maintain personal and social relationships with family and friends. Resident’s rights are respected and acknowledged by the home. Some food opened had not been covered or stored in secure containers to keep them free from germs and bacteria. This could pose a risk to the resident’s health and welfare. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 15 EVIDENCE: There continues to be ongoing difficulties to engage some residents to take part in activities. The Inspector spoke with staff who acknowledged they must keep motivated in order to encourage the residents. The home speaks with those residents who don’t attend daily meetings or take part in completing tasks assigned to them. Those residents who are not always taking part in daily chores and activities are having their placement in the home considered. The home is constantly reviewing the activities residents are engaged with and closely monitoring and recording the activities they take part in. One resident takes part in voluntary work, whilst others attend local drop in centres or College. Those residents spoken with said they were able to come and go freely in the home and liked to keep busy, shopping, attending health appointments and seeing friends. The home runs occasional day trips and have offered holidays to those residents interested. The Deputy Manager informed the Inspector that the home is trying to set up regular groups for those residents not engaging in activities outside of the home. These include bingo, art class and gardening. Residents either access local transport to visit places or occasionally use taxis. One resident spoken with said they would like to get a job in the future. The Inspector met with a family member who was visiting a resident. They informed the Inspector that they are able to visit the home anytime the resident wanted them to. Residents are encouraged to maintain social relationships and can see family or friends either in the home or at the family’s home. A resident spoken with said he went to see his family every weekend. Residents confirmed to the Inspector that they have keys to their bedrooms and to the front door. They also receive their own personal mail. Some residents choose to be independent and attend appointments without members of staff supporting them. The home tries to balance encouraging residents to take part in activities whilst recognising they have a right to spend time alone. Staff were seen during the inspection to talk with residents in a positive and respectful manner. The Inspector viewed the kitchen and overall this was clean and tidy. Residents usually make their own breakfast and lunch and then a named resident prepares and cooks the main evening meal. The residents plan the weekly menus, although staff recognise the need to ensure the meals chosen by residents provide a balanced diet. Meals, where possible, are recorded, in particular for one resident who needs his diet closely monitored. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 16 The Inspector noticed that some food had been opened, in particular several bags of flour, these were not stored in sealed containers and there was spilt flour in the cupboards. This was brought to the attention of the Deputy Manager and a requirement was made that all foods opened or prepared must be covered and dated when opened. Expiry dates also need to be made clear on the containers or packaging. The Deputy Manager acknowledged the need to be more vigilant regarding the storage of food in the kitchen. Overall residents stated they were happy with the meals provided in the home. One resident was seen to be preparing the evening meal and was keen to provide a meal for all the residents living in the home. Fridge and freezer temperatures are taken on a daily basis and these were within an appropriate range. Garthowen DS0000022889.V334453.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. 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. Residents receive personal support in the way they choose or prefer. The health needs for one resident were not being fully met. This issue poses concerns for the welfare of the resident. Staff had not recorded accurately on the medication records. Robust recording medication systems safeguard residents’ health and safety. EVIDENCE: Residents receive various levels of personal care support. Primarily, staff prompt the residents to bathe or change their clothing. Overall the majority of the residents currently living in the home do not need full personal care support, however there is one resident who is having difficulty in washing themselves independently and staff are trying to address this issue. Residents spoken with confirmed they manage personal care tasks independent of staff. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 18 As mentioned earlier in the report, some resident’s placements need reviewing and this has been an ongoing issue in the home and had been noted during the past inspections carried out last year. One resident in particular has specific health needs that are over riding his mental health needs. The home has made steps to address this problem, through encouraging the resident to attend clinics and visiting the local GP to review his health needs. However this has not helped the resident and their health needs have deteriorated since the last inspection. The Inspector discussed this with the Deputy Manager and a requirement was made for the home to either meet the resident’s health needs or look to support them to move on. The Inspector spoke with the family member of this resident who also expressed concerns about how the home was working to support the resident. Furthermore staff also expressed concerns regarding this resident’s health needs. The Deputy Manager acknowledged the urgency of addressing the needs of this resident and will be discussing this with the relevant placing authority within the next few weeks. Other residents’ health needs are met through a variety of health professionals, such as Psychiatrists and GP’s. Appointments are recorded so that staff are aware of when residents’ see health professionals along with any outcome of the health visit. The Inspector viewed the medication systems and was informed that two members of staff now administer and witness medication being administered. Once a week loose medication is counted. The Inspector noted that on the Medication Administration Records, staff had signed for the days a resident had taken medication when going on social leave to visit family. The Inspector discussed with staff the need to only sign and record medication that is actually administered and witnessed. The resident can sign the medication administration records to say they have received the medication, but there is no guarantee that the resident, once they take away this medication, actually take it. This was brought to the attention of the member of staff in charge of ordering and checking medication and with the Deputy Manager and a requirement was made for this practice to stop with immediate effect. The home does not have controlled drugs in the home. Two residents’ self-medicate and they are given a month’s supply of their medication and sign when they have received it from staff. The Inspector viewed evidence of the spot checks carried out on all medication, including the medication that is kept by the residents who self-medicate. The home assesses each resident to determine those who could manage to self -medicate safely. Gradually the home introduces the self- mediating procedure for the resident to follow. Self -medicating is decided in conjunction with the resident, staff and any relevant health professional. Staff would still order the medication and keep any medication that is over the one months supply. Residents selfmedicating only receive one months supply at any one time. Appropriate risk assessments are completed for those residents assessed as being able to selfmedicate. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 19 The Inspector viewed a sample of medication and counted a small sample of loose medication. All were found to be correct and the Medication Administration Records had been completed correctly. The Inspector suggested to the Deputy Manager to liaise with the local Pharmacist regarding medication training, as this could provide further information and support for the staff team. New staff observe medication being given and receive training on the issues relating to this subject. All medication is stored in secure and safe storage. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents feel confident that their views and concerns would be listened to and acted on. Systems are in place to safeguard residents from abuse. EVIDENCE: The home had not received any complaints since the last inspection. The Deputy Manager is in the process of updating the internal complaints policy to amend staff details. Those residents asked were aware of how to make a complaint and would speak with their key worker or the Deputy Manager if they wished to make a complaint. There have been no adult abuse investigations since the last inspection. The home has the Local Authority’s policies and procedures on safeguarding adults and the staff team received information and training from the Local Authority’s safeguarding adults co-ordinators earlier in the year. Some residents also attended this training session. The Inspector counted a sample of resident’s personal money. The majority of residents manage their own finances and staff only become involved if there is a problem with the resident’s money. The money available to count was found to be correct and daily checks occur to ensure there are no errors. The Inspector viewed the financial transactions, which are recorded in a book. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to have maintenance issues that, if managed, proactively would ensure residents live in a welcoming and pleasant home. The home was clean and free from odour at the time of the inspection. EVIDENCE: The Inspector carried out a tour of the home with the Deputy Manager. The washbasin in bedroom seven had been cleaned and there was no lime scale present. The tap, that had been leaking was also fixed. Although the maintenance issues have slowly been addressed, the Inspector noticed some areas still needing to be addressed. • Ground floor flat had no light shade for the ceiling light. • Ground floor bathroom, the seal around the bath needs replacing. • Baths on the ground floor and top floor need re-enamelling. • Various areas in the home have wallpaper starting to peel off the walls. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 22 The Deputy Manager showed the Inspector the two vacant bedrooms that have been decorated. The bedrooms have been a priority, when updating the home. Bedroom furniture, where necessary, is also being replaced. The Inspector acknowledged the size of the home and the layout could make maintaining the home difficult, however staff should continuously monitor the maintenance of the home, so that areas are quickly identified and where possible addressed immediately. The home needs to be pro-active and not reactive when making improvements to the environment. The Inspector viewed a skip outside the home and is aware the home is working to provide a welcoming place to live in. However, areas for improvement are still being found at each inspection visit and a requirement was made for the above issues to be addressed. The home has ordered new sofa covers and chairs and during the inspection a resident asked the Deputy Manager for garden furniture. The Inspector agreed this should be considered, as the Inspector had met a resident in the garden and found few chairs to sit on. The home has domestic help three hours every week- day and staff and residents maintain the home during the weekend. Overall the home was clean and tidy and free from any odours. The laundry facilities are located in a separate room and residents carry out their laundry with assistance from staff. Each resident has a day assigned to them to wash their personal items. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 23 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 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A competent staff team work to meet the needs of the residents’. Information was missing from a staff employment file. This lack of information could place residents at risk. There are some gaps in the training provided for staff. Residents would benefit from being supported by a trained and skilled staff team. Residents benefit from staff having support and supervision on a regular basis. EVIDENCE: The staff team has altered with one member of staff leaving and two new members of staff starting to work in the home. Therefore the home is not currently meeting its target of 50 of staff having an up to date qualification, such as an NVQ. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 24 The Inspector spoke with the learning and training department during the inspection and was informed that local NVQ courses and assessors would be identified as soon as possible, so that staff can be enrolled once they have finished their probation period. After the inspection the Inspector received confirmation that three members of staff, needing to enrol onto an NVQ course, would be doing so in the near future once dates have been agreed. The Inspector was satisfied that the home had done everything possible to ensure the staff team are up to date with the qualifications they need to meet resident’s needs. The staff team is small with various levels of knowledge and experience. During the inspection, staff were seen to interact with residents and were motivated and committed to meeting resident’s individual needs. One survey completed by a care manager, commented on how the home could improve if there was a consistent staff team and permanent Registered Manager. As mentioned above, one member of staff has left and another is due to leave within the next few weeks. There is also a member of staff who has been on long term sick and the Inspector advised the Deputy Manager to ascertain the current situation with regards to this particular member of staff. The hope is that the staff team currently in place will remain working in the home to ensure a consistent and knowledgeable staff team to support the residents. The home uses regular relief workers and, on occasions, permanent members of staff work additional hours to cover vacant hours. Two members of staff work on each shift and the Deputy Manager works Monday – Friday. One member of staff commented on the difficulties there can be when working with new members of staff, as they feel they have to check to ensure everything has been done on the shift. This was fed-back to the Deputy Manager. Those staff asked commented positively on how the staff team were working well together and that much had improved in the home over the past few months. The staff team meet on a regular basis and the Inspector viewed the minutes from these meetings. There is a mixture of ages, experiences in the staff team. The Inspector discussed with the Deputy Manager the importance of having an experienced and competent staff team for the benefit of the residents. This is particularly important in light of the difficulties the home has faced over the past twelve months. The staff team needs to stabilise and work towards the same aims and objectives. The Inspector was satisfied the home has begun to bring together a strong staff team who can move forward with the vision to continue to make improvements in the home. The Inspector viewed a sample of staff employment files. One file contained a completed application form, health declaration, photograph, two references and Criminal Record Bureau Check. The other staff employment file did not contain an application form or health declaration form. A requirement was made for all staff employment files to contain the necessary required information. This had been an issue at a previous key inspection. Staff employment files need to contain accurate information on staff. The Inspector viewed the training and induction programme. The Deputy Manager had identified the training needs of each member of staff and had Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 25 devised a system to record these training needs and the training attended by staff. The two new members of staff had received an induction into the home and the Inspector spoke with a new member of staff who confirmed they had received a detailed introduction regarding the home and had spent time observing existing members of staff. The new members of staff are working through the training programme in order to be up to date with the mandatory training. Food hygiene training had been booked for June 2007, however moving and handling and infection control training was not planned for staff until March 2008. This was discussed with the Deputy Manager and a requirement was made for the training programme to be able to meet the needs of the staff team. Other dates, in areas outside of London, were available and the Inspector encouraged the Deputy Manager to consider enrolling staff, so that they were able to gain up to date information and knowledge. The Inspector also advised the Deputy Manager to ensure the staff team were aware of the Mental Capacity Act 2005, as this had recently become legislation. Evidence was seen that some staff had attended additional specialist training on mental health subjects. The Inspector viewed a sample of supervision notes and was satisfied that staff receive one to one support and guidance from their line Managers. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 26 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, 40 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is now benefiting from a well managed home. Regular quality review checks are carried out and include obtaining residents’ views on the home. Health and safety checks were up to date and safeguarded the residents. EVIDENCE: As stated in the summary of this report, the Deputy Manager will be acting as the Manager Designate until such time as a permanent Manager has been confirmed in post. The home has benefited from the work the Deputy Manager and the staff team have been doing to improve the standards in the home. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 27 The Deputy Manager has been keen to introduce new systems to improve the running of the home. She is in the process of completing an NVQ level 3 and is aware of the need to register with the CSCI should she be in post as the Manager Designate for several months. The Registered Provider has a Quality Assurance Manager who has assisted in introducing a new system to carry out reviews and checks on the home. Each month the Deputy Manager will need to complete a report looking at various aspects of the home. This is then checked by the Quality Assurance Manager to ensure it is accurate. Each year resident’s views will be obtained and considered when looking at the running of the home. On an annual basis an audit report will be developed which will summarise all of the areas looked at. This report should also identify any shortfalls or comments made by residents or their representatives. The Inspector advised the Deputy Manager to consider how this report will be written as it needs to be accessible for residents. In addition, each month the Area Manager visits the home and produces a report of their findings. The CSCI receive a copy of this report. The Inspector noted, whilst viewing some policies and procedures that some of these were several years out of date. The Deputy Manager informed the Inspector that policies and procedures had been updated but that some of these had not been sent over to the home. The Inspector made a strong recommendation for the home to obtain all the up to date policies and procedures, to ensure staff have relevant and accurate information. Samples of maintenance and health and safety records were viewed. Fire equipment, Gas Safety Record, testing for Legionella and Portable Appliance testing were all up to date. A fire risk assessment had been completed which was comprehensive covering the potential hazards within the home. The home had worked through the fire officer’s recommendations. Fire drills had been held at different times and with different members of staff. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 28 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 3 3 x 4 3 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 3 x 3 3 x 3 x Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 4 Timescale for action The Statement of Purpose 31/05/07 must be updated to include all of the criteria as set out in Schedule 1 of the Care Homes Regulations 2001. If the home is unable to 30/06/07 meet a resident’s needs, appropriate and proactive steps must be taken to consider reviewing the placement and supporting the resident to move on. Food must be appropriately wrapped or stored appropriately to ensure it is kept fresh and free from bacteria and germs that could harm residents’. 10/05/07 Requirement 2. YA6 12(1) 3. YA17 13(4)(c)16(2)(g) Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 30 4. YA19 12(1)(2)(3)13(4)(c) The health needs of the residents’ must be met. Where a resident’s primary needs change, arrangements must be made to review the placement so that his/her health is cared for appropriately. 13(2) Staff must only sign for medication administered and not when residents’ are going away from the home on social leave. Attention needs to be paid to areas in the home that need work and/or updating. Monitoring the environment is crucial in order to provide a pleasant home to live in. Staff employment files must contain the necessary documentation as outlined in Schedule 2 in order to safeguard residents’. The Registered Person must ensure that staff receive the training relevant to them for the work they are to perform. In particular mandatory training must be up to date, to ensure a knowledgeable and competent staff team support the residents’. 30/06/07 5. YA20 10/05/07 6. YA24 23(2)(d) 01/08/07 7. YA34 19(1)(b)(i) 31/05/07 8. YA35 18(1)(a)(c)(i) 30/09/07 Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 31 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 YA40 Good Practice Recommendations It is strongly recommended for the home to obtain the up to date policies and procedures. Garthowen DS0000022889.V334453.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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. 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