Inspection on 12/04/05 for Gate Lodge

This inspection was carried out on 12th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gate Lodge 27/04/07

Gate Lodge 21/04/06

Gate Lodge 19/01/06

Gate Lodge 16/06/05

Gate Lodge 04/01/05

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

CARE HOME ADULTS 18-65 The Forge Besley Street London SW16 6BG Lead Inspector Sharon Newman Announced 12 April 2005 10:00 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 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 Stationary 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. The Forge Version 1.10 Page 3 SERVICE INFORMATION Name of service The Forge Address Besley Street, London SW16 6BG Telephone number Fax number Email 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 8946 2686 020 8947 4898 Odyssey Care Solutions for Today Tony King Care Home only (PC) 6 Category(ies) of Learning disability (LD) registration, with number of places The Forge Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The organisation must ensure that minimum staffing levels remain under review and at all times suitably qualified, competent and experienced persons are working in the jome in such numbers as are appropriate for the health and welfare of service users. If at any time the evidence indicates assessed needs of service users has increased, the CSCI will require additional staffing as appropriate. Date of last inspection 25th November 2004 Brief Description of the Service: The Forge was purpose built for operation as a care home to provide care and accommodation for six adults with a learning disability. It opened in February 2004 and is situated in a residential road close to local amenities and transport links. Streatham Common Railway Station is within a short walking distance of the home. There were five service users living at the home at the time of inspection. All service users are accommodated in single rooms with en-suite facilities. There is a strong emphasis on service user independence at this home and they are encouraged and supported to develop upon their independent living skills. The Forge Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 12th April 2005. The Registered Manager was present throughout the inspection and one staff member was also spoken to. Records examined included care planning documentation, health and safety information, medication records and staff files. A tour was taken of the premises. A pre-inspection questionnaire was completed by the Registered Manager prior to the visit. Comment cards were completed by all five service users and these were positive overall about the care in the home. Two comment cards were received from relatives and one from a medical professional which were very positive. Additionally on the day of inspection a relative stated in a telephone call that they were “really pleased with the care” given at the home. Staff were very friendly, welcoming and open throughout the inspection visit. Interaction observed between staff and service users demonstrated an open and caring attitude by staff members. They gave the impression of a genuine commitment to their work and to the service users. Improvements in care planning, medication documentation and risk assessment reviews were seen to have taken place since the last inspection visit. Service users spoken to at the inspection visit were very positive about the care at the home. What the service does well: The staff demonstrated an excellent rapport with service users throughout the inspection. The key working scheme works well in this home and ensures that service user needs are addressed. Staff are caring and conscientious and they are to be commended for the manner in which they successfully promote and encourage independence in service users. The home provides high standards of care using a person centred approach. Service users are enabled to participate in their local community setting and are supported in fulfilling and appropriate activities. The health and social care needs of the service users are well met and thoroughly documented. The environment is attractive, clean and homely and bedrooms are very well personalised. The Forge Version 1.10 Page 6 The manager is competent and experienced and provides good support for the staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Forge Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Forge Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5. Service user assessments are thorough and allow for a detailed care planning process to develop from this documentation. This attention to detail ensures service user needs are met. Good information is provided about the home to service users to enable them to make decisions about their care. EVIDENCE: A Service Users Guide is available and all service users have a copy in their bedroom. The Statement of Purpose contains information about the organisation and the staff team. It describes the care offered at the home including information regarding care planning and life development. It also states that the use of symbols, pictures and makaton are used as methods of communication. Details about the complaints procedure and confidentiality are also contained in this documentation. One service user has left the home since the last inspection as they achieved their set goals thus currently there are only five service users resident at the home. A new service user who was seen at the previous inspection visit and was feeling unsettled was spoken to again at this visit. They have now settled in well at the home and said they liked the staff and their bedroom. The Forge Version 1.10 Page 9 The Registered Manager stated that a new service user would be joining the home soon and would be given the opportunity to visit prior to deciding to stay. Local Authority Contracts and full assessments were seen to be in place for the two service users whose documentation was examined. The Forge Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 There has been an improvement in the updating of care plans and risk assessments, however a more user-friendly care planning format will be of benefit to staff and service users. Care plans are very specific to each service users needs and goals. The person-centred approach to care planning helps to provide high standards of care that are individually tailored to each service user. EVIDENCE: The care plans examined were detailed, thorough and had been regularly reviewed. Each service user had two files, one of which is a daily file and one contained background information. Care plans contained a personal history, healthcare issues and information regarding likes and dislikes. However, as found at the previous inspection visit the care plan format was difficult to follow and would benefit from being streamlined to improve upon the clarity of this documentation. The Registered Manager said a more user-friendly care planning format is to be implemented at the home. He also stated that much of the material in the care plans has now been archived, this has ensured the care plans are now easier to follow. The Forge Version 1.10 Page 11 Care plans were seen to contain individual goals specific to the service user, these included: waking up independently, learning a bus route home and preparing a meal. The registered manager said the home has a Service Summary in place for each service user. This contains an up-to-date outline of the support required by each service user. It includes details about personal care, assistance in daily living , health, finances and communication. Service Summaries were seen to be in place for the two service users whose documentation was observed. A key worker scheme is in place at the home and the Registered Manager stated that the home is now providing a more person centred approach to care planning. Risk assessments were in place in the care plans examined and were seen to be regularly reviewed and updated. Monthly service user meetings take place and minutes seen included discussion about a party for a service user, helping to cook meals and finding a job. Service users were observed to access all communal areas during the inspection visit. The Forge Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,13, 14, 15, 16, 17 Links with the community are good and these support and enrich service users social and educational opportunities. The home provides a very good environment for service users to develop their social skills. Staff encourage and support service users to be as independent as possible. EVIDENCE: Two care plans were examined, and included activities such as cooking, swimming and shopping. The Registered Manager said service users may participate in activities including: art, board games, music, watching television and DVD’s. One service user was accompanied to the hairdressers during the inspection visit. Evidence was seen of service user attendance at local day centres. One attends a local drama club, two are employed by Dust Busters and one attends a women’s group and goes to photography classes. The Registered Manager stated that one service user writes and presents their own comedy sketches at a local learning disability social club. A service user stated ‘I go to the day centre three days a week’. One service user was observed to go in to local The Forge Version 1.10 Page 13 shops accompanied by a staff member. The Registered Manager said service users also go to the pub. The Registered Manager stated that all the service users have regular contact with their relatives. One service user said they regularly visit their relative or their relative visits them at the home. A relative spoken to by telephone at the time of inspection stated they were ‘really pleased’ with the care given at the home. All service users are allocated a key worker. The Registered Manager said he is going to accompany two service users on a holiday to Bognor that he is currently organising. A range of Television and music equipment was observed to be available in the lounge and the service users bedrooms. At the previous inspection it was found that full records of food taken by service users was not being documented – this has now been corrected and full records are available. A service user said ‘I like the food’ and ‘I like to help cook’. The Registered Manager said that service users are involved in the preparation of meals and that meal times are arranged to suit them. The Forge Version 1.10 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The health needs of service users are well met with evidence of good multidisciplinary working taking place. There has been an improvement in the recording of medication documentation. EVIDENCE: At the previous inspection visit the medication cupboard was found to be left open, however, at this visit it was locked securely. A medication policy is in place and a copy is kept in the service users medication file. Medication records examined at this inspection visit were found to be accurate and well maintained. All service users medication records are held in a well organised file. A staff signature list was found to be in place. Two service users are self-medicating and appropriate risk assessments were seen to be in place. A box of service user’s medication was found to be unlabelled. All medication must be clearly labelled and specific to the service user. The Forge Version 1.10 Page 15 As recorded in the previous inspection report the registered manager again stated that he attended a medication training course and then information is cascaded to staff working at the home. It is recommended that medication training is given to all staff members from a creditable source. The Registered Manager said that the home has good links with a local pharmacy. Evidence was seen in care plans of input from health care professionals including: occupational therapists, GP’s, speech and language therapy, dieticians and social workers. One service user is currently receiving domiciliary input from a physiotherapist. One service user said they had recently been to the dentist. District Nursing input is provided for two service users with continence needs. The staff at the home can refer service users to the local Specialist Community Support Team for support and advice. The Forge Version 1.10 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Policies and procedures are in place to protect service users from abuse and harm. The home promotes an approachable and open atmosphere and encourages discussion. EVIDENCE: A complaints policy is available at the home, also a pictorial complaints format is available in the Service Users Guide which can be found in every service users bedroom. The complaints book was seen and no formal complaints were found to have been made to the home. A Local Authority Protection of Vulnerable Adults Policy was displayed on the office wall and an organisational abuse policy was available. An organisational Whistle blowing policy is in place and is entitled ‘Maintaining Good Practice at Work.’ Appropriate individualised risk assessments were found in the two care plans examined. Regular documented monthly service user meetings take place at the home. The Forge Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 27, 28, 30. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. The standard of maintenance of the premises is also good. EVIDENCE: The Forge Version 1.10 Page 18 This is a purpose built home with accommodation over two floors and is served by a passenger lift. The home was found to be warm and comfortable. There is a utility room which leads out to a small patio/garden area that has barbeque equipment. The Registered Manager stated that barbeques are held regularly for service user in the summer months. There is also a large bright open plan lounge and kitchen. However, when service users receive visitors they must do so in this lounge or their bedrooms as there is no other alternative private space. It is recommended this is kept under review and further consideration may need to be given to a change of use of one bedroom in order to provide a separate communal area at the home. The bedrooms seen at this visit were very well personalised to each individual service users taste. One service user said they ‘liked their bedroom’. All bedrooms have en-suite toilet and shower facilities. A range of music, television and video equipment was seen to be available for service users in the lounge and their bedrooms. The home was observed to be clean and hygienic and free from any offensive odours. No maintenance issues were identified at the time of inspection. The Forge Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 Staff are enthusiastic and committed to delivering high standards of care and helping service users to reach their potential. Improvements can be made in the area of training to ensure all staff has up-to-date knowledge in areas such as manual handling, first aid and food hygiene. EVIDENCE: The Registered Manager stated that staffing levels currently meet the needs of the service users and these have improved since the last inspection. Staff rotas were examined and were found to fully record the names of staff on duty at the home. A new member of staff has recently joined the team and the Registered Manager said that the induction process for this individual would be ongoing over a six month period. Staff meetings were seen to take place monthly and are well documented, issues discussed included: health needs of service users, new staff and the team culture. Four staff records were seen at this inspection and found to contain the required information including: two references, application forms, photo identification and CRB checks. The Forge Version 1.10 Page 20 Supervision records for two members of staff were examined and found to be in order. These records are kept in a separate organised folder and stored in a lockable cabinet. There is a supervision contract in place which includes information regarding : confidentiality, preparation, frequency, privacy and documentation. Staff training was seen to require updating particularly in the areas of: first aid, food hygiene and manual handling. One member of staff is currently undertaking the NVQ Level 3. Another staff member has completed their LDAF induction and is in the process of completing the LDAF foundation course. Another staff member is to commence the NVQ Level 3 in September 2005. The Forge Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 and 42. The formal systems for service user consultation are in place and are generally good, however the home will benefit from full implementation of this quality assurance system. The Registered Manager provides clear direction and leadership within this home. EVIDENCE: The Registered Manager said he has been with the Odyssey organisation for 10 years and has managed this home since it opened in February 2004. He is currently completing the NVQ Level 4. He has overall responsibility for areas including: care planning, staff management and service finances. A quality assurance programme is in place in the home, and the Registered Manager said this is yet to be fully implemented. This programme sets specific quarterly targets which include the following areas: staffing, service delivery, service user update, accidents and incidents, complaints and housing issues. It looks at these areas in relation to the outcomes for the service users. The Forge Version 1.10 Page 22 A business plan for 2005/2006 is in place for the home and addresses areas including good practice, training and supervision. The Registered Manager said that the monthly staff and service user meetings are also used to assess quality of care within the home. Records regarding Portable Appliance Testing, fire safety and gas safety were all found to be in order and first aid boxes were seen to be checked monthly. Although most hot water temperatures were being checked weekly not all of those at outlets requiring full body immersion were being checked. Full weekly records for hot water temperatures must be maintained with particular reference to bath/shower outlets. A Legionella risk assessment has now been carried out by Registered Manager and he stated the home is awaiting a formal assessment. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 The Forge Score x Standard No 22 Version 1.10 Score 3 Page 23 2 3 4 5 3 x 3 3 23 ENVIRONMENT 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 3 2 x x 2 x The Forge Version 1.10 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13 (2) Requirement The Registered Provider must ensure that all medication is fully labelled. The use of as directed must be avoided. (Previous timescale of 25/11/04 not met) All care staff responsible for administering medication must receive training directly from a creditable source (accredited where available.) (Previous timescale of 25/11/04 not met) The Registered Persons should ensure that staff training is upto-date. Refresher training must be provided for staff as required with regard to Manual Handling, First Aid and Food Hygiene. The Registered Persons must ensure that a formal system for reviewing the quality of care in the home is fully implemented. (Previous timescale of 01/02/05 not met) The Registered Persons must ensure that hot water temperatures are tested weekly. Timescale for action 30/06/05 2. YA20 13 (2) 31/08/05 3. YA35 18 (1) 31/08/05 4. YA39 24 (1) (2) (3) 31/08/05 5. YA42 13 (4) 31/05/05 The Forge Version 1.10 Page 25 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. 2. Refer to Standard YA28 Good Practice Recommendations Ensure that the communal space available continues to be sufficient for the needs of the service users living at the home. The Forge Version 1.10 Page 26 Commission for Social Care Inspection Ground floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Forge Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!