Inspection on 31/08/06 for High Street, 56

This inspection was carried out on 31st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Street, 56 02/12/09

High Street, 56 31/12/07

High Street, 56 06/09/05

High Street, 56 15/04/05

High Street, 56 29/11/04

High Street, 56 13/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 High Street,56 56 High Street Chislehurst Kent BR7 5AQ Lead Inspector Miss Rosemary Blenkinsopp Unannounced Inspection 31st August 2006 11:00 High Street,56 DS0000006905.V303065.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 High Street,56 DS0000006905.V303065.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. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Street,56 Address 56 High Street Chislehurst Kent BR7 5AQ 020 8468 7016 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) Community Options Limited Mr Cliff Mark Barry Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 10 Elderly persons of either sex suffering with mental illness Date of last inspection 6th September 2005 Brief Description of the Service: This facility is part of the Community Options group of homes. This service is registered for ten residents in the category of mental disorder, excluding learning disability. At the time of the visit there were nine residents in the home, one was attending a hospital appointment. The home is a large detached house in the centre of Chislehurst High Street. There are three floors and bedrooms are located over two floors. There are two sitting areas and a separate dining facility. There is a dedicated smoking room. There is parking to the front of the building. The service is for those residents who have long-term mental health problems. The majority of the residents are now in their later years Staffing is provided throughout the 24-hour period including waking night staff. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced inspection. The preinspection questionnaire had been received in preparation for the visit. The site visit was conducted over a one-day period. The inspector met with two residents who were the latest admissions and these were case tracked. Three staff members, two permanent and one agency, were interviewed by the inspector. All information received confirmed that a good service was provided and staff were supported within their role. The inspector felt that the standards within the home had significantly improved not only in the environment but within the records. Three comment cards were received prior to the inspection, two from residents and one from a health professional, all related positive comments. What the service does well: What has improved since the last inspection? What they could do better: The resident population in this home is older and because of this, more investment should be made in adaptations and aids to maximise their independence. A ramp and hand rail to the front door would be beneficial to residents who have mobility problems and this should be investigated. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 6 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. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4,5. The quality rating in this section is good. This is based on all of the information including the site visit. All of the information required to evidence that robust assessments are conducted prior to admission were in place. EVIDENCE: The inspector accessed the two pre-inspection records for the last admissions. One admission had been in the home since 16 July 2006. Within the documentation there were written records relating to the two assessments conducted both at High Street and his former place of residency. There was a core assessment form received from his previous key worker, at his former placement. The assessment information outlined physical and mental health needs as well as activities of daily living and finances. There was a record relating to his introductory visit in High Street and the observations made by staff relating to this. There was a letter confirming acceptance of placement and thereafter a contract issued. There was an introduction letter to the residents from the Manager. Details of a three-month probation period were included in the terms and conditions. On file was information relating to after care received under Care Programme Approach (CPA) procedures, this included a care plan and assessment. The second pre-assessment information related to a female resident, admitted 2005. Again there was lot of pre assessment information including multidisciplinary input, trial visits and assessments. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 9 Staff with whom the inspector met stated that they were encouraged and prompted to read all documentation on prospective residents . High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9. The quality rating in this section is good. This is based on all of the information including the site visit. Care plans and risk assessments were in place, which addressed the physical, physiological, and social needs of the residents. The daily events were informative and related to the identified problem areas. EVIDENCE: The two care plans of the residents involved with case tracking were inspected. The most recent admission had the care plan provided as part of his CPA, after care. There was not a specific care plan in respect of his stay at High Street. An initial care plan should have been developed within 48 hours of admission, and thereafter added to and amended as required, and as more was known about the residents’ needs. The CPA care plan was reflective of identified needs and comprehensive in content. This was the care plan that staff were working with. There were risk assessments covering aspects of his own behaviour as well as those posed through communal living in a domestic setting developed by Community Options staff. The content of the interventions was good, and could have been amended to be included in his care plan. The second care was developed by staff in High Street. In addition, information received from other sources was available and included in the care plan issues. The care plan reflected the residents needs and contained detailed High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 11 interventions. It had supporting risk assessment documentation which was dated, signed and kept under review. The placing authorities’ formal six-month review, was also on file. In addition there was a report relating to the three months probationary period conducted by Community Options. On all documentation, the residents and the staff member had signed to agree the content. The two files contained records of appointment conducted by all health care professions involved. The appointments were also referenced in the daily events. The files were organised and easy to find specific information from. Please see requirement 1. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 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 the following standard(s): 12,13,15,16,17 The quality rating in this section is good. This is based on all of the information including the site visit. The residents in this home are generally in the older age group hence rehabilitation and employment are not the main focus of their day although independence, choice and individuality are respected. EVIDENCE: Residents were seen to spend time either in their own bedrooms or the communal areas; some were out of the home. The inspector spoke to many of the residents during the course of the inspection but spent more time with the two who were involved with the case tracking. Generally the resident appeared well cared for, particularly one resident who stated that she enjoyed having her hair done. This resident has become more dependant requiring the use of a walking stick and wheelchair. Within her limitations she felt that she was able to choose what she did and how she spent her time. The second resident was seen spending his time in the smoking room. He too felt that choice and independence were encouraged, although he was still High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 13 under an assessment period, he wanted to go out independently not accompanied. On the office wall was a list of activities and events organised through the home. Residents visit the high street where they do shopping , have coffee and generally spend time . Both residents stated that they received visitors one very frequently from his son and brother in law the other resident said it was less frequent. One of the residents had been in several other homes and said of this one “ it is the best place I’ve ever been in.” She was keen that the inspector visited her room, which was found to be personalised and pleasant. All residents make their own drinks having been assessed as capable of doing so. Meals are provided for residents with a hot meal at lunchtime. Lunch was served, two choices were offered, and juice was available. The records relating to hot foodstuffs, fridge and freezer temperatures were in place. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 are: 18. 19. 20. 21. residents receive personal support in the way they prefer and require. residents ’ physical and emotional health needs are met. residents retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. The quality rating in this section is good. This is based on all of the information including the site visit. Residents are supported with personal care by staff in the home. All health care provision is accessed through the community with domiciliary services accessed as needed. EVIDENCE: Residents have support provided in respect of their physical health needs, in the way that they wish and at the time that they prefer within reason. Residents do need support with aspects of physical care more so as many of the residents are now elderly with issues around mobility, and personal hygiene apparent. One resident is ninety-nine years of age. Walking sticks and one wheelchair are in use to meet residents’ mobility issues. The home has a visiting dentist and chiropodist. Most of the residents are able to go out to attend the GP and optician. Al residents have input from the psychiatric services at varying levels. Records were in place for hospital admissions and information relating to subsequent discharge available. Accident records and notification under Regulation 37 were all retained .The home had a “ Critical Incident Crib Sheet” in operation. This provided information for staff in the event of acts of selfharm, suicide overdose etc. This is good practice High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 15 The medication systems were inspected. There is an investigation ongoing in respect of the pharmacy service and medication discrepancies. This was notified to the CSCI, and will be investigated by senior personnel of the supplying pharmacy. It has been evident from staff checks that medications have not been issued from the pharmacy correctly hence the level of concern. Medications are securely stored in a cupboard within the top floor office. There was no over stocking noted. Currently there are no controlled drugs in use. Medications checked were in date. There are no residents who self medicate; all medications are administered by staff. The medication charts were well completed with the residents photograph in place and allergies recorded. Staff who administer medications are subject to medication assessments and proficiency tests on a regular basis. Staff in the home confirmed this. Only regular staff administer medications. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 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 the following standard(s): 22,23 The quality rating in this section is good. This is based on all of the information including the site visit. Information and avenues by which to make a complaint are available and include external bodies. Community Options demonstrate an open culture to complaints and whistleblowing. Staff are knowledgeable on abuse and aware of the appropriate action to take. EVIDENCE: Within the hall there is the complaints procedure which details inhouse and external avenues for raising concerns. There have been no complaints referred to the CSCI since the last inspection. Previous experience in respect of this topic has proved that Community Options take concerns/complaints seriously and action appropriately. Community Options have policies relating to making a compliant, whistleblowing and abuse. These have been in place for some time, an annual review is recommended, or when legislation or good practice guidance changes. This information is also provided in the staff handbook. Residents stated that they would raise concerns in house or through the multi disciplinary team. Within the home’s complaints file there was the complaints monitoring forms, which details the nature of the concerns, the action taken and states whether the complainant was satisfied .The last one recorded was 15/3/06 and was investigated as an internal matter. The three staff with whom the inspector met all had knowledge of adult protection. The agency staff having done some training through her agency High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 17 prior to placement. The two permanent staff both related a good knowledge on abuse, whistleblowing and complaints. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29,30. The quality rating in this section is adequate. This is based on all of the information including the site visit. The home is maintained to a domestic standard and has benefited from redecoration, new flooring and increased domestic input. It is suitable to meet the current needs of residents although this must be kept under review with the aging population and increased dependency. EVIDENCE: The home had significantly improved since the previous visit. Areas had been redecorated including the entrance hall and some of the bedrooms. Redecoration and new flooring in the smoking area had improved this area. The area was less smoky and the inspector was able to chat to residents as some of them do spend considerable periods of time in the room. The inspector was unable to view all bedrooms because they were occupied or locked. One bedroom which had been of concern on a previous visit had improved and was now to an acceptable level, with staff input and ongoing monitoring of this area. Communal areas corridors and hall and stairs were also maintained to a satisfactory level. All areas were clean and hazard free. The inspector was High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 19 advised that the cleaning hours had been increased. This has made a significant improvement. Within this home there are a significant number of older residents and mobility is for some becoming more difficult. The home has limited adaptations and further investment is needed in this area, including a ramp and handrail to the front entrance. This is particularly important as the level of mobility in the home is decreasing and more aids in use including one wheelchair and three walking sticks. One resident is visually impaired and has no specific equipment. This should be investigated to explore if there is anything that could improve her quality of life. The home has a walk-in shower as well as some bath aids as recommended from a previous occupational therapist assessment. Access to the office is via some steep stairs and this is wearing when staff have to access this area several times a day. Please see requirement 2. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. The quality rating in this section is good. This is based on all of the information including the site visit. Staff are provided in sufficient numbers to address residents needs. Training is provided whilst structure such as supervision and appraisal offer a supportive framework for the staff team. EVIDENCE: The inspector met with three staff during the inspection. One member of staff was an agency worker, with whom the inspector met briefly, as she was escorting a resident out, the other two were permanent staff. The Deputy Manager facilitated the inspection. She demonstrated a good knowledge of the residents, the workings and the principles underpinning the home. The agency staff confirmed that she had been required to produce her identification and other documents were obtained through the agency head office. The agency had provide training on statutory topics. On her first shift she had been orientated to the home and had had health and safety within the home explained. The two permanent staff members confirmed that they had been subject to robust recruitment procedures including, two references, CRB interview and literacy numeracy testing . They had received induction through Community Options as well as specific induction into the home. They confirmed that they received supervision through senior staff in home. Confirmation that probation interviews at one, three and six months were conducted . High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 21 Both of the permanent staff had received a number of training sessions coverings statutory topics and mental health issues.The information provided with the pre-inspection questionnaire confirmed training.The inspector did note that some staff receive the company induction some time after their start date. This has been raised with Community Options on previous occasions. The Company must satisfy itself that staff are suitably prepared to work within the home with the resident group prior to commencement of work. Currently there are five staff doing NVQ level 3 and one doing NVQ level 2 The home employs ten staff including the two Managers. It was noted from the off-duty, and confirmed by staff, that due to staff vacancies a lot of agency is used. The staff interviewed did confirm that there was always enough staff numbers on duty be it with the use of agency/bank. Regular bank and agency are used whenever possible. Currently there were 2/3 staff vacancies. The use of agency and bank staff puts increased pressure on the permanent staff and can lead to inconsistencies on care; therefore recruitment must be addressed as a matter of priority. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. The quality rating in this section is good. This is based on all of the information including the site visit. The Manager and his deputy have demonstrated a strong leadership in the home. Community Options provide a supportive framework in which the home operates. Quality assurance measures are in place. Health and safety issues are addressed. EVIDENCE: The Manager has been in post since September 2005. He has completed the CSCI process to become the Registered Manager. He had completed the NVQ level 4, Registered Managers Award, September 2006. Other training included the four-day first aid course, health and safety advanced certificate, as well as other relevant topics. The inspector viewed minutes of staff and residents’ meetings, which were held approximately two-monthly. Topics discussed were relevant to the home and resident group. Minutes of staff meetings are circulated to all staff. In addition there is an annual staff survey which is collated and the results published. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 23 Community Options publishes a newsletter and this is circulated to all the homes. Client feedback meetings provide a forum to discuss up dates on objectives . The residents’ monies was seen to be checked by two staff in the presence of the inspector. These were found to be correct. Checks are made regularly. The service certificates were found to be in date including the lift service, gas electrical and fire installations. The fire records detailed weekly alarm testing, monthly emergency light tests, with additional checks on fire doors. Fire drills had been conducted monthly since April with staff and residents involved. Fire evaluation and general procedures were also in place. From the pre-inspection file, staff have completed first aid training. The Manager has attended a 4-day First Aid training course. High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 24 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 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 X High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation 15 Requirement The Registered Manager must ensure that there is a care plan in place generated by the home within 48 hours of admission . The Registered Manager must ensure that all equipment necessary for resident’s quality of life is available. Timescale for action 30/11/06 2 YA29 23 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 High Street,56 DS0000006905.V303065.R01.S.doc Version 5.2 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. 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