Inspection on 06/09/05 for High Street, 56

This inspection was carried out on 6th September 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 but made no statutory requirements on the home.

Other inspections for this house

High Street, 56 02/12/09

High Street, 56 31/12/07

High Street, 56 31/08/06

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 56 High Street 56 High Street Chislehurst Kent BR7 5AQ Lead Inspector Rosemary Blenkinsopp Unannounced 6 September 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. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 56 High Street Address 56 High Street, Chislehurst, Kent BR7 5AQ 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 8468 7016 Community Options Limited Vacant Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 10 Elderly persons of either sex suffering with mental illness. Date of last inspection 15/04/05 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 or dementia. 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. The service is for those residents who have long-term mental health problems. Staffing is provided throughout the 24-hour period including waking night staff. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced by one inspector. At the time of the inspection there were ten residents in the home. The inspector met with several of them throughout the course of the inspection, one resident for a brief period only. There were no visitors in the home during the inspection. The inspector met with the domestic who is supplied through an agency. Two support staff met with the inspector, one of whom discussed their key resident. The inspector cross-referenced information obtained from one resident and related this with the identified needs in his care plan. The inspector discussed the resident’s care with his key worker. A tour of the premises was undertaken including some individual bedrooms. The kitchen and communal areas were also inspected. A selection of records were inspected including medication charts, health and safety certificates and staff training documentation. What the service does well: What has improved since the last inspection? What they could do better: Some of the documentation should be more comprehensive as previously referred to. This is underway. Systems should be put in place to ensure that all mandatory training is updated at appropriate intervals and all staff, including agency staff, receive it. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 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. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 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 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 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) 1,2,4,5. Residents are provided with good information on which to base their decision on whether the placement would be suitable. EVIDENCE: The home had available the Statement of Purpose, Service Users Guide and the Mission Statement. Due to the change of manager, these documents will need up dating once the new manager has completed the CSCI process for registration. There have been no new admissions since the last inspection, although with one resident due to move to another Community Options facility, a vacancy will occur. There is already a resident proposed to fill this vacancy who is 53 years old. The residents herself has met with Community Options staff and spent a day at the home. Staff who were present one the day of the visit have identified areas, which would need to be addressed through the care plan process. Each resident is issued with an individual service agreement, those, which were inspected, had the residents’ signatures in place and included the weekly fee. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 9 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) 6,7,8,9,10. Residents are provided with individual support and assistance specific to their identified needs. Supporting documentation and risk assessments are currently not sufficiently robust to reflect the support and supervision that residents receive. EVIDENCE: The acting manager has started to review the care plans so that they are reflective of individual needs, comprehensive in content, and have robust supporting information including risk assessments. Two were briefly inspected and contained more comprehensive information. The care plan of one resident was discussed with the member of staff who was the key worker to the resident. The staff member had a good knowledge of the residents and their needs and support they required. The care plan itself was not one which had been updated and was limited in content. Three issues were identified with limited action/intervention recorded. The care plan did not reflect any mental heath issues or strategies to prevent or detect relapse of mental heath problems. Residents have individual weekly activities planners, which details the rehabilitation and leisure activities to be undertaken by the resident with staff support. The risk assessments were also limited in content. In house reviews of the care plans are conducted every six months. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 10 The supporting documentation under the Care Programme Approach did include mental health problems, and, although the content was comprehensive the last review was not dated. Please see requirement 1. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 11 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 Residents are offered opportunities to participate in a range of activities both in the local community and in-house. Individuality, choice and preferences are respected. EVIDENCE: The majority of residents were spoken to over the course of the inspection. One gentleman was using his treadmill as the inspector arrived. It is his own treadmill, which he uses regularly to keep fit. The resident explained that he had been to Biggin Hill air show that weekend which he enjoyed. He spends time in the home and has occasional visitors. He said that staff support him with activities such as food preparation, care of his bedroom etc. Residents in this home opted not to have a group holiday but days out instead. Group and individual outings are organised. Recent trips had included a visit to Leeds Castle, Southend and a trip to the theatre. Residents have “freedom passes” which entitle them to free public transport. Three residents attend the day centres. One resident in the home must be accompanied by staff when out in the community; all others are safe to go out unescorted. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 12 Visiting is open and encouraged. Two of the residents are supported with their own shopping and food preparation. The home employs a cook who prepares the lunchtime meal. Every Sunday there is a roast dinner prepared by the staff. On Saturday evenings the residents choose from a takeaway meal and generally watch TV or a video together. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 13 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) 18,19,20. All healthcare is provided through the community provision, which for these residents is appropriate. EVIDENCE: The residents in this home are encouraged to be involved in the local community and develop daily living skills with staff support. Residents are registered with a local GP service, where they are encouraged to attend. The GP provides District Nurse support when required. All other health care is accessed via the local community including the optician, dentist and chiropody. One resident has recently received treatment through the physiotherapist. The acting manger has requested that an occupational therapist conduct an assessment on the home. The assessment is to explore ways in which the home could be made more suitable for those with declining mobility needs. The residents in this home are becoming older and mobility for some may become an issue. This is to be commended. The residents in this home are under the care programme approach (CPA), which means all have a responsible psychiatrist and regular reviews are conducted under this aftercare system. All aspects of the resident’s mental and physical health are discussed with the multi disciplinary team, the resident and the key worker, from there a care plan is agreed. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 14 Medications are supplied by a local pharmacist. The medication records contained a list of staff signatures and their initials. Residents’ photographs were in place and allergies recorded. The medications received and returned by the home were recorded. There were no gaps in the medication administration records. On some of the “as required” medications, fuller directions in respect of when to use, were needed. The directions should include reason for use, maximum dose and duration. Residents are encouraged to self-medicate where this is possible. This is on a staged process whereby responsibility is gradually increased to a level where the residents are fully responsible for their own medication. Please see requirement 2. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 15 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 Complaints in this home are taken seriously with investigations undertaken by appropriate staff. The home provides information and alternative avenues by which a person may raise a complaint. EVIDENCE: Community Options have a standard complaints procedure, which was on display in the hall. In addition there are standard forms, which work alongside the complaints procedure. Time frames, by which to address complaints, are detailed within the procedure as well as external avenues such as the CSCI. One complaint has been received by the CSCI regarding this service. This was referred to the home to investigate. Members of staff from the Head Office investigated this complaint, which was partly upheld. The inspector advised that the home should set up a log which details all complaints made, the action taken and whether the complainant was satisfied with the outcome of the investigation. This should be retained in the home for inspection. Some residents are without family or friends that visit. If the resident is agreeable then an independent advocate would be sought. Currently there is one resident who has this service. The independent advocate was organised through a local service and has visited the resident twice. Please see requirement 3. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 16 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) 24,25,26,27,28,29,30. In some parts, the home is not maintained to a satisfactory standard, due to the residents’ behaviour, and this remains an issue even with extra staff input and ongoing monitoring. EVIDENCE: The home is located on the High Street at Chislehurst. It is well served by public transport and close to local amenities. The home is a detached building spread over three floors. There is lift access to the first floor although not to the top floor which is the manager’s office. The home was cleaner than on the previous inspection, in particular toilets and bathrooms. The home has benefited from having a regular domestic supplied through the agency. There was some evidence of staining to the lounge carpet and to the skirts of the sofas, although regular cleaning and ongoing replacement of items are addressed. Bedroom accommodation is located throughout the two floors with communal space on the ground floor. There is a separate dining area and sitting room. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 17 The bedrooms inspected were to a variable standard. Some were tidy, clean and personalised. One room was particularly poor. This bedroom had been discussed at previous inspections. The acting manager explained to the inspector that staff routinely address the room cleaning, remove all items of food and waste and generally maintain it as best they can. The resident himself takes no part in either his own hygiene or that of his surroundings. This room is due to have the flooring replaced and redecoration addressed. The room was, even with efforts by staff, in a poor condition. Cigarette burns were evident to the carpet and the furniture. The room was dirty. Portable fans were in use in several areas including communal areas and individual bedrooms, these need to be risk assessed. Please see requirements 4 and 5. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 18 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) 32,33,35,36 Staff are provided in sufficient numbers, supported by experienced senior management and appropriately trained to undertake the work they do. EVIDENCE: Staff recruitment files are held at Community Options head office. The recruitment files will be inspected 14 October 2005. Currently there are two full time staff vacancies, which are covered with the use of regular bank staff. One newly appointed staff is waiting for her CRB clearance. One staff member, who had been in post two months, met with the inspector. She confirmed induction and had received training in medication procedures. She confirmed that she had been on a probationary period and in her personnel file, there was a report confirming this. The agency domestic met with the inspector. She works 10am – 2.30 pm Monday to Friday. She had been in post since March 2005. She confirmed that she had been orientated to the home and given instructions on the cleaning schedules. She was unfamiliar with the procedures relating to COSHH and the action to take in the event of a fire. This was raised with the acting manager 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 19 The staff training records were inspected. Staff had attended a number of training sessions and all five care staff have completed the NVQ 2. Training certificates for one staff member included TOPPS induction, management on medication, alcohol awareness, first aid, manual handling and several other resident related topics as well as those statutory training items. Some of the staff needed to have up dated manual handling as this had expired May 2005. The previous manager last conducted supervision. This is something that the new manager will recommence. Staff meeting are held regularly on a monthly basis, the minutes for the one conducted 30/8/05 were available. Community Options have just started a group covering their homes called a Recognition Group, which is looking at ways of valuing staff. This is to be commended. Please see requirement 6. Please see recommendation 1. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 20 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) 37,38,39,41,42 The acting manager demonstrated a level of competence and experience to effectively run the home. The home is operated in an open and transparent manner. Health and safety aspects are addressed through ongoing service contracts and maintenance. EVIDENCE: The manager for this facility has recently left. The acting manager, Ms Elliot, was on duty during the inspection. She is managing the home until the newly appointed manager starts mid September. The acting manager had previously worked at Sandford Road another Community Options facility. She demonstrated a good knowledge of the residents, their needs and the staff group. She was able to access all items requested by the inspector and gave feedback on recent developments and improvements. Ms Elliot has completed her NVQ 3 and is now doing her NVQ 4. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 21 A selection of health and safety records were inspected including those for hot water temperatures, lift service, portable appliance testing and the fire alarm system. All were found to be satisfactory. First aid boxes were appropriately stocked. One staff member confirmed that he had attended the four-day first aid training. A member of staff who is sufficiently trained in first aid should be on duty at all times. Quality assurance measures were inspected. Records relating to residents and staff meetings were available. Residents’ meeting minutes are available in the communal areas. Regulation 26 visits are conducted monthly unannounced and reports available. Community Options conducts an annual staff and residents survey to obtain feedback on the service they provide. The information is collated and the findings related back to staff. In addition the homes are part of the Investors in People quality assurance programme. 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 2 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 2 2 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 2 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 56 High Street Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 3 x 3 3 x G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 23 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 6 Regulation 15 Requirement The manager must ensure that care plan documentation is comprehensive in content, reflective of needs and has supporting risk assessments in place all, of which are kept under review. Previous time frame for action 31/1/05 The manager must ensure that full instructions are recorded use of as required medications. The manager must retain on site a record of all complaints made including details of investigation and the outcome. The manager must ensure that all parts of are maintained to a satisfactory level including bedrooms and communal areas. Previous time frame for action 31/12/04 The manager must ensure that portable fans are risk assessed to reduce possible injury. The manager must ensure that all staff training is appropriate to work that they do and that mandatory training is kept up to date. Timescale for action 31/10/05 2. 3. 20 22 13 22 31/10/05 31/10/05 4. 28 23 31/10/05 5. 6. 29 32 23 18 31/10/05 31/12/05 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 24 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 36 Good Practice Recommendations The manager should ensure that supervision is conducted six times a year 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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 56 High Street G51-G01 s6905 56 Hight St UI v241696 060905 Stage 4.doc Version 1.40 Page 26 - 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. 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