Inspection on 30/12/05 for Jane`s House

This inspection was carried out on 30th December 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jane`s House 31/05/07

Jane`s House 01/06/06

Jane`s House 15/06/05

Jane`s House 07/10/04

Jane`s House 23/04/04

Jane`s House 20/01/04

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

CARE HOME ADULTS 18-65 Jane`s House 89 Barrow Road Streatham London SW16 5BP Lead Inspector Lynn Hampton Unannounced Inspection 12:15 30 December 2005 th Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 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 Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 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. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Jane`s House Address 89 Barrow Road Streatham London SW16 5BP 0208-677-6196 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) Jane`s House Limited Ms Chan Bisessar Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2005 Brief Description of the Service: Jane’s House provides long term care for people who have enduring mental health problems. There are currently five male residents, although the home has accommodated a mixed gender group since opening in 1990. The home is situated in a residential street off the main road leading to Streatham High Street, and is close to public transport routes, shopping and leisure facilities. It is a semi-detached house on four floors, and blends in well with other houses on the same street. The registered manager owns the property and also owns two other small homes nearby. The philosophy of care states: “The home is flexible with care and support provided as required by anyone who has suffered mental ill health”. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in the afternoon of a weekday, 30th December 2005, and lasted three hours. During the visit the inspector met the registered manager, and one of the care staff. A range of documents was examined and a tour of the building took place. The inspector met four of the five current residents, and spent time with two of them. Residents have differing levels of communication skills, although they were able to indicate their opinion about the service provided at the home in different ways. What the service does well: What has improved since the last inspection? The staff and residents of the home remain stable, and no changes have been made to the home since the last inspection. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 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 Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 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): These standards were not assessed at this inspection visit. All five were assessed at the last inspection visit (June 2005), and were found to be met. EVIDENCE: Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 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 the following standard(s): 6, 8, 9 Case files contain details of service users’ needs, and reviews, which included promoting independence. Service users are consulted about their preferences and routines in the home. EVIDENCE: Case files seen by the inspector had care plans in place that covered health issues as well as emotional and personal development. Action plans were clearly linked to identify areas of need. There were records of reviews, including recent Care Programme Approach meetings, and CPA documentation included a Crisis Plan. Files contain ‘Monthly Review’ sheets, for each person’s care to be commented upon, with details of progress and significant events recorded. However, some of these had significant gaps and it is recommended that this be monitored by the manager to promote completion. Case files contained information relating to promoting independence, including using public transport, self-care, and attending activities outside the home. Relevant risk assessments are in place. Residents are able to come and go from the home as they choose, and to make drinks or snacks throughout the day. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 10 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): 15, 17 Service users are supported in developing and maintaining personal relationships. Meals provided are of a good standard, but choice and variety could be improved. EVIDENCE: At the commencement of this inspection, four of the five current residents were at home. Two were in the dining area playing a board game together; one was listening to music in his room, and the fourth was in the conservatory area that is used as a smoking room. Residents looked to be relaxed and ‘at home’. The home supports and encourages residents to develop and maintain personal relationships in a number of ways. Care plans address social relationships specifically, and outline how staff would support residents to improve skills and have opportunities to meet other people. The manager told the inspector that she arranged for a Christmas party every year, at one of the three homes. Contact and friendships between the residents is encouraged, and it was reported that they enjoyed the party. One resident said that he particularly Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 11 enjoyed being able to meet other people, and that he valued having made friends in the home. One resident was visiting his family for the Christmas period. The manager told the inspector that another resident had recently had contact from his family for the first time, which had meant a lot to him, and staff were supporting him in this. Two residents helped to lay the table for lunch. A member of staff was cooking the meal and was also baking homemade cakes for the residents. She informed the inspector that the residents had asked for lunch to be served at 12.30, earlier than usual, and this was being done. The lunch consisted of ample portions of burger, chips, parsnip, peas and sweetcorn, with pineapple for dessert. Fruit and biscuits were available in the dining room. One resident commented that the food at the home could be improved. The resident concerned does not like red meat, so he may not have liked that day’s meal of burgers. A record of meals is kept on each person’s file, although there were gaps in the records seen. These indicated that a range of meals was offered, although many of these included prepared items such as burgers and chicken sausages. The Manager was fully aware of this resident’s food preferences; she reported that he will eat whatever is put in front of him but may comment later that he did not like it. It was unclear to the inspector how residents are consulted about meals, and this was discussed at length with the manager. It was acknowledged that preparing one meal for five people could be difficult as they will have different tastes/preferences, or they may choose options that are not considered to promote healthy eating. The manager reported that residents are offered a choice on the day, and may choose options that are not healthy or not varied. Ways in which this could be approached to encourage wider options were discussed, as if residents are offered an option on that day, they will be limited to what can be prepared quickly – which could mean something cooked directly from the freezer, such as burgers and sausages. Consideration should be given to improving this, such as preparing individual profiles of meals that each resident does like, so that staff have a range for them to choose from. This may also allow staff to ensure that fresh ingredients are available in advance. The manager reported that some residents are able, and are encouraged to assist with food preparation, within the limits of their mental health problems or abilities. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 19, 20 Service users’ health care needs are monitored and appropriate action taken to address problems or changes. However, this needs to be more fully recorded in user’s case file records. Errors in medication recording were found, as had been identified at the time of the last inspection. These must be addressed as a matter of priority, and action taken if service users do not receive medication due. EVIDENCE: The manager demonstrated an in-depth knowledge of the residents, their health, and care support needs. Case files that were seen by the inspector identified health issues, and there were records of medical appointments. One resident’s file noted that there had been concerns about weight loss. It was not clear from record what being done about this, although the manager was able to describe to the inspector what action was being taken, and reported that the resident had recently gained weight. Reasons being investigated for the problem included possible links to recent faecal incontinence, but again this was not clearly documented on the case record. This was discussed with the manager, and a new Requirement is made that case records are reviewed to ensure that they are fully up-to-date with details of residents’ health, particularly where there may be changes or concerns. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 13 A Requirement was made in the report of the last inspection that the registered person must ensure that staff complete all medication records fully and accurately at the time of administration, including reasons for nonadministration. Also, that the registered person must make sure all medication received is recorded accurately at the time of receipt and a running total is kept on the medication sheet. A record book of medication received from the pharmacy is kept, and at the end of the month, a member of staff checks the balance of tablets and this is now recorded on the medication charts. This was checked by the inspector, and the balance did not correspond with stocks held. One medication count appeared to be one tablet out, although it was quickly noted that this was because the morning dose had been administered and not signed for. Medication must be signed for at the time of administration. A second medication was checked, and the balance did not tally with the record. It appeared that more tablets had been dispensed by the Pharmacy, and received by the home, than was recorded in the Medication Received book, or the medication tally on the chart. One resident’s chart did not indicate that the medication had been administered. The manager explained that the resident refused this medication. A code (usually ‘R’ for refused) should be entered to indicate that this was the case, which will enable staff to monitor the situation and take action to ensure that he is receiving adequate medication levels. Finally, it was noted that medication had been signed for as administered, on the chart of the resident who was visiting his family at home. He had in fact taken the medication with him to self-administer. In these cases, staff should not sign to indicate medication as given. This was discussed with the manager, who demonstrated an awareness of the issues involved, and outlined steps that he would take to address the situation. See Requirements. Continuing non-compliance with Requirements relating to medication records will lead to consideration being given to Enforcement Action. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 14 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): These standards were not assessed at this inspection visit. Both were assessed at the last inspection visit (June 2005), and were found to be met. EVIDENCE: Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 15 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, 25, 26, 27 Service users live in a homely environment, with adequate communal as well as individual space. The home is furnished in a domestic style, but would benefit from a programme of redecoration as some areas (particularly the bathing facilities) are showing signs of wear and tear. The manager has reported to the Commission that there are plans to improve the bathroom facilities, which will benefit the service users. EVIDENCE: Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 16 The home is a semi-detached house, laid out over four floors. The layout and number of stairs in the home mean that it is not suitable for people with mobility problems. The ground floor consists of a large comfortable lounge, which leads into a small conservatory/smoking area; a kitchen, which leads into a large dining area; and one resident’s bedroom. A small paved patio and garden area is to the rear of the home. The laundry facilities are located in the basement away from where food is prepared and eaten. There is one bathroom and a separate toilet on the first floor and a toilet on the ground floor. Five people share these facilities. The manager has informed the Commission that there are plans to make one bedroom smaller and use the space to install another bathroom, which would bring the home into line with recommended standards for newly registered homes. At the time of the last inspection, the registered provider was reported to be discussing the changes with the service user and their family. All service users have single rooms, which are spread out over all floors. The inspector saw three bedrooms used by residents. Two of these were very spacious and exceeded minimum space requirements. One of the rooms is less than 10sq metres but this is noted in the statement of purpose. Each was personalised to reflect the interests and tastes of the residents, in terms of equipment such as music centres, artwork and music. There are two staff offices at the top of the home. A Requirement was made in the report of the last inspection that the registered person must replace the stair carpet. The manager confirmed that this had been fitted 2 – 3 weeks ago. This Requirement is met. A Recommendation was made in the report of the last inspection that the hall and stairs would benefit from being redecorated. The inspector found that the decoration in the hallway is of a reasonable standard in most places, although edges and areas around banisters were showing signs of wear and tear. The manager felt that the hallway did not need to be fully redecorated, but acknowledged that some areas would benefit from being tidied up or made more presentable. The inspector and manager discussed issues around the redecoration and maintenance of the home. Although the home is decorated in a domestic style throughout, furnishings and decorations were worn in several places. Ornaments and pictures throughout the home did not reflect the culture or interests of the residents. The smoking area was sparsely furnished and the corrugated roof was stained. The bathroom and communal toilet next door were shabby and in need of redecoration, including replacement of tiles. The manager acknowledged this, and outlined how it was hoped to prioritise redecoration, starting with the bathroom, and gradually upgrade decorations throughout the home, subject to budgetary considerations. A new Requirement is made that a programme for this is drawn up and submitted to the Commission. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 17 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): 35 Staff are undertaking a range of training courses relevant to the care that they provide, but this needs to be fully documented on records held in the home. EVIDENCE: Records of staff training showed that they had undertaken a range of training that included medication, infection control, First Aid and a range of care subjects such as managing aggressive behaviour, risk assessment, abuse and protection. However, records held at the home indicated that the majority of this had been undertaken in 2004. The manager reported that most staff were undertaking NVQ 2 or 3, and the records must be updated to demonstrate this. See Requirements. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 18 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, 38, 42 Service users benefit from a well-run home, and the manager provides clear leadership. Systems are in place to address Health & Safety issues. EVIDENCE: The manager demonstrated a clear understanding of the needs of the service users, and her responsibilities in ensuring that the home met registration standards. There was evidence that the service users benefited from the ethos of the home, and those that were able to express an opinion to the inspector were positive in their comments, and clearly indicated that they liked living there. Interaction between staff and residents was warm and appropriate. Records were in place that indicated that Health & Safety checks were undertaken regularly, and a valid Certificate of Employer’s Liability Insurance was on display. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 19 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 X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Jane`s House Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 X DS0000022736.V263252.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 YA17 Regulation 16(2)i Requirement The Registered Person must review meal planning and preparation in the home, to promote choice and healthy meal options for service users. The registered person must ensure that staff complete all medication records fully and accurately at the time of administration, including reasons for non-administration. Previous timescale of 12/10/05 not met. Continued non-compliance will lead to consideration being given to Enforcement action. The registered person must make sure all medication received is recorded accurately at the time of receipt and a running total is kept on the medication sheet. Previous timescale of 12/10/05 not met. Continued non-compliance will lead to consideration being given to Enforcement action. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 21 Timescale for action 01/04/06 2 YA20 13(2) 01/02/06 3 YA20 17(1)a 01/02/06 4 YA24 23(2)b&d 5 YA27 23(2)d&j 6 YA35 18(1)c The Registered Manager must 01/04/06 develop a written plan, with indicative timescales, which will set out a programme of redecoration for the home. This should indicate how service users will be consulted and/or involved in the plans. To be submitted to the Commission by 1/4/06 The Registered Manager must 01/04/06 carry out repairs and redecoration to the bathroom and toilet on the first floor of the home. The manager must inform the Commission in writing of plans in respect of these facilities by 1/4/06, and include timescales for work to be undertaken. The Registered Manager must 01/04/06 ensure that records of staff training are accurate and kept up to date. 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 YA6 Good Practice Recommendations The Registered Manager should ensure that Monthly Reviews on case files are completed regularly on a monthly basis. Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Jane`s House DS0000022736.V263252.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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