CARE HOME ADULTS 18-65
Jean Garwood House 25 Bramley Hill South Croydon Surrey CR2 6LZ Lead Inspector
Barry Khabbazi Unannounced Inspection 17th and 18th January 2006 8:45am Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Jean Garwood House Address 25 Bramley Hill South Croydon Surrey CR2 6LZ 020 8681 7338 020 8604 8904 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) Garwood Foundation Care Home 14 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Room number 11 is to be used for 1 respite bed. Date of last inspection 13th June 2005 Brief Description of the Service: Jean Garwood House is sited in a residential street close to the centre of Croydon on Bramley Hill. The house is fully registered as a residential care home for adults with physical disabilities and learning disabilities. Some residents visit their families at weekends and so the numbers in residence can vary at certain times. The ground floor of Jean Garwood House provides 11 single residents rooms. The shared rooms in the home consist of a lounge and dining room. Corridors in the home are wide and long and easily accessed by wheelchairs. Bathrooms are located either end of the long corridor, as are the toilets. All ground floor bedrooms exit onto a patio area that surrounds the house. The first floor has been converted into a semi-independent living unit for three people and has now been registered as such. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The key Standards identified throughout this report were all inspected at the last inspection. Please see that announced inspection report for a full audit of all the key Standards. This unannounced inspection therefore focused on following up on previous requirements and new issues arising, for example the change in management. The inspection was unannounced and started at 8.45 a.m to enable all the residents to be met before some residents went to their day activities. All the residents were met during this inspection. During this inspection the Director and new Deputy manager were also met and the Deputy manager was interviewed. Records, policies and care plans and the building were examined. Timescales for previous unmet requirements have been extended to give the new management a chance to implement them. However, they will not be extended again. What the service does well: What has improved since the last inspection?
The gas safety certificate has been sent in to the Commission to confirm the safety of the gas supply. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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): 3 and 5. Although the home meets the needs of its main client group well, staff do not have the training required to meet the needs of those residents with an acquired brain injury. The residents’ rights are not fully enhanced through their contract with the home. EVIDENCE: Staff have had training sessions regarding cerebral palsy and on the philosophy of care. Some staff can use some Makaton signing and a phrase book is being set up. Access to advocacy is available and information about this is held by the social worker also based at the day centre. Last year’s announced inspection report recorded the following: ‘The home has admitted a service user with a brain injury and no congenital learning disability, unlike the other service users. This service user will require different skills from staff i.e. re-learning former skills as opposed to learning new skills as with the current client group. The following requirement is therefore set. The home must provide evidence to the Commission that the staff team are adequately trained in the field of brain injury and associated rehabilitation.’ This had not occurred. This requirement therefore remains in force. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 9 The last inspection report contained a recommendation for the contract to contain the elements of the care plan to be met outside the home through other resources. This had not occurred. This requirement also remains in force. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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, Residents’ assessed needs and changing needs are recorded to ensure that these needs are known and can therefore be met by staff. However, residents could be better supported to make decisions about their lives if the care plans were in a more accessible format. EVIDENCE: The 2002 announced inspection contained a requirement regarding daily notes and key-worker notes. Monthly key-worker reports are now being produced and the daily notes are more detailed. This was the case at the last unannounced inspection and has been maintained since. This requirement was previously met but should also continue to be monitored. The last announced inspection report contained the following recommendation: Care plans should be translated into more accessible formats for the residents This had started but needs to conclude. This recommendation will remain in force until such time. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 the following standard(s): 17 Residents are offered a healthy diet and have choices in meals offered. EVIDENCE: Mealtimes in the evening and morning have been frequently observed and are always presented in a clean and congenial setting. Meals were unrushed and residents can take as much time to eat, as they want. Meals are regular and menus appeared nutritiously balanced. There was a lively and fun atmosphere, with service users joking and laughing with each other and staff in a friendly manner. The residents design the menu themselves and are able to take meals at flexible times and are also able to choose alternatives. Residents are actively encouraged to be involved in the preparation of meals. Snacks and drinks are available at all times. Nutritional monitoring and dietician support occur where required. A pictorial menu is being developed, see recommendation under Standard 40. A bag of ham was found in the fridge with no date of opening recorded. To put things in perspective, the fridge was clean, this was the only unlabelled item and the deputy immediately threw it away as its age could not be determined. The following requirement is set: Refrigerated and frozen food items must be labelled with the date of opening.
Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 12 One resident has said that the positioning of the pay phone was in a busy area and not sufficiently quiet or private. As other telephone options are available it is suggested only at this stage that options to improve privacy for residents’ phone usage should be explored. Evidence of current good practice presented {Standard 14}: The home has been one of the first to achieve funding agreements for holidays. In addition these are realistic holiday funding figures. The residents have raised the good frequency and good quality of outings. Residents have also raised the good food, good access in the home, and that they were happy at this home. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 the following standard(s): These standards were all assessed as met at the last inspection and were not re-assessed at this follow-up inspection. Please see that inspection report for details. EVIDENCE: Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 all assessed as met at the last inspection and were not re-assessed at this follow-up inspection. Please see that inspection report for details. EVIDENCE: Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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): 30. The home is hygienic and clean, homely and comfortable. This environment therefore facilitates the residents’ health and emotional well-being. EVIDENCE: The building is always particularly clean and tidy at both announced and unannounced inspections. This was also the case at this unannounced inspection. The home gives the impression of a clean and hygienic home. The home has specific policies covering the disposal of clinical waste, control of infection, use of cleaning materials, storage and preparation of food, and dealing with spillages. Protective clothing was observed to be present. Laundry facilities have easily cleanable non-permeable floors and easily cleanable walls. Washing machines have appropriate programmes over 65 degrees to control risk of infection. The laundry room is positioned so that laundry does not need to be carried through the kitchen. Evidence of current good practice presented {Standard 28}: Shared communal spaces exceed the National Minimum Standard. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 16 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): Residents’ needs are not well met by appropriately and fully trained staff. EVIDENCE: The 2004 inspection report contained the following requirement: All staff recruited since April 2002 must undertake six month foundation training to Sector Skills Council workforce training targets and both this training and the induction training must be evidenced. Although this is being set up this has still not occurred and staff therefore still do not met minimum induction and foundation training requirements. This requirement remains in force and further action will be considered if not met by the new extended timescale. The above is reflected with a Standard rating of 1. {A major shortfall}. Potential area of good practice: Service users have access to additional specialist staff. A social worker is employed and based at the day centre. The home may wish to evidence the positive outcomes of these for the residents, for consideration for inclusion as good practice in the next report. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 17 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): 39 and 42 The home’s quality assurance system generally involves the residents and relatives, and provides feedback to them, to allow them to be involved in improvements and measure improvements in the home for themselves. The health and safety, and welfare of the residents is generally promoted and protected. EVIDENCE: The home’s registered manager has left since the last inspection. Since that time the organisation has speedily recruited to the vacant management posts. The previous Deputy has been appointed to the manager’s post and will be registering with the Commission as the new registered manager. A new Deputy has been appointed to the Deputy manager’s post. This Standard will be assessed in detail at the next inspection when the new staff will have had a chance to settle in. The last inspection report contained the following recommendation. The home should continue to translate policies relevant to the residents into more accessible formats. This is happening with new pictorial staffing rotas
Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 18 and fire evacuation procedures but needs to continue for activities, menus and some policies that are relevant to the service users, for example, access to files policies. The recommendation therefore remains. The last inspection report contained the following recommendation: The new satisfaction surveys need to be sent to relatives and residents. This has not occurred and the recommendation remains. The last inspection report contained the following requirement: The registered person must send a copy of the up to date gas safety certificate to the Commission. This has occurred and this requirement is now met. Evidence of current good practice presented {Standard 37}: The home has recruited swiftly to its vacant management posts which minimises disruption caused by staff changes for the service users. Evidence of current good practice presented {Standard 43}: The home was previously not financially viable. However it achieved an over 40 increase in funding following the first annual inspection identifying the shortfall. This is a major achievement and should result in positive outcomes for the residents placed through better funding of the service. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 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 Standard No Score 1 X 2 X 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 x 34 x 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x x x x x x x x x Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 20 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 YA3 Regulation 18(1) Requirement The home must provide evidence to the Commission that the staff team are adequately trained in the field of brain injury and associated rehabilitation. {Previous timescale of 1/10/04 not met} Refrigerated and frozen food items must be labelled with the date of opening. All staff recruited since April 2002 must undertake six month foundation training to Sector Skills Council workforce training targets and both this training and the induction training must be evidenced. {Previous timescale of 1/10/04 not met} Timescale for action 01/04/06 2 3. YA 17 YA35 13[3] 18(1a&c) 01/02/06 01/04/06 Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 21 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. 3. 4. Refer to Standard YA5 YA6 YA39 YA40 Good Practice Recommendations The contract should contain the elements of the care plan to be met outside the home through other resources. {From the May 2003 inspection} Care plans should be translated into more accessible formats for the residents. The new satisfaction surveys need to be sent to relatives and residents. The home should continue to translate policies relevant to the residents into more accessible formats. Jean Garwood House DS0000025802.V278798.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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