Inspection on 14/03/06 for La Rosa

This inspection was carried out on 14th March 2006.

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 36 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

La Rosa 28/08/08

La Rosa 20/08/07

La Rosa 05/07/06

La Rosa 21/11/05

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

CARE HOME ADULTS 18-65 La Rosa La Rosa 97 Babington Road Streatham London SW16 6AN Lead Inspector Sonia McKay Unannounced Inspection 14th March 2006 09:00 La Rosa DS0000065081.V286502.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 La Rosa DS0000065081.V286502.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. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service La Rosa Address La Rosa 97 Babington Road Streatham London SW16 6AN 020 7787 9694 020 8835 0981 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) Mrs Parvadee Shumoogam Mr Radhakrisna Sookur Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st November 2005 Brief Description of the Service: La Rosa is a private residential care home that provides 24-hour care and support for three adults with mental illness. The home is situated in a residential area, close to high-street shopping and transport links. The home opened in September 2005. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of the second inspection of La Rosa. The inspection involved talking with both service users currently living in the home, a member of staff and the registered manager. Records relating to care needs assessment, care planning, health and safety, staffing and the running of the home were examined. There was also a partial inspection of the home environment and garden. What the service does well: What has improved since the last inspection? What they could do better: New staff must be inducted and must not work alone in the home before full recruitment checks have been completed. There is high staff turnover and some staff are working too many hours consecutively because of staff shortages. Medication handling and staff training in this area must be improved to ensure service user safety. There must be clear guidance on the nature of support that a service user requires. This must include careful consideration of whether a service user requires support with accessing the community, managing financial affairs and medication. Record keeping in the areas of induction, recruitment and medication must be improved and the home manager must ensure that accurate records are kept of the time he spends on duty in the home. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 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. La Rosa DS0000065081.V286502.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 La Rosa DS0000065081.V286502.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): 1, 2, 3, 4, 5 & 6 Prospective service users have the information they need to make an informed choice about moving to the home and have opportunity to visit and test drive the service. Prospective users individual aspirations and needs are assessed prior to admission, although there is slow progress in addressing goals and identified needs in some cases. Each service user has an individual written contract stating the terms and conditions of living in the home. EVIDENCE: There is an informative ‘Statement of Purpose’ and a ‘Service Users’ Guide’ to the home. The home provides long-term placements. There is opportunity for visits and overnight stays. This allows the referred person to experience life in the home before making a positive choice to move in for a trial period. Two service users have been admitted to the home. One service user confirmed that he visited the home before making a decision to move in. Care records show that the manager attended review meetings prior to this admission to assess the suitability of the placement. A care plan is in place and is in accordance with the social work placement review meeting recommendations. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 9 Interactions between the member of staff on duty and the service users provided evidence of established and effective communication. Information about local advocacy services is available on a display of reading materials in the communal lounge. One of the service users requires significant staff assistance with healthcare, medication and financial affairs. His medication is not being administered correctly and the nature of assistance he requires with financial matters is not documented. (See requirements 1, 2, 3, 4, 5, 6 & 8) Although the service user is registered with a local GP his mental health care has not yet been transferred to the local community mental health team. A placement review is scheduled and the home manager has requested that this essential transfer be affected as soon as possible. Service users have a contract of service and occupancy. The service user and the registered manager sign these contracts. La Rosa DS0000065081.V286502.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, 7, 8 & 9 Individual care plans are in place and set clear objectives, however, progress with meeting these objectives is slow in some areas and some areas of need are not addressed. Careful multi-disciplinary consideration must be given to the decisions made by, and the rights of, one service user who is deemed by staff to be unable to manage his financial affairs and personal health and safety. EVIDENCE: Written plans for care are in place for each service user and include an overall risk assessment and risk management/contingency plans. Each service user has a key worker and key worker/service user meetings are held regularly (although one key worker has recently ceased employment in the home and is yet to be replaced). There is a record of these meetings that also includes a monthly progress report. Both parties sign these notes. One service user said that he is in agreement with the arrangements in place. He is assessed as able to continue to self-medicate and attend day services independently. The social services placement plan identifies rehabilitation as the placement aim. Steps have been taken to include elements of La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 11 rehabilitation in the in-house care plan as required in the previous inspection report. The most recently admitted service user has an initial care plan setting out clear objectives to be achieved by the end of March 2006. There has been little progress with meeting these objectives at the time of this inspection. For example, there has been no referral to an OT to assess for specialist equipment (a bed and chair) and the service user has not registered with a dentist, chiropodist, optician or local community mental health services. (See requirement 5) This service user may need considerable support to make decisions. He is refusing to withdraw any of his state benefits, which are paid directly into his building society account. His cigarettes are held by staff on duty and are paid for by the registered provider. The service user is identified as being at risk of developing smoking related illness and staff are restricting his cigarette intake as a preventative measure. This has led to an incident of aggressive behaviour and during the inspection the service user was observed to ask staff repeatedly for a cigarette. The service user has refused to attend smoking cessation clinic appointments. The service users building society book is being held in safe keeping by the registered provider. The home manager was unable to access the building society book, which is locked in a safe in the office. There are no records kept of the whereabouts of this bank book or of the amount of money held in the account. The registered provider arranged for the safe key to be made available during the inspection so that the bank book could be examined. There have been no cash or cheque withdrawals made from the account since the service user moved to the home in December 2005. The home manager said that the registered provider is currently purchasing toiletries and personal items for the service user as necessary, but there are no records available of these purchases. This arrangement must be reviewed and any reasons for, and manner of, financial support must be documented and regularly reviewed. Purchases made on behalf of a service user must be documented and receipted. (See requirements 1 & 2) Given that the service user is presently legally entitled to access/manage his own finances, and could, in theory, buy his own cigarettes, it is essential that the difficult issues of capacity, choice and risk be discussed with the service user and the relevant disciplines involved in his care in the service users best interests. Decisions made in these forums must be documented in the care plans and risk assessments. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 12 (See requirement 3) There have been two incidents of the service user going missing/getting lost whilst out in the community alone since he moved into the home in December 2005. Both incidents resulted in hospitalisation. On one occasion he was admitted to hospital suffering from hypothermia. The home manager said that staff try to go out with the service user to prevent him getting lost as he has poor memory and becomes confused at times. This can only be facilitated when two members of staff are on duty (this presently only occurs for a maximum of six hours during the weekday daytime period when the home manager is available). At other times the service user is encouraged to tell staff if he is leaving the building and where he intends to go. During the inspection a member of staff went out for a short local walk with the service user. The manager said that the service user carries ID but does not know if he carries a bus or travel pass. (See requirement 4) Minutes of the discussions held with service users in monthly house meetings and service users household chore rosters are in place. These provide evidence that service users are being involved in decision-making and being encouraged to take responsibilities for some of the housekeeping/cleaning tasks. Although the registered provider buys the bulk of the food shopping, one of the service users is given a small quantity of cash to buy extra provisions during the week if needed. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 13 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): 11, 12, 13, 14, 15, 16 & 17 Service users who require less support have access to opportunities for personal development, community involvement and a range of activities. Service users who require a higher level of support have restricted access to, and opportunity for, a fulfilling lifestyle. EVIDENCE: Information about local college courses and specialist services is available in the communal lounge. One service user living in the home has been able to continue with activities engaged in prior to entering the home. These activities include attending daytime social groups and skills development sessions at a daycentre. The service user is familiar with the local area and transport links. He visits members of his family on a regular basis and is being encouraged and supported by staff to re-establish other family links. The other service user has no structured daytime activities, and although he has applied to a day service, he cannot be considered for placement until his mental healthcare is transferred to a local community based team. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 14 Both service users like to spend some of their leisure time with staff, for example, in-house activities such as movies and board or card games, and trips out of the house for walks and to the cinema. There is no petty cash or activities budget available. This would be of great benefit to key workers and the home manager and enable them to plan trips in advance. Staff currently spend their own money and are reimbursed by the registered provider. Opportunities for community involvement for one service user are restricted by current staffing arrangements and lack of money. (See recommendation 1 and requirements 1, 3 & 4) Although there is a four-week rolling menu programme available, as there are only two service users in residence a daily choice of meals is prepared. Records are kept of these meals. The records show that a range of meals have been prepared, including culturally appropriate dishes. The service users are encouraged to assist staff to cook and both service users said that they enjoyed the meals provided. Food shopping is done in bulk by the registered proprietor. It is recommended that service users be involved with shopping for food provisions to develop shopping and budgeting skills and aid rehabilitation in a more formal manner. (See recommendation 2). La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 15 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): 18, 19 & 20 Service users receive personal care in the way that they prefer and require. The physical and mental health needs of one service user are not being met and the homes handling of medication does not provide service users with adequate protection or promote good healthcare. EVIDENCE: Service users are able to maintain their own personal care, receiving only verbal prompting and assistance to set baths if necessary. One service user is assessed as needing input from an occupational therapist in regard to assessment of the need for a specialist bed and chair. The home has not arranged this referral. The service user has not seen a psychiatrist or CPN since moving to the home in December 2005, and the manager has expressed concerns about his mental health. There is also concern that the service user has refused to attend outpatient appointments for essential blood tests to monitor levels of medication. The service user has not registered with a dentist or optician. The home manager said that a placement review is scheduled where it is hoped that these matters will be discussed and resolved. (See requirement 5) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 16 One service user is self-medicating. A risk assessment is in place in regard to self-medication. Staff monitor compliance in accordance with the written care plan. A lockable cabinet is available in the service users bedroom to store a weekly supply of tablets. The other service user requires staff assistance to obtain and take his medication. Medication stocks are stored securely in a lockable wall mounted cabinet in the staff office. Examination of stocks and records show that the home has failed to commence the administration of topical medications prescribed on 27 January 2006 and 24 February 2006. (See requirement 6) There is no record of the collection of these items from the pharmacy, the reason they are prescribed or how/where/when they are to be applied. (See requirement 7) In addition, the service user has an unlocked medication cabinet in his bedroom, where two other topical medications and a prescribed inhaler are stored. (See requirement 8) There are no home remedies (over the counter medications) in stock. This would be of use if a service user developed a headache or toothache during the night. (See requirement 9) There are no regular and justified checks on MAR charts and stocks of prescribed and homely medication. (See requirement 7) There is no information available about possible side effects or the reasons that individual medications are prescribed. (See requirement 10) There is a medication policy that includes staff administration of medication and self-medication. Four members of staff were due to attend training in the safe handling of medication, as required in the previous inspection report. Unfortunately, three of the staff have since ceased employment in the home. The registered person must confirm all staff administering medication have undertaken training that includes a competence assessment and that arrangements are in place to train new staff in the safe administration and handling of medication. (See requirement 11) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 17 A sample signature of trained staff is not maintained in the medication administration records. (See requirement 12) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 18 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 complaints procedure is adequate. Service users have not been adequately protected from potential abuse. EVIDENCE: There is a complaints procedure in place. There have been no complaints made. One service user said he felt confident to raise any complaints or concerns with staff or during regular key work or house meetings. Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing) to ensure the safety and protection of service users. There are adult protection procedures in place that include dealing with aggression and service users finances held in safekeeping. However, the procedures in regard to the safeguarding of the finances of one service user have not been followed. (See requirement 2) On examination of staff duty rosters and recruitment records there is evidence that staff with only a POVA First check in place are working alone, including providing night cover. This is unsafe practice. An immediate requirement was issued and the home manager took steps to revise the staff rota immediately. Staff recruitment records do not contain adequate references or proof of address. (See requirements 13 & 15) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 19 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, 28, 29 & 30. Service users live in a homely, comfortable and safe environment with bathrooms that meet the modern expectations of service users. Shared spaces complement and supplement service users individual rooms. Bedrooms do not meet national minimum standards in regard to fittings and furniture in all cases. EVIDENCE: The large home is clean, comfortably furnished and well decorated. All bedrooms are single occupancy and there is a choice of bedrooms available. The ground floor has a sitting room, small staff office, small kitchen, dining/sitting room and access to a back garden. There are toilet facilities and a small laundry area. The first floor has four bedrooms, three with en-suite facilities. There is also a bathroom. The second floor has three bedrooms, two with en-suite facilities and there is an additional bathroom with a shower unit. There is also a staff room. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 20 One occupied bedroom was seen during this inspection. The room did not have any chairs or an external television aerial socket. The service user may also need assessment by an occupational therapist to ensure that his bed and any chair provided are appropriate and meet his individual needs. (See requirements 5 & 14) Both service users said that their bedrooms are comfortable and warm enough. Bathrooms and toilets are fitted with appropriate privacy locks and hot water is regulated to within safe temperature limits. The safety of unguarded radiators and hot central heating pipes must be assessed if any service user who experiences falls, epileptic seizures or blackouts of any sort is admitted to the home. (See recommendation 3) The LFEPA inspected the home in December 2005. Two requirements were issued and both have been addressed. A fire door has been fitted to the laundry room and a lock has been fitted to the door leading to the basement staircase. A recommendation was made for automatic door closure mechanisms to be fitted to doors to prevent them being wedged open. Although fire doors were not wedged open during this inspection, this action is recommended as a precaution. (See recommendation 4) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 21 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, 33, 34, 35 & 36. There is a high staff turnover and a shortage of staff that is a serious concern. Recruitment practices do not provide service users with adequate protection and staff induction and the training and development needs of current staffing must be re-assessed. EVIDENCE: Staffing levels reflect the fact that there are only two service users living at the home. One member of staff is on duty at all times. There is a lone- working policy and procedure in place. The homes statement of purpose contains an organisational structure. This shows that one deputy manager; six day carers and four night carers are to be employed. The deputy manager and four members of staff have recently resigned. This represents high staff turnover in a small home and has adversely affected consistency, continuity of care and staff training plans. The registered provider also works in the home on a regular basis. Staff duty rosters and the staff signing-in book provide evidence that staff have been working long hours in the home without a break. For example, one member of staff worked continuously for 30 hours on two occasions and other members of staff are regularly working for 24 hours without a break. The home manager said that this is because of staff shortages. (See requirement 16) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 22 Recruitment records do not include all of the documents required by legislation. For example, references and proof of address are missing in some cases. (See requirement 15) Staff without full enhanced criminal records bureau checks have been working alone in the home. An immediate requirement was issued on the day of the inspection and the home manager took immediate action to revise the staff duty roster. (See requirement 13) Staff contracts of employment do not specify the number of hours that an individual is contracted to work. (See requirement 17) The induction records for staff recently employed were not available. (See requirement 18) Team meetings are held each month and supervision meetings are held with each member of staff on a regular basis. However, new members of staff (without adequate checks) have not been appropriately supervised. (See requirement 13) A member of staff spoken with during the inspection was confidant in the out of hours on-call service in place and said that the registered manager and registered provider were easily contactable in an emergency. There is a staff training plan for 2005-2006 in place, but it does not reflect recent changes in training plan revised accordingly. (See requirement 19) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 23 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, 41 & 42 The manager is qualified and experienced but must review his management approach to ensure clear leadership and open and transparent management. Record keeping practices must be improved to ensure service user safety and home accountability. EVIDENCE: The registered home manager has relevant experience and qualifications (RMN/RGN/Dip/SW & CMS). He is currently undertaking a registered managers award (RMA). The home manager said that he aims to be in the home for 30 hours each week. This is generally between Monday and Friday. Staff signing in records do not provide evidence that the manager is available in the home for 30 hours each week, and the manager explained that he has other work commitments to attend to during the week. The manager also agreed that the staff duty rosters in place are not an accurate account of his presence in the home as his working hours vary each day/week. La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 24 Staff on duty were unsure of what time he would be arriving on the day of the inspection. He arrived at 11a.m, but was on the staff duty rota for a morning shift that commences at 8am. This is unsatisfactory and does not communicate clear leadership and direction or an open and transparent process for the management and running of the home. (See requirement 20) Health and safety checks include: • Daily COSHH checks • Weekly bedroom checks • Fridge and freezer temperature checks • Hot water temperature checks • Fire alarm call point testing Sharp knives are risk assessed as needing to be kept locked away when not in use. Fire evacuation drills are conducted with the required frequency and the results recorded. The main electrical circuitry was safety tested in May 2005. Small electrical appliances supplied by the home are mostly new as the home has recently opened. However, service users have bought their own electrical appliances into the home and these items are not new in all cases, so should be safety tested. (See requirement 21) La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 25 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 3 2 3 3 2 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 1 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 1 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 X 3 1 X X 1 2 X La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 26 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 Regulation Requirement Timescale for action 05/05/06 YA14YA16YA7YA6 15(1) 12(1)(b) 2 YA41YA7 17(2) Sch 4(9) 3 YA13YA16YA7 17, 12 Sch 3(3)(q) The registered persons must ensure that each service user has a written plan of care that clearly sets out identified support needs. This must include the level of assistance required with medication, financial affairs and budgeting and restrictions on choice or freedom. The registered persons 28/04/06 must ensure that accurate and detailed records are maintained, and available for inspection, of all financial transactions made on behalf of any service user and of any valuables held in safe keeping by staff. The registered persons 19/05/06 must ensure that service users human and legal rights are maintained. Restrictions imposed for one service user in regard to smoking Version 5.1 Page 27 La Rosa DS0000065081.V286502.R01.S.doc 4 YA13YA9 12(1) 13(4) 5 YA29YA19 13(1) 12(4) 6 YA41YA20 13(2) Sch 3(3) 7 YA41YA20 13(4)(c) cigarettes and vulnerability whilst out in the community alone must be reviewed/agreed with placing authorities in a best interests forum. The registered persons must assess the risks posed to one service user during independent community access and ensure that any risk management strategies, such as familiarisation with the local area and transport links and ensuring that the service user has/is reminded to wear suitable outdoor clothing have been addressed. The registered persons must ensure that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. The registered persons must ensure that medications are administered as presribed and a record kept of each administration or the reason that medications has not been administered. The registered persons must ensure that all receipts and returns of medication are logged, and regular stock checks conducted and evidenced to provide a complete stock audit trail for prescribed items. 28/04/06 28/04/06 28/04/06 28/04/06 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 28 8 YA20 12(1) 13(2) 13(4) 9 YA20 12 13(1) 10 YA20 12(1) 13(2) 13(4) 11 YA20 13(2) 18(1)(c) 12 YA20 13(2) The registered persons must ensure that the practice of storing prescribed topical products and inhalers in service users bedroom is risk assessed to ensure that adequate steps are taken to maintain the safety of service users. The registered persons must ensure that advice is sought from the GP in regard to appropriate ‘homely remedy’ medicines for each service user. Evidence of agreed medicines and their administration must be maintained in medication records. The registered persons must ensure medication profiles are updated for all service users to include potential side effects in order to effectively monitor any changes in condition of a resident which may be due to medication and should include when required “PRN” medication also. The registered persons must ensure that all staff administering medication have completed training in the safe handling of medication The registered persons must ensure that a sample signature list of staff trained in the safe handling of medication is maintained with the medication administration records. 28/04/06 19/05/06 19/05/06 30/06/06 30/06/06 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 29 13 YA36YA34YA23 19(5)(d) Sch 2 14 YA26 23 15 YA41YA34YA23 19 Sch 2 16 YA33 18(1) 12(1) 12(5)(a) 17 YA34 The registered persons must ensure that staff do not work alone in the home prior to satisfactory checks being completed. Staff with only a POVA First check in place must be supervised by someone with a full, enhanced criminal records bureau disclosure. Immediate requirement. The registered persons must provide each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. An audit of each bedroom must be undertaken to ensure that all items listed in NMS 26.2 are available. Where an item is deemed as unsuitable a record of the reason for this decision must be kept in the individuals records. The registered persons must ensure that all staff working in the home have adequate and satisfactory recruitment records in place. Previous timescale of 21/11/05 not met. The registered persons must ensure that staff do not work for extended periods without a break. The registered persons must ensure that staff have written contracts and statements of terms 14/03/06 09/06/06 28/04/06 28/04/06 30/06/06 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 30 18 YA35 18(1) 19. YA32YA35 18(1) 20 YA41 17(2) Sch 4(7) 21 YA42 23(2)(c) and conditions of employment. This must include the number of hours that they are contracted to work. The registered persons must ensure that all staff receive structured induction training (within six weeks of appointment) and foundation training (within six months of appointment) to Sector Skills Council specifications. Previous timescale of 31/01/06 not met. The registered persons must ensure that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’. Within previous timescale of 31/03/06. The registered persons must ensure that a duty roster is kept of all staff working in the home (including the home manager) and a record of whether the roster was actually worked. The registered persons must confirm that small electrical appliances have been safety tested. 28/04/06 31/03/06 14/04/06 31/05/06 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 31 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 Refer to Good Practice Recommendations Standard YA14YA13YA12 The registered persons should provide an activities/petty cash system to cover staff activities costs and the cost of providing in house activities. YA17 The registered persons should involve service users in shopping for food provisions to promote and develop independent living skills. YA24YA42 The registered persons must assess the safety of radiators and hot pipe-work if any service is admitted who experiences falls or seizures. Appropriate remedial action should be taken in this event. YA42YA24 The registered persons should fit automatic door closure mechanisms that allow fire doors to be held open safely to prevent fire doors from being wedged open. 4 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 32 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 La Rosa DS0000065081.V286502.R01.S.doc Version 5.1 Page 33 - 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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