Inspection on 20/08/07 for La Rosa

This inspection was carried out on 20th August 2007.

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 14 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 05/07/06

La Rosa 14/03/06

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 97 Babington Road Streatham London SW16 6AN Lead Inspector Sonia McKay Key Unannounced Inspection 20th August 2007 10:00 La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service La Rosa Address 97 Babington Road Streatham London SW16 6AN 020 7787 9694 020 8835 0981 vadee.larosa@yahoo.co.uk 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 Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th March 2007 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 health needs. The home is situated in a residential area, close to high-street shopping and transport links. The home opened in September 2005. Fees range between £550.00 and £900.00 per week and vary according to the support needs of the individual. The home provides prospective service users with a written guide that provides information about the service. A copy of the most recent CSCI inspection report is available in the reception hallway. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit began at 10.00 a.m. and was completed in seven hours. The inspection consisted of discussion with residents, staff on duty and the new home manager. There was a partial tour of the home premises and examination of records relating to care and staffing. The Commission required that the manager complete a written assessment of the service provided (an Annual Quality Assurance Audit sometimes called an AQAA). Information supplied in this self-assessment is used to inform this report. The lead inspector completed a random inspection of the service in March 2007 to check on progress in meeting the requirements made in the report of the key inspection carried out on 5th July 2006. Findings from this additional visit are also included in this report. The Commission also sought the views of other professionals involved in the care of residents. Comments were received from: • A health and social care team manager • A social worker The Commission would like to thank all those who kindly contributed their time, views and experiences to this inspection. What the service does well: What has improved since the last inspection? La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 6 Prospective residents are offered an opportunity to visit the home and there is an informative written guide about the home and the services provided and information about fees has been added. The staff help people to address their physical and emotional healthcare needs and to keep good records about them. There is also support to help people to manage their own medication. The new home manager has improved the back garden and there are now vegetable patches and more shrubs and flowers. Residents are being encouraged to take part in the gardening. There now appears to be more rehabilitative support available, and a resident is being supported towards living more independently whilst still living in the home. Staff recruitment practices are more thorough and provide residents with protection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 8 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.V341589.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Prospective residents are offered an opportunity to visit the home and there is an informative written guide about the home and the services provided. There must be better assessment of the care needs and aspirations of prospective residents so that care arrangements can be made and agreed with residents before they move in and so that the ability of the service to meet these needs can be properly considered before a placement is offered. EVIDENCE: As a result in a change of legislation, the service was required to amend the information provided to prospective residents in the residents guide to include greater detail about fees and what they are for. There are two booklets about the home, a written guide and a guide with photographs of the home and the various rooms. The written guide has been amended and now contains information about fees, as required in the random inspection report. The home provides long-term rehabilitative placements. There is opportunity for pre-admission visits and overnight stays. This allows the referred person to La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 10 experience life in the home before making a decision to move in for a trial period. Records examined indicate that the home manager obtained some useful care needs information about a person who has recently moved into the home before the placement began. Information obtained includes copies of recent care programme approach reviews reports and the written care plans from a previous care setting. However, there is no community care assessment, application form or evidence of the homes own needs assessment available. The new home manager said that there is a comprehensive needs assessment tool available. It is essential for the individual aspirations and needs of all prospective residents to be fully assessed during the pre-admission period. A decision can then be made as to whether the service can meet these needs and aspirations and if so, how this is to be done, before a placement is offered. (See requirement 1) The home manager confirmed that the resident had visited the home, to see what it is like, with family members and a social worker before the placement began. The quality audit completed by the home manager prior to the inspection (AQAA) also identifies that prospective residents can have up to three trial visits, so that they can get a proper feel for what living in the home is like and so that they can get to know staff and other residents. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Written plans for how each person needs to be supported or cared for are in place, but they in need of review to reflect changes and a wider range of support needs. There is insufficient evidence that residents have been fully involved and consulted on plans for their care and written information is not easily accessible to staff. EVIDENCE: Each resident has two files of written information. Two sets of written records examined indicate that: • There is no standard format for how information is presented and stored • It is difficult to ascertain current care needs and risks • Staff have mistakenly filed written information in the wrong residents file on some occasions (See recommendation 1) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 12 • • • • (See • Some care plans have not been reviewed within the timescale stipulated at the last review (monthly) or have not been reviewed in the last six months Care plans have not been reviewed when needs have changed and do not reflect the residents current situation in some cases Residents have not signed all of their care plans Some care plans are not dated requirements 2 & 3) The range of issues covered in the care plans is limited and there are no written plans about how wider needs and aspirations are to be met (for example, cultural needs) (See recommendation 2) During the random inspection visit it was noted that has a significant forensic history. The deputy manager could not locate and was not aware of a lone working risk assessment or policy. Staff were on duty alone at night and during periods of the day. A requirement was made for a risk assessment to be completed in regards to lone working and to ensure that staffing levels are sufficient to ensure safety. A lone working risk assessment is now in place. During this inspection it is noted that a risk assessment completed in March 2007 identifies an area of risk behaviour as needing further investigation. These investigations have not been pursued and a potential risk is therefore not assessed. This is poor practice. All areas of risk must be assessed properly so that steps can be taken to ensure adequate safety. (See requirement 4) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to maintain friendships and relationships and the local area is culturally diverse and well resourced. There are more opportunities for residents to develop their independent living skills whilst living in the home and this is an improvement. More should be done to assist people to find out about other opportunities for employment, education and leisure. Meals are enjoyed and menu choices meet the individual needs and preferences of each person. EVIDENCE: Current residents engage in a variety of daytime activities, and mostly do so without support from staff. Residents are able to maintain friendships and relationships whilst living in the home and on the day of the inspection one resident had members of family visiting. There is a payphone for residents to La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 14 use and people open their own post, but my request staff support to keep letters and documents safely. There is good general information about cultural and other individual needs (for example, calendars that highlight celebration dates for different religions and cultures) available to staff and discussion with the home managers indicates that cultural awareness is often the focus of discussions during residents meetings. The resident population is culturally diverse, as is the staff group and local community. Of the four residents currently living in the home, three attend a day service away from the home on some days during the week and one person also intends to start a college course later this year. The staff have arranged some activities with the residents as a group. These have included regular trips to the cinema, a day trip to Brighton, barbeques and bingo nights in other residential homes run by the registered provider. There are also regular movie and popcorn nights for those interested. The home hires a mini-bus on occasion. There is a television, DVD player and music system in the communal lounge/diner, and a pleasant back garden and patio area with seating. One resident keeps pet goldfish fish in the communal lounge. Residents are consulted about the choice of activities provided in regular house meetings. The home manager is encouraging residents to get involved in growing plants and vegetables in the back garden. This is therapeutic. There is also a range of sports and leisure facilities and high street shopping in the local area. Emphasis is placed helping new residents to get to know the local area. This involves a member of staff going out with all new residents to familiarise them with the local area, transport links, shops and leisure facilities. All residents are registered on the electoral role and staff assist residents to obtain a freedom bus pass if appropriate. There is a four-week rolling menu programme available and records are kept of all meals served. The records show that a range of meals have been prepared, including culturally appropriate dishes. Each resident completes household chores to the best of their abilities. These include responsibilities for the care of their own bedrooms and the communal areas of the home. Responsibilities for the cleaning the communal areas are discussed and agreed in house meetings. One resident is moving towards independent living. The deputy manager described how staff support and encourage his increasing independent living La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 15 skills. The resident is now doing his own menu planning and food shopping. The social worker, who recently undertook a placement review, said that staff are keeping the placing authority informed of any issues as they arise and plans for moving towards greater independence are going well. Other residents are now also encouraged to take part in regular food shopping trips. This is evidence of progress in implementing a recommendation to involve people in more food shopping and cooking in the home. As recommended, there is now a petty cash system in place. This enables staff to re-coup any costs incurred whilst supporting residents to take part in community-based activities and for paying for some activities for the residents as well (such as some of the cinema trips). A health and social care professional commented that there are concerns that the activities and lifestyle can be a little institutional, and would like to see more encouragement around rehabilitation. It is also acknowledged that some people can be difficult to motivate in this respect, and there may be a need for residents to have more individual time with staff to get this encouragement and support. (See recommendation 3) Staff maintain a record of the activities that each resident has taken part in as part of the daily recordings. Feedback indicates that staff are sometimes unaware when people do not attend a planned day service. This can be improved by better monitoring and communication with residents and day services. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Plans are in place to describe the type of assistance that people may need to maintain their personal care, but there must be better evidence that these plans have been agreed. Physical and emotional healthcare needs are addressed and records are kept of follow up appointments and health advice if necessary. There is improvement in planning with people to manage their own medications, although practice must be improved around staff administration to ensure safety. EVIDENCE: Staff can provide assistance with personal care tasks if needed, but generally support residents by verbal prompting if needed. There are both male and female staff available. If assistance is required, this is detailed in a specific care plan. One care plan about personal hygiene is not signed by the resident, this plan must be agreed with the resident, so that he receives support in the way he needs and wishes. (See requirement 3) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 17 When a new resident moves in there is a ‘community attachment plan’. This plans identifies healthcare needs and ensures that new residents register with appropriate local health services. These plans have been effective. Residents attend appointments by themselves if they wish, although staff can provide support and assistance to keep records and dates of appointments as required. Residents attend appointments with either the community mental health teams (CMHT) or psychiatric teams attached to their placing authority. There is progress in ensuring referral to local community mental health teams for all residents. All are registered with a dentist, optician and chiropodist. One resident is self-medicating. A risk assessment is in place and a lockable cabinet is available in the resident’s bedroom to keep medications safely stored. Staff monitor compliance with medication in accordance with the written care plan. During a recent period when the person was less able to manage their own medication staff provided additional support. This is evidence of effective monitoring of changes and of taking appropriate action to support people when necessary. Other residents are administered their medication by staff. Medication stocks are stored securely. During the random inspection carried out in March 2007, it was noted that there was progress in meeting the requirements made in regard to the handling of medicines. All four requirements were met. Records examined indicated that: • • • • A record is maintained of the administration of any medication outside the home, for example depot injections administered at clinics Full instructions on the use of all prescribed items is available, for example, inhalers GP advice has been taken about what ‘over the counter’ medicines each resident can safely take Medication profiles are updated to include detailed information about the possible side effects During this inspection, it is noted that: • All prescribed medications are in stock • There are no controlled drugs being stored • Medication Administration records show no gaps • Most medication is supplied from the pharmacy in blister packs • A random stock check of a medication not stored in a blister pack proved accurate However, La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 18 Medication administered to a resident on the morning of the inspection had been taken from the afternoon blister pack (In this instance, there is no danger, as the medications are exactly the same, however, this shows lack of care during administration and is potentially dangerous • One resident, who is administered medication by staff, is encouraged to sign the MAR chart himself. Although this shows encouragement towards the resident taking responsibility for taking his own medication, he is not yet self administering and there must, therefore be a record of which member of staff has administered the medication • Justified stock checks do not take place. (See requirements 5 & 6) • La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The views of residents are listened to and acted upon and they are protected from neglect and self-harm. EVIDENCE: There is a complaints procedure in place. The record of complaints and the AQAA (Annual Quality Assurance Assessment) show that there have been no complaints made. There are regular opportunities for residents to discuss concerns during regular key work and house meetings and for staff to take action. Residents have previously commented that they talk to staff if they have a concern and that they fell able to do so. Procedures are in place for responding to suspicion or evidence of abuse or neglect (including whistle-blowing) to ensure the safety and protection of residents. As recommended, a copy of the local authority ‘safeguarding adults procedures’ has been obtained and this guidance on what to do if they suspect that an adult is at risk of any form of abuse is now available for staff and managers. No adult protection referrals have been made. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 & 30. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is comfortable, clean, safe and homely and people have single bedrooms and communal areas that suit their needs. 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/office, a small staff office, a small kitchen, and a dining/sitting room with access to a back garden. Since changes in legislation about smoking in communal settings, residents are asked to smoke in the garden and not in the communal lounge diner. There are adequate toilet facilities and a small ground floor laundry area. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 21 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. Three residents said that bedrooms are comfortable and warm enough, although only empty bedrooms were viewed on this occasion. Bathrooms and toilets are fitted with appropriate privacy locks and hot water is regulated to within safe temperature limits and tested regularly. The safety of unguarded radiators and hot central heating pipes must be assessed if any resident who experiences falls, epileptic seizures or absences of any sort is admitted to the home. (See recommendation 4) During the random inspection it was noted that building materials had been cleared from the rear garden, which is now a pleasant outdoor communal area. The garden shed was padlocked and there were no COSHH materials left out (substances hazardous to health, like garden and decorating chemicals). The requirements made to address these areas were therefore met. The new home manager has also improved the back garden and there are now vegetable patches and more shrubs and flowers. Residents are being encouraged to take part in the gardening. A payphone is now available for resident to use in private (a cordless handset was previously in use). 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. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is progress in developing a qualified staff team and a wider range of specific training around good practice and mental illness is planned. This will better prepare the staff to meet the individual needs of the residents. Staff must be supervised more often and staff induction training must be in accordance with improved national standards. Staff recruitment practice provides residents with protection. EVIDENCE: A health professional commented,” There is a pleasant and kind approach to clients and a relaxed atmosphere.” The information supplied about staffing in the AQAA (Annual Quality assurance Audit) indicates that: • There are 9 permanent care staff • 6 are male and 3 are female • 4 have already obtained a national vocational qualification in care (NVQ) • 5 are currently working towards an NVQ La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 23 There are two staff on duty during the day and one at night. A lone working policy is in place and the acting home manager provides an on-call support and advice service. A training and development plan that encompasses the mandatory induction training, the national vocational training (NVQ) and the specific training required to enable staff to meet the specific needs of this group of residents was previously required. Information supplied by the new home manager indicates that this has now taken place, and each member of staff has an individual training and development plan in place. Pre-inspection information completed by the home manager indicates that training in the following areas is planned: • Supervision training • Refresher courses in First Aid • Key worker responsibilities • Stress and anxiety • Rehabilitation models • Fire training refreshers • P.O.V.A • Registered Managers Award • Medication traini9ng • Health and Safety • Care plans • Mental Health Act • Awareness and understanding of mental health illnesses • Stigma and Discrimination During the random inspection it was noted that staff recruitment records had improved and evidence of satisfactory checks were in place. However, evidence of thorough staff induction training was not available. During this inspection, two sets of recruitment records were examined and there is evidence that all required checks have been done. Employment contracts are in place and the GSCC Code of Conduct is distributed to new employees. Staff induction training records examined show that the booklets are being kept as evidence of dates when each element of staff induction training is achieved. The booklets are of an old type (TOPSS) and should be in accordance with ‘Skills for Care’ training targets. The AQAA says that this is an area that the home plans to improve on. (See requirement 7) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 24 The new home manager has provided the deputy manager with ‘in-house’ training in supervision. Supervision records examined indicate that there are gaps of several months (in one case, a five month gap) in between meetings. Staff must have regular supervision meetings and annual appraisals. (See requirement 8) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Home managers are experienced and qualified. Frequent change in management arrangements means that a manager has yet to register with the Commission. Resident’s views about the service are sought but are yet to be included in a wider review and incorporated into a development plan for the service. The registered provider must also provide evidence of better monitoring of the running of the service. EVIDENCE: The random inspection was carried out during a period of management change. The home manager, who had yet to register with the Commission, had gone on a period of extended leave and has since resigned. A new manager is now appointed and has applied to register with the Commission. (See requirement 9) La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 26 The new home manager is a qualified mental health and state registered nurse with many years experience of managing residential care services for adults. The AQAA states that there are plans to put a quality assurance system in place. Resident surveys have been introduced and were sent to resident in May 2007 to obtain their views about the service. The home manager said that if residents had raised issues they would have been discussed with the individual. General feedback has not yet been given. There is no annual development plan for the home and the views of all stakeholders are not sought. (See requirement 10) The registered provider is required to visit the home each month, unannounced to carry out an inspection of how the home is operating. A report of the outcomes of these visits must be available in the home. Only two reports are available. This indicates that the registered provider is not monitoring the home properly. (See requirement 11) Employers Liability Insurance is in place and the certificate of registration is prominently displayed. An accident and incident record are available. There are no injuries recorded in the accident book and the CSCI and the placing authorities have been notified of incidents as required. Environmental health and safety and fire risk assessments are in place, but are overdue for annual review. Given the changes in arrangements for smokers this should be a priority. (See requirement 12). Fire evacuation procedures and a building floor plan are displayed. Fire detection equipment is tested each week, and the fire fighting and detection equipment is also professionally tested on a regular basis. Records relating to fire evacuation drills provide evidence that drills are now carried out frequently. A previous requirement in this regard is therefore met. Gas and electrical appliances were safety checked in 2007. Records are kept of fridge and freezer temperatures and hot water temperatures and the results show that temperatures are maintained to within safe limits. No fire doors were observed to wedged open during this inspection. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 27 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 2 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 2 X La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 28 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 YA1 Regulation 14 Requirement Timescale for action 28/09/07 2. YA6 15 3. YA6 YA7 YA18 YA9 15 4 12 13 The registered person must not provide accommodation to any resident unless the needs of the prospective resident have been assessed by a suitably qualified or suitably trained person; a copy of the assessment is obtained; there is appropriate consultation regarding the assessment with the prospective resident or their representative and the registered person has confirmed in writing to the resident that having regard to the assessment the care home is suitable for the purpose of meeting the residents needs in respect of health and welfare. The registered person must 31/10/07 ensure that written care plans are reviewed regularly and when needs change. The registered person must 31/10/07 ensure that written care plans are dated and agreed by residents. The registered person must 30/09/07 ensure that all areas of risk are appropriately explored and steps taken to identify how these risks DS0000065081.V341589.R01.S.doc Version 5.2 La Rosa Page 29 can be minimised. 5. YA20 13 The registered person must 14/09/07 ensure that staff sign a medication administration record when they administer medication and that they administer the correct medication at the correct time. The registered person must 30/09/07 ensure medication stocks are checked on a regular basis. The stock check must be justified in terms of medication received into the home, medication administered and medication stock available. This must be done to ensure accurate administration within the home. The results of these checks must be recorded along with any actions taken to investigate any discrepancies. The registered person must 30/09/07 ensure that staff undertake a structured induction to the service in accordance with Skills for Care training targets. The registered person must ensure that staff receive support and supervision on a regular basis. The registered person must appoint and register a manager with appropriate experience and qualifications to manage the service effectively. The Commission has received an application. There is therefore progress, although as the manager has not yet been registered with the Commission the requirement not met. 10. YA39 24 The registered persons must ensure that there are effective quality assurance and quality DS0000065081.V341589.R01.S.doc 6. YA20 13 7. YA35 18(1)(a) 8. YA36 18 30/09/07 9. YA37 9 31/10/07 31/10/07 La Rosa Version 5.2 Page 30 monitoring systems, based on seeking the views of service users, in place to measure success in achieving the aims, objectives and statement of purpose of the home. The previous timescales of 31/10/06 & 31/05/07 are not fully met, although there is progress. Evidence that further action has been taken to meet this requirement must be supplied to the Commission by 11. YA39 26 24 The registered person must ensure that unannounced visits are carried out each month in accordance with Regulation 26. Copies of the outcomes of these evaluation of the running of the home must be available I the home and available to the Commission. The registered must ensure that the health and safety and fire safety risk assessments are reviewed at least annually. 30/09/07 12. YA42 23 13 30/09/07 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. Refer to Standard YA6 YA6 Good Practice Recommendations The registered person should ensure that written information about residents is stored so that current and pertinent information is readily available to staff. The registered person should take a more holistic approach to planning with residents and not focus on identified ‘problem’ areas alone. Care plans should be person DS0000065081.V341589.R01.S.doc Version 5.2 Page 31 La Rosa 3. YA12 YA13 4. YA24 centred and should cover a range of appropriate topics, including any cultural needs. The registered person should take further steps to develop opportunities for people to develop their independent living skills, to increase their social networks and to find out about opportunities for education and employment. The registered persons must assess the safety of radiators and hot pipe-work if any prospective resident experiences falls or seizures. Appropriate remedial action must be taken in this event to ensure adequate protection from contact burns. La Rosa DS0000065081.V341589.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V341589.R01.S.doc Version 5.2 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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