Inspection on 24/04/08 for Lingfield Avenue, 11

This inspection was carried out on 24th April 2008.

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

Other inspections for this house

Lingfield Avenue, 11 31/08/07

Lingfield Avenue, 11 09/08/06

Lingfield Avenue, 11 22/02/06

Lingfield Avenue, 11 02/09/05

Lingfield Avenue, 11 21/09/04

Lingfield Avenue, 11 06/05/04

Lingfield Avenue, 11 03/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Lingfield Avenue, 11 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL Lead Inspector Lee Willis Key Unannounced Inspection 24th & 25th April 2008 10:00 Lingfield Avenue, 11 DS0000013400.V361708.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 Lingfield Avenue, 11 DS0000013400.V361708.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. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lingfield Avenue, 11 Address 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL 020 8546 2905 020 8546 0947 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) www.scope.org.uk SCOPE vacant post Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD 2. Physical disability - Code PD The maximum number of service users who can be accommodated is: 14 31st August 2007 Date of last inspection Brief Description of the Service: Lingfield Avenue is a large detached property offering accommodation and personal support for up to fourteen adults with physical and learning disabilities. The homes new acting manager, Roger Hughes, was appointed in August 2007 and is awaiting a ‘fit’ person interview with the CSCI in order to become the services registered manager. Roger is also responsible for running two other Scope services in London. The home is close to good transport links and is relatively near Surbiton town centre, with its good leisure and community facilities. The service no longer has its own transportation, but vehicles are hired as and when required. The property is relatively well furnished and suitably adapted to maximise people’s independence. The majority of the people who use the service choose to have their own single occupancy bedrooms. A married couple currently occupies the self-contained flat on the top floor. The open plan layout of the ground floor makes the communal areas wheelchair accessible. This consists of a large kitchen/dinning area, a main lounge that can be partition in two, entrance hall, laundry room and separate storage area, larder, new staff room, two offices, and a staff sleep-in room. The garden at the rear of the property is well maintained and is also wheelchair accessible. The home has developed clear information to help people who use the service and their representatives to understand what facilities and services are provided. The service currently charges £30,000 £70,000 per annum for each placement. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The new quality rating for this service is 1 stars. We therefore consider the people who live at Lingfield Avenue to experience adequate quality outcomes. From all the available evidence we gathered during this key (main) Inspection it was clear the service now has significantly more strengths than areas of weakness. Furthermore, where areas for improvement have emerged the new management team are quick to recognise problems and establish action plans to address them. We spent eight and a half hours at the home spread over two consecutive days. During these site visits we spoke at length to five people who currently use the service, a Regional Director from Scope, the new acting manager, one of the homes new team coordinators, a part-time activities coordinator, an agency member of staff, two support workers, and the manager of a local day centre. We also looked at records and documents including, the care plans for three people who use the service. The remainder of this site visit was spent touring the premises. We received nine ‘have your say’ comment cards about the home. The relatives of people who use the service completed six and members of staff returned the rest. The acting manager also returned our Annual Quality Assurance Assessment (AQAA) in a timely fashion that tells how the service ensures good outcomes for the people using it, and what future developments are being planned. What the service does well: What has improved since the last inspection? Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 6 Sufficient evidence was found during this inspection to show the newly appointed manager has significantly improved the service in the short time he has been in post. We can confirm that as stated in the homes AQAA the management have responded well to the vast majority of requirements identified in its last inspection report and we agree with the services own assessment that it is now much better at, “promoting independence and encouraging people who reside within the service to make informed choices in all aspects of their daily lives”. 100 of both the written and verbal feedback received about the new acting managers approach was extremely positive. Typical comments included, “things have improved considerably under the new manager’s reign”, “the new manager is excellent – the best we’ve had for a long time”, and ”if I am unhappy and will always talk to the manager about it first”. Other improvements made include, making information about the service more widely available. For example, the home’s Statement of Purpose, Guide, last CSCI report, and AQAA are now all available in a bound folder conspicuously displayed in the entrance hall. Furthermore, a new notice board has been pinned to the wall in this communal area that tells people how to make a complaint and what activities are available each day, amongst other things. Care plans have been made far more person centred with a greater emphasis on the strengths and personal preferences of the individual. The plans also contain far more detailed information about the individualised support people who use the service need to receive in order to achieve their aspirations. Staff record keeping of health care appointments people who use the service attend has also improved. The way in which the home consults the people who use the service about how it is run on a day-to-day basis has improved. Regular meetings about the new menus and in-house activities have enabled the people who use the service to have far greater influence on the key decision making process within the home. The published menus have been improved to include far more nutritionally well-balanced and varied meals. All the environmental requirements identified in the home’s last report have been met in full including, the replacing of dead locks with more suitable devices and the repairing of the faulty call bell alarm system. In addition to these, some new tables have been bought for the dinning room, enabling the people who use the service to sit together in much smaller groups at mealtimes. The homes arrangements for checking out the suitability of new members of staff have been tightened up. Furthermore, having employed a number of new staff in recent months the service is no longer so reliant on temporary agency Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 7 staff. Large numbers of people who use the service and their relatives were concerned that too many agency staff who were not familiar with people’s individual daily routines and preferences were used last year. Staff who usually work during the day are now receiving fire safety instruction and attending fire drills at regular intervals in line with good fire safety guidance. What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice that the home must take urgent action to address in order to improve the lives of the people who use the service as well as keep them safe. We agree with the new managers AQAA statement that, “Lingfield needs to build on the improvements made last year by ensuring that there is a comprehensive recording of all positive activities and choices to provide sound evidence of the progress being made.” The providers must ensure the new team coordinators have the necessary knowledge and skills to perform their new duties following the organisational restructuring of the way the homes is managed. Care plan reviews must be kept in the home and this information used to up date them to ensure they accurately reflect changes in people’s needs and aspirations. People who use the service must have far greater opportunities to engage in a wider variety of community-based social, leisure, and recreational activities of their choosing, especially in the evenings and at weekends. As required in the homes last report copies of all the monthly reports prepared by senior representatives of Scope about the conduct of the home must be kept on the premises at all times. This will ensure the quality of the service the people living at the home receive is continually monitored. The homes annual water heating system check for legionella is well over due. The way the service ensures this continues to happen at regular intervals must be reviewed. This will ensure the people who use the service are kept safe. All staff that regular work nights in the home must be involved in at least one fire drill practice or receive fire safety instruction every three months or so. A number of good practice recommendation were also made in this report for the home to consider implementing: People who use the service should have access to ‘easy to read’ versions of the homes Statement of purpose, and Guide. For example, these documents could be illustrated with photographs, pictures, and symbols. This will ensure they Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 8 have all the information they need to know about what service and facilities the home has to offer and what support they can expect to receive. People who choose to smoke should have a shelter built for them in the rear garden to enable them to enjoy their cigarettes in more comfort. When recruiting new staff the manager should be mindful of the gender imbalance that currently exists between the staff team and the service user group. If more male support workers can be employed this will ensure the personal care preferences of some of the male service users can be met. The way in which the service up dates its policies and procedures should be reviewed to ensure they accurately reflect current ‘best’ practice. Staff should also have access to up-to-date copies of all the homes policies and procedures and be able to produce them on request. This will ensure the rights and best interests of the people who use the service are safeguarded by the homes polices and procedures. 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. The summary of this inspection report can be made available in other formats on request. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 9 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 Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 10 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate, and up to date information. People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. EVIDENCE: Some typical comments from people living at the home included, “I like living at Lingfield Avenue, its great”, “On the whole its fine most of the time”, and “I’m quite happy here”. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 11 The home has a comprehensive Statement of Purpose and Service User Guide, which since the last inspection have been reviewed to include, the services most recent CSCI inspection report and Annual Quality Assurance Assessment (AQAA). These documents have been recently up dated and are now contained in a single bound folder which is conspicuously displayed on a new table in the entrance hall where all visitors are required to sign in. However, the information contained in the new folder is not available in a format that is particularly easy for the people who use the service to read and/or understand. The recommendation that the service should consider looking a new ways to make these documents more accessible to the people whom use the service is repeated in this inspection report. The acting manager told us staff explain the Guide to people they keywork. The service should consider including the results of satisfaction surveys it has recently undertaken with the people who use the service and their representatives in the homes Guide next time it is reviewed. The service currently has two vacancies. The acting manager told us he would always insist on receiving a copy of a prospective new service users care plan before admission. Furthermore, suitably qualified senior staff would carry out their own assessment of need with the full involvement of the prospective service user and their representatives ensuring their views were always taken into account. The acting manager also told us before approving any new referral he would always be sure consider all the information he had about the individual to determine whether or not the home was capable of meeting their needs and if they would be compatible with the existing service user group. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 12 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are met. The home has improved its care plan format that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, although there is room to improve the support and choices people who use the service receive to enable them to be involved in the day to day running of the home. Staff promote the rights of the people who use the service and are supported to take ‘responsible’ risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 13 EVIDENCE: It was evident from the three care plans being case tracked that they had been improved in the past six months by making them far more person centred. All the people who use the service who were asked about the new care plan format told us they had been fully involved in developing them and were much easier to read. The two support workers met told us the new plans were easier to follow than the previously format. All three care plans looked at in depth sets out in detail how their needs are to be met and contained far more individualised information to help staff deliver person centred care. The new Team Coordinator told us care plans continue to be reviewed on a sixth monthly basis and people who use the service are actively encouraged to be involved in the review process. A number of people who use the service confirmed they and their representatives had been invited to attend their care plan review meetings on a regular basis. However, staff on request could produce no record of the outcome of these requirements on the second day of this inspection. The team coordinator explained that the home had been experiencing technical difficulties with the homes new computerised system which she told us contained the minutes of the most recent care plan reviews carried out in respect of the three people who care was being tracked. The home continues to work a keyworker system with each person who uses the service allocated a named member of staff who works closely with them. The acting manager also told us he was considering introducing a cokeyworker system to ensure a second named person would be always be available to cover a lead keyworkers absence. His will be assessed at the homes next inspection. A new notice board is available in the entrance hall, which keeps the people who use the service informed about what is going on in the home. Several people who live at the home told us they liked the new board and thought it was a good idea. There was some evidence to show individuals are involved in decision making within the home, such as planning social activities and reviewing menus. Furthermore, it was clear from comments made by the staff met that they recognised the rights of individuals to take greater control of their lives when ever practicable. However, typical comments received from the majority of people who use the service spoken with during the visit indicated this was an area of practice the service could still do much better at, despite recent improvements. One individual told us, “we are not always consulted about what goes on in the home”, while another said “Some staff do not respect my right to be Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 14 independent as I would like and don’t always seem to know what I can do for myself”. The newly appointed manager and a team coordinator both acknowledged that areas where individuals can affect real change in the home remained limited, but agreed to review the way it consulted the people who use the service about its day-to-day operation. Care plans looked at in detail confirmed that as required in the homes last inspection report they now contained far more comprehensive risk assessments and management strategies that covered every aspect of these individuals lives including, e.g. the support they required to manage their medication and finances, access the wider community, and use of the kitchen. These assessments are reviewed at regular intervals. It was evident from comments made by the new acting manager that he has a positive approach to managing risk and is keen to enable people who use the service to take ‘calculated’ risks in order to help people maintain their independence (so far as reasonably practical). Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 15 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): 11, 12, 13, 15, 16, & 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person is treated as an individual and the care home is responsive to people’s culture, religion, age, disability, and gender. People can take part in age appropriate activities in the local community and staff support them to follow their personal interests, although there remains considerable scope to improve the quality of the community based activities, especially in the evenings and at weekends. This will ensure they have far greater opportunities to live more meaningful and fulfilling social lives. People are able to keep in touch with family, friends, and representatives and the home supports them to have appropriate personal and family relationships. Dietary needs and preferences are well catered ensuring the people who use the service are provided with daily variation, choice, and nutritionally wellbalanced meals. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 16 EVIDENCE: 50 of staff who completed our surveys and who were spoken with told us the home could improve the number and variety of community based recreational activities people who used the service engage in locally, especially in the evenings at weekends. Typical comments made by people who use the service were also critical about the lack of opportunities they had to go out and included, “it would be great to go out when I wanted, but there’s not always enough staff on” and “when we had the minibus we went out on more trips”. The new acting manager told us he recognised there was an issue and has agreed to review current activity schedule arrangements. During a tour of the premises the homes part-time activities coordinator was observed on several different occasions supporting a number of people who use the service to engage in a variety of in-house activities including, cake decoration and playing skill enhancing games. All three care plans examined contained detailed programmes which set out what social, leisure and recreational activities people planned to engage in each week, but also household chores they had agreed to do as part of a structured programme to develop independent living skills. The manager told us that in the past there had been no ‘structured’ programmes in place to help people who use the service maintain and develop their independent living skills. Two people who use the service told staff are now much better at supporting them to keep their room tidy and make their bed. It was also clear from comments made by staff spoken with that they are committed to ensuring the people who use the service are actively encouraged to do more things for themselves. The service no longer has its own transportation, which a number of people whom use the service told us they were disappointed about (see comment above). The manager told us he was aware of this issue and had sent two members of staff on training courses to enable them to drive hired minibuses. The manager told us the home operates an open visitors policy without restrictions. People who use the service have the opportunity to develop and maintain important personal and family relationships. On arrival staff told us to sign the visitors book. One person who uses the service told us they had been provided with key to the front door and that they were offered a bedroom door key, which they had declined to take up. The up dated care plans contained detailed information about people’s food and drink preferences and dislikes. In response to a good practice recommendation made in the homes last two inspection reports the manager Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 17 was able to produce a six weekly rolling menu which included far more healthy eating options whilst still taking peoples food preferences into account. For example: chips, which had been the main stay of a large proportion of the meals served, whilst remaining on the published menus are now limited to a few days a week. The new menus also displayed the different vegetable the people who used the service could choice to go with each meal. The manager told us staff had developed the new menus based on the food preferences of the people who used the service who were then asked at a service users meeting to approve the six weekly rotating menu. Typical comments made by the people who use the service about the food served at the home included, “the food is alright here”, “you can get what you want most of the time”, and “I often eat my meals in my bedroom, which I’m allowed to do”. During the morning of the first day of this inspection staff were observed drawing on petty cash to go food shopping for an individual who had not fancied any of the lunchtime options advertised on the day’s menu. The new round tables purchased for the dinning room enable people who use the service to sit to together in much smaller groups. The atmosphere over lunch was very congenial and relaxed during both days of the inspection. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 18 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medication, the care home supports them with it in a safe way. EVIDENCE: All the people who use the service met during the visit were suitably dressed in clothes that seemed to match their personality and were appropriate for the season. One person who uses the service told us they always choose what they wear each day and they often go clothes shopping with staff. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 19 Information contained in the two care plans being case tracked showed people’s personal healthcare needs are clearly identified and action plans are in place to meet them. Staff maintain detailed records of all the appointments people who use the service attend with various health care professionals including, GP’s, dentists, opticians, and chiropodists. Documentary evidence was produced on request to show staff continue to weigh the people who use the service at regular intervals and to record their findings. Staff maintain detailed records of all the accidents and significant incidents involving the people who use the service. In the past year there has been a low number of referrals made as a result of lack of incidents, rather than a lack of understanding about when incidents should be reported. Staff spoken with demonstrated a good understanding of what constituted a ‘significant’ incident and knew how to record such an incident, when it needed external input, and who to refer it too. Incidents and accident sheets sampled at random showed that all those involving the people when use the service had been well managed by staff on duty at the time. No recording errors were noted on medication administration records (MAR) sheets sampled at random. These records reflected current medication stocks held by the home on service users behalves, which were securely stored in a locked metal cabinet in an annex off the kitchen. An audit of a schedule 4 Controlled Drug currently held by the home on behalf of a person who lives there could all be accounted for. The manager told us that the one people who are willing and able to selfadminister their own medication are actively encouraged to do so. Appropriate support measures and monitoring arrangements are also in place to minimise the risks associated with this independent living skill. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 20 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. It is available on request in an easy to read format that is illustrated with coloured pictures and symbols to help anyone living at, or involved with, the service to complain or make suggestions for improvement. The complaints procedure is included in the homes Guide and is conspicuously displayed on the new information board in the entrance hall. The new team coordinator told us she would always keep a full record of any complaints made about the home, including details of the investigation and any actions taken. The home has received two formal complaints about it operation in the past six months, which included one made on the day of this inspection. The outcome of this complaint/concern will be assessed at the homes next inspection. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 21 The first complaint was made about the attitude of staff when they were notified about a medical emergency involving someone who lived there. We invited the providers to investigate this matter using their own complaints and safeguarding adult’s protocols. Scope up held the complaint and appropriate action was taken in a timely fashion to remind staff about their duty of care. A new ‘escorting people who use the service to hospital’ policy has also been developed as a direct consequence. All staff spoken with about the new policy told us they had read and understood these new emergency guidelines. However, a copy of the new policy could not be located at the time of this inspection (See outcome groups 37 to 43 – Conduct and management, and Recommendation No.7) The acting manager was able to demonstrate he understood the local authorities procedures for Safeguarding Adults and said he would always attend meetings or provide information to external agencies as and when requested. The low number of referrals made in the last six months is the result of lack of significant incidents, rather than a lack of understanding about when incidents should be reported. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 22 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, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe and well-maintained home that is relatively homely, clean, and comfortable. People live in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. People have enough privacy when using toilets and bathrooms. EVIDENCE: During several tours of the premises it was noted the communal living areas of the home are appropriate for the particular lifestyle and needs of the people who use the service and look relatively homely and comfortable. For example, the open plan layout of the home ensures people who live there can enjoy maximum independence in a discrete non-institutional environment. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 23 The furniture and fittings are relatively well maintained, and the home is very well lit, clean, and smells fresh. The manager told us a three-year rolling programme to redecorate all the communal areas and bedrooms has recently been approved by Scope to improve the homes interior design. We will monitor progress made by the providers to implement this programme at forthcoming inspections. The acting manager told us a new gardener/handy person has been employed to maintain the garden, which has recently been cleared to make this area more accessible and safe for the people who use the service. One person who chooses to smoke was observed having a cigarette in the rain. The manager told us the providers were still considering whether or not to erect a shelter in the rear garden for use by smokers in inclement weather. The main lounge can be partitioned in two using some double doors which enables the people who use the service to meet with their family and friends in private if they wish without taking them to their bedroom. Records are appropriately maintained of the temperature of hot water emanating from all the homes water outlets on a weekly basis. Bathroom taps are coloured coded to minimise the risk of people being scalded and suitably adapted with easy to use handles. A member of staff was observed responding to a call bell being activated in a toilet on the first floor in a very timely fashion. People who use the service told us they had not been experiencing the same problems with the homes call bell alarm system they had in the past. The homes washing machine and dryer have both broken down on numerous occasions in the last six months. The manager explained that this combined with the fact that the home had been using a lot of agency staff lately was the reason why such a usually high number of items of clothes had been misplaced or sent to the wrong owner. The manager told us he is confident the risk of similar incidents reoccurring in the future has been minimised with the fixing of the washing machine and recruitment of a number of new permanent staff. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 34, 35 & 36 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. In the main people who use the service receive safe and appropriate support because there are usually enough competent staff on duty, although there is considerable room to improve the number of training opportunities available to staff. They also have confidence in the staff at the home because checks have been done to make sure that they are suitable. Furthermore, people’s needs are met because staff get the right supervision and support they need from their manager, although training will need to be given to the new team coordinators to ensure they are competent to run the home in the managers absence. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 25 EVIDENCE: Since the homes last inspection new job descriptions have been produced to ensure all the senior staff are clear about their new roles and responsibilities within Scopes new organisation structure. One of the homes new team coordinators, which is a post created as a result of Scopes restructuring, told us they were very aware of how much more responsibility that had for the dayto-day running of the home in the managers absence, but had yet to receive any training in their new role. We saw that staff were caring and spoke to individuals in a polite and respectful manner. Care staff we spoke to had a good understanding of what person centred care is. Feedback about the way the staff carried out their duties was generally positive. Comments received from people who use the service included, “I feel able to talk to the new manager and certain members of staff if something is bothering me”, “staff are brilliant here and the manager is great”, and “most of the staff are very kind”. However, 50 of all the written and verbal responses received from people who the use, their relatives and staff were concerned that far too many temporary agency staff had been used by the home in the last six months to cover staff shortages. The new acting manager acknowledged that the service had experienced an unusually high turnover of staff in the second half of last year as a direct result of the organisations restructuring. The home currently has only one full-time staff vacancy and all the people asked about the use of agency staff since the turn of the year told us things had improved significantly. The manager told us a number of the agency staff used during last years staffing crises have now been employed on a permanent basis. Staff duty rosters sampled at random and the numbers of staff observed to be working on both days of the inspection were adequate to meet the needs, activities, and aspirations of the people using the service. A number of the people who use the service and staff told us the service does not employ enough male support workers to enable those people who would prefer to have a same sex keyworker and/or personal care provider. With only one male member of staff currently employed the gender mix of the staff team is clearly imbalanced and does not reflect that of the service user group. The manager should be mindful of this when he next recruits new members of staff. The acting manager told he believed the recruitment of good quality carers was the cornerstone of delivering good outcomes for the people who use the service and was very keen to ensure the right people for the job are employed. Information held by the home in respect of it three most recently recruited members of staff indicated that all the relevant checks had been carried out by Scope before allowing these individuals to commence working at the home. This included; a completed application form, two written references, up to date Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 26 Criminal Records Bureau and Protection of vulnerable adults checks, proof of their identity, Home Office approved visas where applicable, and induction records. The service sees induction and any probation as vital to the success of staff recruitment and retention. The content of the induction and probationary periods are seen to be very robust, detailed, and service specific. Staff spoken with told us they had received a thorough induction before being allowed to commence working at the home. Documentary evidence was produced on request to show the induction process is linked to Skills for care and covered safe working practices, worker role, and the needs of the people using the service. The new manager has carried out a thorough training needs and strengths assessment of his entire staff team, which revealed very a large number of gaps in his new teams knowledge and skills. However, the manager has been quick to respond to the training crisis and has already made suitable arrangements for staff to attend the relevant courses in the forthcoming months. We will closely monitor progress made by the service to rectify this major shortfall. The team coordinator told us all staff are supervised at regular intervals, although they were able to produce any recorded evidence that these session had taken place. Staff spoken with told us they regularly meet with senior members of staff to discuss work related issues. We recommend up to date records be kept of these meetings. Records revealed staff meetings are being held on a monthly basis that cover every aspect of life in the home including, the needs of the people who use it, health and safety matters, and staffs new job roles. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 27 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, 40 & 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service have confidence in the care home because a suitably qualified manager runs it, although concerns were raised about his lack of availability and how the home operates in his absence. In the main people who use the service believe their opinions are central to how the home develops and reviews its practice because on the whole there are good quality assurance and monitoring systems in place. The rights and best interests of the people who use the service are not always safeguarded by the home because of poor record keeping and arrangements for reviewing their policies and procedures at regular intervals. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 28 The people using the service are being put at risk of harm because not all the homes health and safety measures, which include fire safety, are being carried out in line with good practice guidelines. EVIDENCE: The homes new acting manager, Roger Hughes, has well over two years experience managing residential care services and supported living project for adults with learning disabilities. He also holds a National Vocational Qualification Level 4 in both management and care in line with National Minimum Standards for residential care home managers. Roger was able to describe a clear vision for the home as well as sound understanding and application of ‘best practice’. Typical comments received from the people who use the service, their relatives, and care professionals about the new managers approach were extremely favourably included, “Roger is the best manager we have had for ages, “ he is very approachable and always listens to us” and “he’s made a big difference to the home since his arrival”. The acting manager told us he has now submitted his application for the Commission to consider his ‘fitness’ to become the homes registered manager. As previously mentioned throughout this report Scope has recently changed its organisational structure. As a consequence the acting manager is also responsible for running two other Scope services in London including, another residential care home and a supported living project. Roger told us he spends at least one day a week at Lingfield Avenue and is always contactable by phone. However, a day centre manager told us “relations with the home had improved since the arrival of the new manager, but as he was not based at Lingfield Avenue because he was responsible for running two other establishments he was quite difficulty to get hold of”. The Regional Director of Scope told us, as Roger will not be based at Lingfield Avenue they have created two new team coordinator posts who will be responsible for the day-to-day running of the service in the managers absence. The manager was absent on the second day of this inspection. The new team coordinator who was left in charge of the home on the day was unable to produce all the records requested and did not come across as totally comfortable with their new ‘deputy’ managers’ role. As previously mentioned in this report, we recommend all the new team coordinators receive additional support and training to enable them to carry out their new duties effectively (See Recommendation No 5). We will continue to closely monitor progress made by the organisation to resolve this matter. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 29 The quality assurance system the providers have introduced in recent years covers every aspects of life in the home and use the views of major stakeholders to monitor how successful or not the home has been regards achieving its stated goals. An annual quality assurance report for 2007 was produced on request, which contained a lot of feedback from the people who used the service about the standard of care they received at the home. The team coordinator was only able produce one Regulation 26 report that had been compiled following an unannounced visit by senior representatives of Scope. This was identified as a major shortfall at the homes last inspection. The time scale for appropriate action to be taken to ensure copies of reports regarding the conduct of the home has been extended in this report. Failure to address this outstanding matter for a second consecutive time will result in the Commission considering taking enforcement action to ensure future compliance. According to the homes AQAA a large proportion of the homes policies and procedures have not been reviewed for well over three years and therefore have not been up dated recently to reflect current best practice. Furthermore, as mentioned previously in this report, a copy of the homes new escorting service users to hospital policy could not be produced on request. The London Fire and Emergency Planning Authority (LFEPA) visited the home in April 2008 and identified no major breaches of the fire safety Regulations. Two good practice recommendations were made in respect of evacuation signs and storage of boxes, which the manager told us arrangements, had already been made for them to be met. The firemen also ensured all the staff on duty at the time of their visit received some fire safety instruction. The team coordinator told us staff were shown how to use a fire extinguisher correctly. The team coordinator activated the fire alarm system during the first site visit to the home and all its fire resistant doors on the ground floor were either observed or heard closing flush into their frames. The fire alarm system continues to be tested on a weekly basis and fire drills are now being carried out at regular intervals as required in the homes last inspection report. However, fire records showed the homes permanent night staff had not been involved in fire drill practice or attended any fire safety instruction for over three months. During a tour of the kitchen it was noted that all items of food were correctly stored in line with basic food hygiene standards. A set of multi-coloured chopping boards was also observed being used for the safe preparation of food. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 30 Up to date certificates of worthiness were produced on request to show the homes boiler and gas installations (i.e. landlords test), electrical wiring, passenger lift, and mobile hoist, had all been checked by a suitably qualified professionals. However, the homes water heating system and tank is well over due is annual test for legionella. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 31 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 X 4 X 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 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 3 X 2 X Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 32 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 YA6 Regulation 15(2)(c) & 17(1)(a) Sch 3.1(a) Requirement All the people who use the service must have care plans that are up dated each time they are reviewed (i.e. at least once every six months) to reflect any changes in need and provision. This will ensure the people who use the service receive the person centred support they need. Timescale for action 01/11/08 2. YA13 16(2)(m) (n) People who use the service must be supported (as far as reasonably practicable) to attend a wide variety of community-based social, leisure, and recreational activities of their choice, especially in the evenings and at weekends. 26(5) 01/06/08 3. YA39 Copies of all monthly reports 01/06/08 prepared by senior representatives of Scope about the conduct of the home must be kept on the premises and made available for inspection on request. This will ensure the quality of the service the people living at the DS0000013400.V361708.R01.S.doc Version 5.2 Page 33 Lingfield Avenue, 11 home receive is continually monitored. Previous timescale for action of 1st November 2007 not met. 4. YA42 23(4)(e) All night staff that work in the home must be involved in at least one fire drill practice or receive fire safety instruction every three months (day staff its once every six months). This will ensure the people who use the service are kept safe. 15/05/08 5. YA42 13(4) Suitably qualified 15/05/08 professionals must test the homes water heating system and tank for legionella at least once a year. The way the service ensures this continues to happen at regular intervals must be reviewed. This will ensure the people who use the service are keeping safe. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations All the people who use the service should have access to ‘easy to read’ versions of the homes Statement of purpose, and Guide. For example, these documents could be illustrated with photographs, pictures, and symbols. This will ensure they have all the information they need to know about what service and facilities the home has to offer and what support they can expect to receive. This recommendation was made at the homes last key inspection, but was not implemented. Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 34 2. YA7 The way in which the service obtains the views of the people who live in the home should be reviewed to ensure they have every opportunity to take decisions about how the service operates and influence its day to day running. People who choose to smoke should have a shelter built for them in the rear garden. This will ensure anyone who chooses to smoke on the premises can do so in more comfort. This recommendation was made at the homes last key inspection, but was not implemented. When recruiting new staff the manager should be mindful of the gender imbalance that currently exists between the staff team and the service user group. If more male support workers are employed this will ensure the personal care preferences of some of the male service users can be met. Relevant training must be provided for all senior members of staff appointed team coordinators to ensure they have the necessary knowledge and skills to carry out their new managerial duties as specified in their job descriptions. All supervision session’s people who work at the home attend with suitably qualified and experienced senior members of staff should be recorded. This will ensure the people who use the service benefit from being supported by a well-supervised staff team. The way in which the service up dates its policies and procedures should be reviewed to ensure they accurately reflect current ‘best’ practice. Staff should also have access to up-to-date copies of all the homes policies and procedures and be able to produce them on request. This will ensure the rights and best interests of the people who use the service are safeguarded by the homes policies and procedures. 3. YA24 4. YA33 5. YA35 6. YA36 7. YA40 Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 35 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 Lingfield Avenue, 11 DS0000013400.V361708.R01.S.doc Version 5.2 Page 36 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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