Inspection on 31/08/07 for Lingfield Avenue, 11

This inspection was carried out on 31st 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Lingfield Avenue, 11 24/04/08

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 09/07/2008.

CARE HOME ADULTS 18-65 Lingfield Avenue, 11 11 Lingfield Avenue Kingston Upon Thames Surrey KT1 2TL Lead Inspector Lee Willis Key Unannounced Inspection 31st August 2007 10:30a Lingfield Avenue, 11 DS0000013400.V345984.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.V345984.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.V345984.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 0208 546 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 Mrs Kelly Elizabeth McCorley Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A variation has been granted to allow specified service users in the following categories to be accommodated. 1 service user Physical disability - over 65 (PD(E)) 1 service user Physical disability - over 65 (PD(E)) and Sensory impairment - over 65 (SI(E)) 1 service user Physical disability - over 65 (PD(E)) and Learning disability - over 65 (LD(E)) . This variation remains in force until such time as the needs of the service users can no longer be met or until such time as the placements cease. 9th August 2006 Date of last inspection Brief Description of the Service: Lingfield Avenue is owned and run by the registered charity Scope to provide accommodation and personal support for up to 14 adults with physical and learning disabilities. As part of providers restructuring plans Lingfield Avenue has been merged with another Scope service located in West London and a new acting manager appointed to run both projects simultaneously. To enable the new manager, Roger Hughes, to run these services Scope has created a number of new senior support positions. Team leaders and shift coordinators will be responsible for the day-to-day operation of the service in the project managers absence and will provide the service with additional lines of accountability. The homes former acting manager was appointed Team leader in August 2007. Lingfield Avenue is located on a residential street in Surbiton and is relatively close to a wide variety of local shops, cafes, restaurants, pubs, and banks. The home has its own transport, is on a main line bus route, and is less than a mile away from Surbiton train station. Built over two storeys this large detached property has twelve bedrooms, the majority of which are single occupancy. There is an independent flat on the top floor, which caters for couples that wish to cohabitate. The ground floor has an open plan layout that makes communal areas wheelchair accessible. Communal space includes a large kitchen/dinning area; a separate lounge, which can be divided in two as and when required; a laundry room; two offices, a new staff area, and a sleepin room. The garden at the rear of the property is reasonably well maintained and is wheelchair accessible. People who use the service are given copies of the homes Statement of Purpose and Guide. Fees charged for facilities and services provided currently ranges between £30,000 to £70,000 per annum. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. From all the available evidence gathered during the inspection process the Commission for Social Care Inspection (CSCI) has judged the service as having a number of strengths as well as areas of particular weakness that will require improvement through an action plan that will be monitored by the Commission. Overall, we judge that the people using the service are safe, although some potential risks regarding staff recruitment were identified during the site visit, which will need to be resolved as a matter of urgency. This unannounced site visit was carried out on a Friday between 10.3am and 6.30pm. During the course of this eight-hour inspection half a dozen or so people who use the service were met as a group and on a one-to-one basis. The homes new acting manager, Team leader (services former acting manager), and several support workers were also spoken with at length during the visit. We looked at records and documents, including three people’s care plans that were selected for case tracking, and the home’s Guide. The remainder of this site visit was spent examining the homes records and touring the premises. The home has not yet completed its Annual Quality Assurance Assessment (AQAA) and we were therefore unable to use information compiled by Scope to tell us about the service they provided, how it makes sure of good outcomes for the people using it, and any future developments being planned. What the service does well: People living at the home feel well cared for. Typical comments from people who use the service were very positive and included “they look after me very well” and “I couldn’t image living anywhere else”. We saw that staff relate well with the people that live there and the atmosphere was relaxed and pleasant. Individuals spoken to said that staff were friendly and polite. Comments included “they treat us well”, “they listen to me”, and “I get on with most of them”. People living at the home generally enjoy the food provided and most told us they are satisfied with the choice of meals they are offered at mealtimes. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: All the positive comments made above notwithstanding their remains a number of areas of practice that require action to be taken by the providers to improve outcomes for the people who use the service: When risks are identified for the people using the service how the providers propose to deal with them must be more clearly recorded. Similarly, when people who use the service attend health care appointments the outcome of these visits must also be clearly recorded. In terms of the homes environment all the bedrooms must be provided with ‘suitable’ curtains and/or screens that meet the individual needs. Deadlocks should not be fitted to toilet doors and appropriate action taken to replace them with more suitable devices that can be overridden in an emergency. Action must be taken to test and repair the homes faulty/temperamental call bell alarm system. All staff, including the new manager, whose job titles and responsibilities have recently changed, must have their job descriptions up dated and be appropriately trained in their new duties. Immediate action must be taken to obtain two written references and a Protection Of Vulnerable Adults (POVA) first check in respect of the homes most recently recruited member of staff. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 7 Senior managers representing the providers must carry out unannounced inspections on the home on a monthly basis. The findings of any visit must also be recorded and made available for inspection on request. Fire drills must be carried out at least once every six months and appropriate records kept. Finally, the home should think more creatively about how to get the people who use the service more involved in running the home, particularly in respect of planning the weekly menus. 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.V345984.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 Lingfield Avenue, 11 DS0000013400.V345984.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 & 5 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 who use this service have good information about the home in order to make an informed decision about whether the service is right for them. People’s needs are fully assessed prior to admission so the individual, their representatives, and the home can be sure the placement is appropriate. EVIDENCE: A copy of the homes Statement of Purpose was looked at. The homes new Team leader (former manager of the service) told us the document had been reviewed in August 2007 and updated accordingly to reflect Scopes new management arrangements and all the changes made to it. The up dated document clearly sets out the objectives and philosophy of the service and what the people who use the service can expect in terms of the quality of the accommodation, qualifications of staff, and how to make a complaint if they are dissatisfied with any aspect of their care. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 10 The new project manager told he was proposing to develop more accessible versions of both the homes Statement of purpose and Guide by illustrating these documents with various pictures, symbols, photographs ect. Progress made on this matter will be assessed at the homes next inspection. The Team leader told us the home had accepted one new referral in 2007 who had been offered a three-month ‘trial’ period in line with Scopes own admissions procedures. This prospective service user who was met during the site visit told us they had been able to visit the home on two separate occasions to meet other residents and staff before moving in. Documentary evidence was provided on request to show that the providers had obtained a summary of the needs assessment undertaken by a care manager representing the prospective service users placing authority. A support worker told us they had been provided with basic information about the new admission to enable them to meet their personal, social, and health care needs. The Team leader was able to produce costed contracts for the three people whose care was being case tracked that set out in detail their terms and conditions of occupancy, including the fees they could except be charged, and what they did and did not cover. Lingfield Avenue, 11 DS0000013400.V345984.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 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. The needs of the people using the service are being met because their care plans reflect what is important to the individual, their strengths, and what support they need to achieve their personal goals. The views of the people using the service are taken into account when major Discussions about the way the home operates are taken because suitable arrangement are in place to enable them to be consulted. The home actively encourages and supports people who use the service to take ‘responsible’ risks as part of an independent lifestyle, although the way risk assessments are recorded needs to be improved to ensure staff have all the information they require to minimize the likelihood of identified risks occurring. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 12 EVIDENCE: The three care plans examined in depth were all person centred and set out in plain language, what the individuals objectives were, what support they needed to work towards those objectives, and how often this information needed to be reviewed. The Team leader told us the task of introducing more person centred care plans for all the people living at the home was now complete. Two people who use the service told us they had been involved with their keyworkers in developing their new care plans, which they both felt placed a greater emphasis on their unique strengths and personal wishes. Staff met told us it was ‘easier’ to access information from the new care plans. The new project manager told us he planned to improve the new care plan format further by making it more accessible to the people for whom it was intended and illustrating plans with ‘easy’ to read pictures, symbols and photographs (See Recommendation No1). One member of staff met told us they had helped developed the new care plan with the person they keyworked and was able to accurately described the support this individual required to achieve their personal goals. Documentary evidence was produced on request to show that all three care plans being case tracked had been reviewed in the past six months and up dated accordingly to reflect any changes in provision. Two people using the service told us they are always invited to attend their care plans reviews along with their other representatives, which includes their keyworker, family members, and care managers. The team leader told us Scope had invited an independent advocate to represent the views of one person using the service when conflicting accounts about whether or not this individual wanted to continue living at Lingfield were raised by the placing authority and the providers. The home is commended for ensuring the service user received independent support and advice from a neutral source who clearly had no vested interest in helping this particular individual stay at Lingfield Avenue or move out. Three people using the service told us they are regularly invited to attend residents meetings, which are held approximately once a quarter. The minutes taken at a meeting held in January 2007 revealed that it had been well attended and had covered a wide variety of relevant topics, including how to make a complaint if you are dissatisfied with any aspect of life in the home. The Team leader told us a meeting had also been held to discuss Scopes new management arrangements and what impact this would have on the people using the service. Unfortunately, no minutes of this or two other residents meetings held in 2007 could be made available for inspection on request. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 13 Risk assessments were included in all three care plans being case tracked, which set out in detail management strategies to deal with identified risks associated with these individuals. The Team leader told us that various management strategies were in place to minimise risks associated with one individual’s nighttime behaviour, although no record of the risk assessment could be produced on request. Staff met demonstrated a good understanding of the new management strategies put in place. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 14 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, 14, 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. People who use the service have a wide variety of opportunities to develop their social, emotional, communication and independent living skills. This is because staff understand the importance of supporting personal development and helping people participate in suitable leisure activities. Dietary needs and preferences are in the main well catered providing daily variation and interest for the people who use the service. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 15 EVIDENCE: The general consensus of opinion expressed by a group of half a dozen service users who were sitting in the dinning room waiting for their lunch was that the number and variety of activities on offer at the home ‘wasn’t bad’. Two people spoken with at length told us they led very active and stimulating social lives, and that they particularly enjoyed attending a disco held locally each week. On arrival it was noted that well over half the people currently residing at the home were out pursing a wide variety of social, educational and vocational interests, including shopping, visiting friends, having lunch out, attending a local day centre or working. The Team leader told us the homes part-time activities coordinator who also works every third weekend is particularly good at encouraging people who use the service to engage in all manner of social activities both at home and in the wider community. During a tour of the premises three people who use the service were observed watching anytime television on the main lounge, an activity the team leader told us was particularly popular with a number of the generally older service users. The team leader told us daily diary notes are used to record the various social, leisure and recreational activities people engage in each day, but conceded the practice of keeping them up to date remained variable. One service users daily diary notes contained very few references about what activities they had engaged in over the summer months despite comments being made contrary by the individual themselves and the team leader. On arrival the member of staff who answered the door politely invited me to sign the visitors book in accordance with Scopes visitor’s policy. People who use the service told us they were not aware of any restrictions made regards visiting times. One person who uses the service told us they always received their mail delivered to the home unopened and staff usually knocked on bedrooms before entering. The atmosphere in the dinning room over lunch felt very relaxed and congenial. The general consensus of opinion expressed by the half a dozen or so service users spoken with as a group just before lunch was that the meals they were served were on the whole quite varied. During lunch it was observed people who use the service were offered a number of different meal choices, which included cheese sandwiches, ravioli, and beans on toast. Furthermore, the record of food actually consumed revealed people who use the service always had a choice between two main meals in the evening. The published menu for the day showed people who use the service could choice between macaroni cheese and chicken chasseur that evening. The new care plan format also contains more detailed information about each service users unique food and drink preferences, as well as their dislikes. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 16 However, these positive comments notwithstanding several people who use the service told us the three weekly rotating menus are not changed on a regular enough basis and therefore meal choices can become rather repetitive. The team leader told us people who use the service are actively encouraged to help plan the published menus, but there is no formal process in place for ascertaining service users views about the food they want to eat. The projects new manager also told us he believed the meals offered were not always as nutritional well balanced as they might be. The good practice recommendation made in the homes last inspection report that sufficient numbers of staff should attend a ‘promoting healthy eating’ course has not been implemented and will be repeated at the back of this report for the provider to reconsider implementing. During a tour of the kitchen it was noted all the food kept in the home was stored correctly and labelled in line with basic food hygiene standards. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 17 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 who use the service generally receive personal support from staff in the way they prefer and require, although the homes recording of health care appointments service users attend is rather variable and will need to be improved to ensure peoples physical and emotional health needs are always met. If people who use the service cannot manage their medicine, the care home supports them to do so in a safe way. EVIDENCE: Discussed with two people who use the service what choices they were given each day. Both stated they could choose what time they got up, had a bath, and what they wore. Health care records were examined for the two people whose care was being case tracked. One record had been appropriately maintained by staff and contained detailed information regarding the outcome of various appointments Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 18 this particular individual had kept with various health care professionals in the past six months, which included their GP and dentist. However, the second record contained very little information about the appointments the Team leader told us this individual had recently attended with various health care professionals. Members of staff must be reminded about how to maintain service users health care records and why it is important to keep them up to date. One member of staff spoken with about health care matters demonstrated a good understanding of individual service users unique health care needs. Documentary evidence was produced on request to show that staff are appropriately maintaining detailed records of all the accidents and incidents involving all the people who live at the home. Records revealed that none of the people who use the service had sustained any ‘serious’ injuries since the home was last inspected, although there had been a dozen accidents, which largely pertained falls. The Team leader told us all the data maintained by the home about accidents and incidents involving service users is still analysed on a regular basis by Scopes own health and safety manager. No recording errors were noted on Medication Administration Record (MAR) sheets sampled at random, which showed medicines were being given as prescribed. The Team leader told us Controlled Drugs are currently being held by the home on a service users behalf. This controlled drug is securely stored in the homes lockable medication cabinet and staff are appropriately maintaining the Controlled Drugs register, which is kept in addition to medication administration records. The record is always signed by two suitably trained members of staff, and includes information regarding the receipt, administration, and disposal of this type of medication. The Team leader told us both the homes most senior members of staff had recently attended a refresher course to up date their existing medication handling knowledge and skills. Lingfield Avenue, 11 DS0000013400.V345984.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 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. The homes complaints and adult protection protocols and sufficiently robust and understood by staff to ensure service users feel safe and listened to. EVIDENCE: A copy of Scopes complaints procedures was conspicuously displayed on a notice board in the entrance hall. One person using the service told us they had recently attended a meeting in which the former manager had reminded those present that they had the right to raise concerns if they were not satisfied with any aspect of life at the home. Several people who use the service told us the providers always take their complaints seriously. Two formal complaints have been made about the home since it was last inspected. The first complaint was made by a local day centre who were concerned about one service users rapid weight loss. Due to the serious nature of the complaint the Local Authority took the decision to investigate it under their safeguarding adult’s protocols. A multi-disciplinary meeting was convened and it was concluded there was insufficient evidence to uphold the complaint, although a number of poor practice issues were identified, which the providers acknowledged needed to be improved. Documentary evidence was made available on request to show all the people using the service are now weighed on a regular basis. The Team leader also told us relations with the local day centre had begun to improve. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 20 The second complaint was received by the Commission and was dealt with by the providers who were invited to investigate the matter using their own complaints procedures. The complainant and the Commission received a response within 28 days of the matter being brought to the provider’s attention and the Commission was satisfied with the action taken to try and resolve the issue. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 21 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, 26, 27, 28, 29 & 30 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. In the main people stay in the home have enough space and facilities for them to lead the life they choose. The home gives them the right specialist equipment that encourages and promotes their independence. However, not everyone has enough privacy when occupying their bedroom or using the toilet. The environment is not as safe as it could be for the people who live at the home because the call bell alarm system is faulty. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 22 EVIDENCE: Since the homes last inspection bathrooms on the ground and first floors have been retiled. The new project manager has also provided staff with lockable storage space for them to keep their possessions safe. During a tour of the premises it was noted that despite the requirement being made in the homes last inspection report a deadlock fitted to a first floor toilet door had still not been replaced with a more suitable locking device that could be overridden by staff in an emergency. The timescale for appropriate action to be taken to address this shortfall has been extended for a second a final time. Failure to address this on going issue in a timely fashion will result in the Commission considering taking enforcement action to ensure future compliance. The Team leader told us the home operates a non-smoking policy and anyone who chooses to smoke may only do so in the garden. It is recommended the providers may wish to consider providing the one people who currently lives at the home who is a smoking with a covered shelter in the rear garden. During a tour of the premises one person who occupied a first floor bedroom invited us to view their private living space. On the whole the room was decorated to a reasonable standard and contained the vast majority of furniture and fittings required by National Minimum Standards for bedrooms. However, it was noted that blankets were being used instead of curtains to cover the window. The Team leader told us this individual often pulled down their curtains and it was agreed that more imaginative ways of maintaining this service users privacy needed to be explored with them. A rolling programme to renovate the ground floor bedroom, which was in the process of being vacated by the current occupants who were moving to a self contained flat on the top floor, should be established. In particular the damaged bedroom doorframe will need repairing/replacing. The couple who were moving upstairs told us they were looking forward to it because the flat would provide them with a lot more space and privacy. The Team leader also told us the couple would have more opportunities to maintain and develop their independent living skills in the flat, which was self-contained. The home has a call bell alarm system in place. Having tested the point installed in a ground floor bathroom the system bleeped for no more than 5 seconds before going silent. Three people who use the service told us the call bell alarm system was very temperamental and did not always function, as it should. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 23 Records showed staff test the temperature of hot water used in the home at regular intervals. The team leader told us all the homes shower facilities had been fitted with suitable thermostatic mixer valves that prevented water temperatures exceeding 43 degrees Celsius. The home was clean throughout and no offensive odours were detected during a brief tour of the premises. The homes washing machine is capable of cleaning laundry at appropriate temperatures and has a sluice programme for dealing with foul laundry. The walls and floor of the laundry room are readily cleanable. Gloves and aprons were available in the laundry room for staff use. Lingfield Avenue, 11 DS0000013400.V345984.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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. An effective staff team supports people who use the service, but their understanding of what is expected of them now their job roles and responsibilities have changed needs to be improved. People who use the service have safe and appropriate support as there are enough competent qualified staff on duty at all times. However, The Commission is concerned about the recruitment of new staff because not all the checks have been done to make sure that they are suitable. EVIDENCE: Since the homes last inspection there have been significant changes made to the way it is managed and staffed. As previously mentioned in this report the providers have already appointed a new project manager to oversee Lingfield Avenue and several other Scope owned services in South West London. To support the project manager in his new role a Team leader post has been created, which has been filled by the homes former acting manager. The project manager also told us that in addition to Team leaders Scope were Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 25 planning to introduce a third layer of senior staff whose role it would be to run shifts in the absence of both the project manager and Team leaders. It was therefore surprising to note that despite all these changes made to the management structure of the home, no job descriptions for these new posts could be produced on request clarifying what managers and staffs new roles and responsibilities were. Furthermore, it was clear from comments made by the new Team leader and several members of staff met that they had not received any information or training regarding their new senior roles and responsibilities. On arrival three support workers and the new Team leader were all on duty, which matched the numbers identified on that morning’s duty roster. The Team leader told us this ratio was adequate to meet people who use the service needs. Staff observed during the site visit took their time to deal with service users questions and came across as very approachable. The Team leader told us all four-agency members of staff that were recently used to cover staff shortfalls completed an initial induction before being allowed to commence working at the home. However, no record of these initial inductions could be produced in request. The Team leader told us one new member of staff started in July 2007. There personal file was examined and it was extremely concerning to note that the home had failed to obtain two written references or a Protection of Vulnerable Adults First check in respect of this individual. An Immediate Requirement Notice was issued at the time of the site visit and the providers made aware that this individual must not be permitted to work in the home until all the aforementioned information had been obtained. No issues regarding staff training were identified at the homes last key inspection and therefore this standard was not assessed on this occasion. The Team leader told us all the staffs training needs and strengths are going to be reassessed by the end of the year, the outcome of which will be examined at the homes next inspection. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 26 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, 38, 39 & 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. In the main people who use the service believe their opinions are central to how the home develops and reviews its practice because there are good quality assurance and monitoring systems in place, although the frequency of unannounced inspection by senior representatives of Scope will need to be improved. The people using the service are generally not put at risk of harm because the homes health and safety arrangements are in the main sufficiently robust to safeguard them, although some of the home fire safety measures will need to be reviewed. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 27 EVIDENCE: The homes recently appointed manager is suitably qualified and experienced to run Lingfield Avenue. The new project manager is aware that in order to be registered he will have to successful complete a ‘fit’ person interview with the Commission. The new project manager was able to describe a clear vision of the home and able to evidence a sound understanding and application of ‘best practice’, particularly in relation to improving people who use the service quality of life. The new managers job description has not been updated to include his new roles and responsibilities, the support he will be receiving to carry out these new duties, and the new lines of accountability within Scope (See Requirement No.6). Since the homes last inspection a message book for staff use has been introduced to improve communication. The Team leader told us a number of satisfaction surveys had been distributed to people who use the service and their representatives at the beginning of the year (2007) and the home was now in the process of analyzing their findings. The Team leader told us the results of these questionnaires would be made public by the end of the year. Progress made on this matter will be assessed at the homes next inspection. The Team leader acknowledged that monthlyunannounced inspections of the home by senior representatives of Scope had not been carried out for some time. These visits should form part of the providers quality assurance and monitoring systems and will needed to be reintroduced as a matter of urgency. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 28 Documentary evidence was made available on request to show that the homes fire alarm system continues to be tested on a weekly basis. However, it was not clear from fire records examined how often fire drills were being conducted in the home. The record showed that eight months had elapsed between the homes last two fire drills, the last of which was carried out over five months ago (March 2007). This contravenes Scopes fire safety policy and advice given by the London Fire and Emergency Planning authority. Fire drills should be undertaken at least once every six months. During a tour of the premises it was noted that none of the homes fire resistant doors were being inappropriately wedged open to prevent there automatic closure in the event of a fire. Two fire doors tested at random both closed flush into their frames when released. Staff spoke with about the homes emergency evacuation protocols demonstrated a good understanding of their responsibilities in the event of the fire alarm being activated. A fire risk of the building was made available on request. Up to date Certificates of worthiness were in place to show that suitably qualified engineers had tested all the homes portable electrical appliances, and fire alarms system/extinguishers, in the past twelve months. The Team leader was aware that the homes mobile hoist was overdue its annual service review, but was able to produce documentary evidence to show he had followed this matter up with the manufacturers. Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 29 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 3 5 3 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 2 27 1 28 3 29 2 30 3 STAFFING Standard No Score 31 1 32 3 33 3 34 1 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 3 2 X X 1 X Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4) Requirement When a risk to a person using the service is identified and a strategy developed to manage it this must be recorded to ensure that the individual receives the appropriate support they require to minimise the identified risk/hazard. When people who use the service attend health care appointments the outcome of these visits must be clearly recorded. This will ensure all the people who use the service have their health care needs met. ‘Screens’ used to cover windows in people’s bedrooms must be fit for purpose. This will ensure the privacy needs of all the people who use the service are respected. The deadlock fitted to the first floor toilet must be assessed for the risk it presents to the people that use it and appropriate action taken to minimise the identified risk. Requirement not met within the previous timescale for action (i.e.01/04/07). DS0000013400.V345984.R01.S.doc Timescale for action 01/10/07 2. YA19 17(1)(a) Sch 3.3(m) 01/10/07 3. YA26 16(2)(c) 15/10/07 4. YA27 12(4) & 13(4) 01/10/07 Lingfield Avenue, 11 Version 5.2 Page 31 5. YA29 23(2)(c) 6. YA31 18(1)(a) 7. YA34 19, Sch 2.3 & 2.7 8. YA39 26(2), (3) & (4) 9. YA42 23(4)(e) & 17(2), Sch 4.14 Action must be taken to test and repair the homes faulty call bell alarm system. This will ensure the safety of the people using the service. All staff, including the new manager, whose job titles and responsibilities have recently changed, must have their job descriptions up dated accordingly and be appropriately trained in their new duties. This will ensure the safety of the people using the service. Two written references and a Protection Of Vulnerable Adults First check must be carried before any new member of staff is permitted to commence working at the home. This will ensure the safety of people using the service. An Immediate Requirement Notice was issued at the time of this site visit. Unannounced inspections of the home must be carried out be a senior representative each month and a report compiled in respect of their findings. This will ensure the quality of the service the people living at the home receive is continually monitored. Fire drills must be carried out at least once every six months and appropriate records kept. This will ensure the safety of the people using the service, their guests, and staff. 15/10/07 01/01/08 01/09/07 01/11/07 01/10/07 Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 32 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 The schemes recently up dated Statement of purpose, Guide, and care plans should be reviewed to make the formats more accessible to the people who use the service. This will ensure they have all the information they need to know about the home and the support they can expect to receive. All residents meetings should be minuted to enable anyone authorised to inspect these records to determine whether or not people who use the service are consulted on and involved in making decisions within the home. The way in which the service records what social, educational, and vocational activities the people who live at the home engage in should be reviewed as the current approach is to inconsistent and variable. This will ensure anyone authorised to inspect these records can determine whether or not people who use the service have sufficient opportunities to lead stimulating social life’s. All staff who are involved in planning menus and preparing food at the home should be appropriately trained in nutrition and promoting healthy eating. This will ensure the people who use the service are offered healthier diets. This recommendation was made at the homes last two inspections, but has not been implemented. The way in which the home obtains the views of the people who use the service when planning the weekly menus should be reviewed to enable service users to have greater control over the food they choose to eat. This will also ensure the published menus are changed more regularly to meet services users changing food and drink preferences. 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. Damaged bedroom doorframes should either be replaced or repaired. When agency staff are employed the induction they receive should be clearly recorded. 2. YA7 3. YA11 4. YA17 5. YA17 6. YA24 7. 8. YA26 YA35 Lingfield Avenue, 11 DS0000013400.V345984.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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. 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