Inspection on 26/07/07 for Liverpool Grove, 26

This inspection was carried out on 26th July 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Liverpool Grove, 26 16/11/06

Liverpool Grove, 26 05/01/06

Liverpool Grove, 26 14/07/05

Liverpool Grove, 26 11/01/05

Liverpool Grove, 26 07/09/04

Liverpool Grove, 26 02/10/03

Liverpool Grove, 26 25/04/03

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

CARE HOME ADULTS 18-65 Liverpool Grove, 26 London SE17 2HJ Lead Inspector Ornella Cavuoto Key Unannounced Inspection 26th July 2007 09:30 Liverpool Grove, 26 DS0000007089.V340969.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 Liverpool Grove, 26 DS0000007089.V340969.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. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Liverpool Grove, 26 Address London SE17 2HJ 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) 0207 703 1935 F/P 0207 703 1935 PLUS (Providence and LINC United Services) Robert Agrawal Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2006 Brief Description of the Service: Liverpool Road is a Care Home providing personal care and accommodation for four people with a learning disability. The home is run by PLUS (Providence and LINC United Services), a voluntary organisation. The property is actually owned by Hexagon Housing Association and managed by Choice Support. The home is located in Camberwell, close to bus routes, shops, post office, pubs, and most amenities. The home consists of two floors, two bedrooms on the ground floor, one bedroom and an independent flat situated on the first floor that has recently been moved into after a long period of being vacant. There is no passenger lift; the ground floor is designed to be wheelchair accessible. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day. The registered manager was not present for the inspection but was spoken to shortly after the inspection was carried out to give feedback and seek further clarification on matters. Four of the residents within the home have communication difficulties and so could not be consulted about the home. However, one of the residents was spoken to and some observation of the other residents took place. In addition, a relative who was visiting the home was spoken to as well as three of the support workers. Other inspection methods included a tour of the premises and inspection of care records. What the service does well: What has improved since the last inspection? The home had contacted an independent advocate to look at the residents’ terms and conditions to protect their individual rights. Improvements had been made in respect to residents’ individual plans that these had been updated to ensure all information regarding residents was accurate. The home has begun to get plans in place to address service users’ wishes in respect to dying and death. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 &5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The resident who had recently moved into the home had their individual aspirations and needs fully assessed. The statement of terms and conditions that has been issued to residents is to be checked through by an independent advocate. EVIDENCE: A new resident had recently moved into the self -contained flat that is situated on the first floor of the home. This had been vacant for a number of years. Prior to the resident moving in there was evidence within their personal file that the admission had been carefully and thoroughly planned. Relevant information and reports about the residents’ needs had been obtained. A number of meetings also took place prior to them moving in to which all those involved in supporting the resident including family and professionals were invited to discuss the placement and ensure the home would be able to meet all their individual needs. At the last inspection it was identified that all the residents had a statement of terms and conditions that had been issued by Choice Support in 2002 that are responsible for the management of the house. A housing manager had signed these documents and it was considered that an advocate or a relative should also look at them and sign them on the residents’ behalf. It was reported by Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 9 the registered manager in the Annual Quality Assurance Assessment (AQAA) completed prior to the inspection that this had been discussed with the advocate who is linked to the home but that they did not consider it appropriate to sign the documents. The advocate was spoken to following the inspection. They agreed to check the documents but confirmed that they would not sign on residents’ behalf. A relative had signed one of these documents on behalf of one of the residents and the resident that had recently moved into the flat had signed the statement of terms and conditions after it was reported an advocate had gone through this with them. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans had addressed all their needs and measures had been taken to update information although where goals/ aims had been set in relation to their care and support these had not all been clearly reviewed six monthly. The home had taken measures to ensure that decisions made were in residents’ best interests and where appropriate that they were involved in this process. Comprehensive risk assessments had been completed. EVIDENCE: The personal files of all the residents were looked at. The files belonging to the residents living within the main part of the house each included a ‘Care Support Profile’. These had been written in the first person using simple and plain language and included photographs. It had been specified on the profiles that they had been drawn up using observations and experiences of the key workers, other staff at the home and also relatives in recognition of the residents’ involvement in the plans being limited due to having severe communication difficulties. At the last inspection it was identified that although Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 11 the profiles did address all aspects of personal, social and health care needs including communication needs and individual preferences and needs around personal care and daily routines that this information had not been reviewed for some time, for example for two of the residents the profiles on file had not been updated since April and September 2004. At this inspection there was evidence that the ‘Care Support Profiles for all of the residents apart from one had been updated within the last six months ensuring that the information on residents’ needs was accurate. The other resident ‘s profile was last done January 2006. In addition to the profiles that had been drawn up residents had personal plans in place. These had been completed following a placement review at which professionals and relatives had been invited to discuss all aspects of residents’ care and support needs. Each plan included agreed objectives and goals to be achieved with residents. However, despite timescales of six months being specified for these goals to be reviewed there was no evidence that this had been completed for three of the residents where dates indicated this should have been carried out. Although there was some evidence within individual personal files that action had been taken to address some of the agreed goals, reviews of the plans should have been completed to assess progress made. In respect to the resident that had moved in the self contained flat, a ‘Care Support Profile’ had yet to be drawn up by the home but there was evidence of support guidelines that had been obtained from where they had been living previously in supported accommodation (See Requirements). At the last inspection it was reported that the home was in the process of introducing person centred planning (PCP) to ensure ways of recording information about residents was accessible as possible and to provide residents with as much opportunity as possible to exercise choice and control. Although there was some evidence that this was beginning to be implemented by the home, for example identifying different ways of recording information about residents, this was still in the early stages and delays had been incurred due to the staff member that was leading on the issue leaving. At this inspection it was reported that not much progress had been made in this area but that some of the staff were to due to complete some training in ‘Essential Lifestyle Planning’ to be able to take forward this way of working. In relation to supporting residents to take control and make decisions about their own lives all of them have access to an advocate that visits the home and attends the placement review meetings held annually. Where particularly important decisions have needed to be made about residents’ welfare there was evidence within personal files that a ‘best interest’ meeting had been arranged to which all professionals and relatives had been invited. For the resident that moved into the flat there was evidence within their personal file that they had been involved in making choices in relation to the décor, including the colours for walls and carpets and the resident who was spoken to, confirmed this. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 12 There was evidence that risk assessments had been drawn up for a range of activities and areas of need presented by individual residents. These included control measures to reduce the risks identified and they had been regularly reviewed. For the new resident the home had obtained risk assessments and guidelines regarding how to manage behaviour found to be challenging by staff from where they had been living previously. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities provided to residents for personal development had been addressed within residents’ care support profiles and personal plans. Residents had been provided with opportunities to engage in appropriate activities although records indicated these were not occurring on a regular basis. Residents have been part of the local community and have used local facilities. Where appropriate residents had been supported to maintain personal and family relationships. Routines of the home do respect residents’ rights and aim to promote independence where possible. Generally, residents had been provided a healthy diet although meals cooked could have been more varied at times and staff had still not consistently recorded all meals provided. EVIDENCE: Subject to a previous requirement that residents within the home should be provided with opportunities to learn and develop life skills and this needed to be monitored and recorded within individual care plans, this had been met. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 14 There was evidence within ‘Care Support Profiles’ and the personal plans that individual residents were being supported to develop social, communication and other practical life skills, for example with one resident the home had introduced objects of reference to support them to develop their communication as well as enabling staff to achieve a better understanding of their needs and preferences particularly in respect to activities. At the last inspection it was reported that residents had been supported to participate in a range of activities both inside and outside the home. However, although there was some evidence to confirm this by looking at residents’ personal dairies that were then being used by staff, individual activity charts in place had not been consistently completed by staff to be able to ascertain how regularly residents had been engaged in activities. At this inspection, it was reported within the AQAA that residents had continued to be supported to engage in different activities. These included inside the home, sensory sessions with one resident having been supported to purchase new sensory equipment, aromatherapy massages, hand and nail care, cooking/ baking sessions, listening to music whilst outside the home there had been trips to the sensory rooms in Woolwich, being taken for walks, trips to the library, lunches out and one resident attends trampolining and a movement group organised by physiotherapy services. Furthermore, since the last inspection a new form had been introduced for staff to record activities that residents had been involved in as well as their level of engagement. These records, which are part of daily monitoring, confirmed that the activities specified in the AQAA had taken place with residents but that they had still not been carried out on a regular basis, for example for one resident whose activity charts were checked for the month up till the day the inspection took place it could only be identified that they had been taken to the library on one occasion, had had one cookery session and had been to the park once. On discussing this with staff it was reported the resident had actually been taken every week to the library and other evidence was produced to confirm this. From this it was evident that records were still not being consistently maintained by staff and this needs further attention. Records should also be monitored more closely to ensure staff are carrying out activities with residents on a regular basis (See Requirements) It was evident from activity records maintained that residents had been involved in the local community and had used facilities such as the shops, the library and local cafes. The day the inspection was held staff accompanied some of the residents to a nearby café for lunch. Also, speaking to the resident that had recently moved into the independent flat within the home, they confirmed they were very much involved in the local community attending college and various clubs, using local transport to get around and going to the pub with friends. There was evidence from personal files and records of placement reviews and other meetings held that residents where appropriate had been supported to maintain contact with family and friends. Some of residents attend the Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 15 Gateway club where they can meet up with people and also social occasions at other PLUS homes. A relative spoken to who visited the home the day the inspection was held confirmed how they had always been encouraged by the home to be involved in decision making and had always been kept up to date on any changes that had occurred. Although for the majority of the residents living in the home their level of independence is limited because of their level of disability, the home’s routines do aim to respect their rights and independence. It was observed that staff treated residents respectfully and they interacted with them. Overall, residents within the main part of the house do have unrestricted access to the home and grounds although due to the level of disability of the residents this is within a risk management framework. For the resident living in the self contained flat it was observed that their privacy was respected. They had also been given their own key to the main entrance of the home. In respect to meals the home does not have a menu plan although the registered manager reported that the home does have old menu plans that are used for ideas for cooking different meals. At the last inspection, it was identified that staff had not consistently recorded meals provided to be able to monitor adequately that residents were eating a sufficiently varied and nutritious diet. At this inspection, there was evidence of a new form that had been introduced that required staff to record in more detail the meals provided/ offered as well as snacks and drinks and also to record what had been consumed. However, in checking the forms that had been completed for all the residents living in the main part of the house, it was evident that staff had still not recorded all meals or foods provided as there were frequent gaps. Given that concerns had been identified for two of the residents regarding their nutritional intake and one resident had stopped taking solid food it is important this is matter addressed and accurate records are maintained. In addition, generally records indicated that the diet eaten by residents was nutritious but some repetition of foods was identified and it is advised a wider choice of meals is looked into that can be cooked for lunch and supper (See Requirements and Recommendations). Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Personal support has been provided to residents in a way that meets their individual needs. Generally, residents’ physical health needs and emotional needs had been met but for certain residents their weight had not been monitored as specified within their individual plans. Staff had not adhered to all areas of medication policies and procedures to protect residents. EVIDENCE: For all the residents living within the main house there was detailed information within their personal care profiles about all their support needs and individual preferences. Specific cultural needs had also been addressed. For the resident living in the independent flat support staff were meeting with them weekly to discuss their needs and to address any concerns they may have. In addition, a weekly schedule had been drawn up in an accessible format using pictures and photographs to inform the resident which staff member would be supporting them on each day of the week. The resident confirmed that they were happy with the support they had received since moving into the home. A key worker system was also in use at the home and Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 17 staff spoken to generally had good knowledge of residents’ needs. Residents were observed as being well dressed and tidy in their appearance. As mentioned with regards to Standard 6 residents’ personal care profiles all included information about their health care needs. Generally, evidence within the personal files indicated that these had been addressed with contact with a range of health professionals including the GP, dentists, dieticians; district nurses chiropodists, physiotherapists and psychologists. In addition, where required there were detailed guidelines in place for staff to follow in respect to specialist interventions, for example one resident has to have daily exercises carried out with them. However, it was noted that in respect to two of the residents where concerns had been identified about their nutritional intake and consequently it had been stated that their weight needed to be monitored staff had not carried this out. For one resident it had been specified that they should be weighed once every two weeks but their weight had been recorded monthly. For the other, records indicated that they had only been weighed once in six months (See Requirements). The home’s medication system was checked and it was identified that staff had not entered quantities of medication received on the medication record sheets. This is necessary as part of monitoring stocks of medication kept within the home and to be able to audit medication effectively. It was noted within the last community pharmacist report written June 2006 that it was recommended that the home carry out weekly stock checks but there was no evidence this had been carried out. It is advised the home review this in that although medication is administered via dossette boxes other boxed medication should be checked regularly to ensure stocks correspond with that medication that has been administered. In addition, it was found that where staff had hand written the instructions for the administration of medication on individual residents’ medication record sheets these had not always been written correctly as the medication had been prescribed, for example where a medication was prescribed to be given ‘one to be taken four times a day when required for pain’ this had been written on the medication record ‘one to be taken four times a day’. This leaves room for errors to be made and must be addressed by the home. In respect to another medication although it had been prescribed to be given three times a day staff were only giving it when required. This is not appropriate. In circumstances where staff consider medication is no longer necessary or not needed by the resident this should be reviewed by the GP as soon as possible for it to be stopped or changes to the prescription to be made or an alternative medication prescribed. Otherwise medication should always be administered as it is prescribed. Furthermore, for two residents gaps were identified where medication had been given but not signed for. Training records indicated that most staff apart from those newly recruited had completed medication training. A previous recommendation that homely remedy records needed to be updated had been addressed (See Requirements and Recommendations). Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 18 At the last inspection it was identified that only one resident had a funeral plan in place. It was recommended that this be addressed for all the other residents living within the home. At this inspection, there was evidence that some progress in this area had been made in that a best interests meeting had been held for one of the other residents to discuss this matter. It was reported similar meetings would be held for all the residents living in the home (See Recommendations). Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have access to independent support to ensure complaints and concerns are addressed on their behalf. The home has taken appropriate measures to ensure that residents have been protected from abuse in all areas. EVIDENCE: At the last inspection it was found that the home had been issued with a new complaints policy that was robust and had also been placed on DVD to increase its accessibility to residents. However, given three of the residents living at the home have a dual sensory impairment this was still not appropriate to their needs. Yet, as mentioned in respect to Standards 5 and 7 there is an independent advocate that is allocated to all the residents to ensure any complaints or concerns are addressed on their behalf. Following the inspection the advocate was spoken to who confirmed they had been sent a copy of the complaints policy and procedure for their information. The home has a complaints log but there had been no complaints logged since the last inspection. The home’s adult protection policy and procedure had been updated since the last inspection. This was very comprehensive detailing the different types of abuse and what action staff at different levels should take on the identification or suspicion of abuse. The home also has a robust whistle blowing policy. All staff working for the provider PLUS are required to complete as part of their probationary period the Learning Disability Award Framework (LDAF) Units 1Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 20 4, which involves training on adult protection. At the inspection all the staff spoken to had completed the LDAF or were in the process of completing it. All had a working knowledge of adult abuse and the procedures to follow if required to report an incident of abuse. At the last inspection concerns were raised that bank staff do not receive training on adult protection, as they are not required to do the LDAF, this is optional. However, it was reported that the provider ensures bank staff are aware of the policy and procedures to be followed. There have been no adult protection investigations undertaken in respect to the home since the last inspection. The registered manager is the appointee for all the residents in relation to the management of their finances. The home has robust procedures in place with accurate records being maintained and receipts kept for all transactions. Checks of residents’ monies are carried out twice a day as part of staffs’ handover and further audits are carried out by the registered manager and as part of monthly provider visits. At the inspection a sample of residents’ monies were checked and all were found to be accurate. Liverpool Grove, 26 DS0000007089.V340969.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall, the home is well maintained, homely and comfortable. Residents’ bedrooms suit their individual needs and toilets and bathrooms provide sufficient privacy and meet their individual needs. Communal areas are spacious and complement service users’ individual rooms. The home is clean and hygienic. EVIDENCE: The home provides a safe, homely and well-maintained environment. The ground floor is wheel chair accessible and furnishings are of a good quality and domestic in character. A previous requirement where the kitchen worktop was burnt that this should be replaced or part of it replaced had not been addressed (See Requirements). All residents have their own individual rooms that are a good size and are furnished to required standards. Two of the bedrooms have en –suite bathrooms, one on the ground floor and one upstairs although this is shared Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 22 with the other resident whose bedroom is upstairs. All the bedrooms have been nicely decorated and all of them have been personalised to reflect their individual needs, interests and culture. Also, as mentioned upstairs there is a self- contained flat that is now occupied. This had been decorated and furnished taking into consideration the resident’s personal wishes and choices. There are sufficient bathrooms and toilets to meet the needs of the residents. A previous recommendation that a risk assessment should be drawn up to address the issues of there not being any hand washing facilities and hand towels in the down stairs bathroom due to these being persistently destroyed and removed by one of the residents who uses this toilet and does not like anything on the walls or to be in the toilet was not checked at this inspection. This will be looked at the next inspection (See Recommendations). The home has accessible communal areas with a large spacious lounge/dining area on the ground floor that has patio doors that lead out to a good- sized garden that is very attractive and well maintained. The kitchen is spacious and there is a small table where residents can sit and eat that is in addition to a table situated in the dining area. The home was clean and hygienic on the day of the inspection. The home has appropriate laundry facilities that are sited away from the preparation of food. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 &35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have been supported by the home to achieve relevant qualifications to ensure they are able to meet the needs of residents effectively. There were sufficient staff on duty to support residents and the registered manager was no longer part of the rota. There was insufficient information available to fully assess whether residents are protected by the home’s recruitment practices. Staff have been given opportunities for training to ensure that residents individual and joint needs can be met. EVIDENCE: As mentioned in respect to Standard 23 all permanent staff are required to complete the Learning Disability Award Framework (LDAF) Units 1-4 in their probationary period. Staff are then supported to undertake a National Vocational Qualification (NVQ). At present, of six permanent staff working at the home two had achieved NVQ Level 3 and two had completed NVQ Level 2. It was also reported that the deputy manager who had just commenced working at the home also had a NVQ qualification. Consequently, the home had met the required target as specified within National Minimum Standards Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 24 (NMS) that 50 of staff need to have completed or be working towards a relevant qualification. The day the inspection was held there were sufficient staff on duty and as mentioned in regards to Standard 13 some of the residents could be accompanied out locally for lunch by staff. Previous inspections had identified that staffing levels did not always allow for sufficient flexibility to ensure residents were able to undertake activities inside and outside the home and for more individual time to be spent with residents to carry out skills teaching sessions. The registered manager reported that although new staff had been recently recruited including a deputy manager two permanent staff are still needed to make up a full complement of staff for the home although regular bank staff are used. However, it is advised that staffing levels continue to be reviewed to ensure that residents’ needs can be fully addressed by staff on a consistent basis. Subject to a previous recommendation that the registered manager should not be included in the rota to do shifts and sleep-in duties this had been addressed (See Recommendations). The home does not keep staff recruitment records at the home these are held at the provider, PLUS’ head office. However, CSCI gave PLUS a proforma where all the necessary information on staff in relation to recruitment required for inspection could be recorded and maintained within the home. At the last inspection these were inspected but had not been fully completed so this standard could not be fully assessed. These could not be accessed at this inspection, as the registered manager was not present for the inspection. However, it had been identified previous to the inspection that there were still problems with the proformas and that the provider needed to clarify further with the managers of PLUS homes the procedures for ensuring that these were completed (See Requirements). All new staff have to undergo a five day induction held at head office in which they complete all mandatory training including manual handling, first aid, fire safety, health & safety and food hygiene. This is updated as required. Also, as part of the induction staff are given an introduction to working with individuals with learning disabilities and then as mentioned they have to complete the LDAF units 1-4 within their probationary period before being assessed to go on to do either a NVQ Level 2 or 3. One staff member spoken to who had only recently been recruited confirmed they had completed this induction prior to commencing work at the home and were in the process of doing the LDAF. Individual records of training for other staff were accessible. These indicated that training courses had been identified and organised for staff to attend to support them in meeting the individual and collective needs of residents. These included, autism, cerebral palsy, essential lifestyle planning/ person centred planning (PCP) and epilepsy amongst others. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 25 Liverpool Grove, 26 DS0000007089.V340969.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, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Overall service users benefit from a home that is well run. Although the home does have some quality assurance systems in place feedback about the home from individual residents from relatives and professionals still need to be sought as part of self- monitoring. The health, safety and welfare of residents are well promoted and protected. EVIDENCE: The present registered manager was acting manager before taking up the post permanently in August 2005. He has the relevant qualifications, skills and experience to ensure the home is well managed. He has completed a NVQ Level 4 in Health and Social Care. In addition, he has a BA degree in Sociology and has done a Certificate in Management Studies (CMS). Furthermore, he is very familiar with the needs of the residents to ensure the home is run in their best interests. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 27 The home does have some systems in place as part of quality assurance to ensure standards are met, for example quarterly monitoring reports are completed for Commissioners at London Borough of Southwark that provides updates on residents’ progress and outlines goals to be achieved with individual residents, generally for the home and with staff. A copy of this is also sent to CSCI. As mentioned the registered manager aims to carry out audits of service users’ finances fortnightly. Following the inspection some evidence that monthly provider visits had been completed was sent to CSCI. However, copies of these reports should be kept in an accessible place within the home so they are available for inspection. At the last inspection, it was reported a formal quality assurance system, (PQASSO) was being piloted by PLUS within one of the homes. At this inspection, it was reported via the AQAA that this had proved successful but there were no clear timescales of when this would be rolled out to all other homes. Another measure that the provider had taken to improve quality assurance mechanisms was to develop a questionnaire in an accessible format to obtain feedback from people using services as part of self- monitoring. However, this would not be appropriate for the majority of the residents at Liverpool Grove who have severe communication difficulties but feedback could still be sought from relatives and professionals and there was no evidence this had been completed (See Requirements). The home has robust health and safety policies and procedures in place. As mentioned staff have all areas of mandatory training regularly updated. Incidents reports had been completed and sent to CSCI as required. In terms of fire maintenance there was evidence that alarm call points had been tested weekly and fire drills had been carried out regularly. Maintenance checks of other fire equipment had been completed. An up to date fire risk assessment was sent to CSCI shortly following the inspection. Risk assessments had been completed covering aspects of health and safety of the building. There was an up to date gas safety maintenance certificate in place as well as one for the hoist equipment used, a Portable Appliance Testing (PAT) certificate and a certificate for electrical wiring for the home. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 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 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X 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 2 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 2 3 X 2 X X 3 X Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 29 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 YA6 Regulation 15 Requirement The registered person must ensure that all residents have a care plan in place that is reviewed at least every six months as specified within the NMS to ensure service users’ personal goals and changing needs are reflected. (Previous timescale of 31/05/07 partially met). The registered person must ensure that all staff consistently records the activities that residents partake in using the activity charts provided to be able to monitor that residents are being given sufficient opportunities for social interaction and stimulation. (Previous timescale of 31/05/07 not met). The registered person must ensure that all staff maintains an accurate record of all meals provided to residents to ensure they are receiving a nutritious and balanced diet. (Previous timescale of 31/05/07 not met). DS0000007089.V340969.R01.S.doc Timescale for action 31/01/08 2. YA12 16 (2) (n) 31/01/08 3. YA17 16 (2) (i) 31/01/08 Liverpool Grove, 26 Version 5.2 Page 30 4. YA19 12(1) 5. YA20 6. YA20 7. YA20 8. YA20 9. YA24 10. YA34 The registered person must ensure that all the health care needs of residents are addressed, specifically that for those residents where it is specified in their care plans that their weight should be monitored this is carried out and recorded. 13(2) The registered person must ensure that as part of keeping a record of stocks of medication being kept within the home and to be able to accurately monitor and audit medication that is administered that staff enter the quantities of medication on individual residents’ medication record sheets. 13(2) The registered person must ensure that instructions for the administration of medication are recorded accurately on residents’ medication record sheets to ensure they receive the medication as prescribed. 13(2) The registered person must ensure that all medication is administered to residents as prescribed unless this is reviewed or changed by a GP. 13(2) The registered person must ensure that staff consistently adhere to medication policies and procedures to protect residents, specifically that they always sign the medication records after administering medication. 23 (2) (b) & The registered person must (c) ensure that the kitchen worktop that is damaged is replaced. (Previous timescale of 31/05/07 not met). 19 The registered provider must (4)(b)&17(2) ensure that the forms provided DS0000007089.V340969.R01.S.doc 31/01/08 30/11/07 30/11/07 30/11/07 30/11/07 31/01/08 31/01/08 Liverpool Grove, 26 Version 5.2 Page 31 11. YA39 24&26 by CSCI to record the required information on recruitment are fully completed and made available for inspection within the home. The registered person must ensure that an effective quality assurance system is in place based on seeking the views and reporting back findings to residents, their families and other stakeholders. Also, to ensure as part of quality assurance that monthlyunannounced visits are carried out by the responsible individual and copies of the report are available for inspection. (Previous timescale of 31/08/07 not exceeded but partially met. New timescale for compliance set) 31/03/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA17 YA20 YA21 Good Practice Recommendations The registered person should try to look into providing a wider range of meals to residents to keep any repetition to a minimum and provide as much variety as possible. The registered person should consider carrying out weekly medication audits to monitor that staff are consistently adhering to medication policies and procedures. The registered person needs to try to ensure that clear plans showing wishes regarding death and dying are put in place. Also, the home needs to consider whether residents need support to make a will The registered person should try to ensure that a risk assessment is drawn up regarding the resident removing all hand washing facilities in the down stairs toilet and DS0000007089.V340969.R01.S.doc Version 5.2 Page 32 4 YA27 Liverpool Grove, 26 5. YA33 what alternative measures need to be taken with regards following infection control procedures The registered person should try to keep staffing levels under review to ensure that all residents needs can be met on a consistent basis. Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 33 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 Liverpool Grove, 26 DS0000007089.V340969.R01.S.doc Version 5.2 Page 34 - 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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