Inspection on 25/04/05 for 10 Love Walk

This inspection was carried out on 25th April 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

10 Love Walk 25/06/08

10 Love Walk 18/10/07

10 Love Walk 11/07/06

10 Love Walk 15/12/05

10 Love Walk 25/10/04

10 Love Walk 20/05/04

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 10 Love Walk London SE5 8AE Lead Inspector Alison Pritchard Announced 25 April & 3 May 2005, 10:00 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 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 Older People and 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. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 10 Love Walk Address London SE5 8AE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7703 3632 020 7252 4958 lovewalk@missioncare.org.uk Mission Care Mr Paul Barker CRH Care Home PC Care home only 22 Category(ies) of PD Physical Disability registration, with number of places 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 22 (twenty-two) people with physical disability, some of whom may be over 65 years old Date of last inspection 25 October 2004 Brief Description of the Service: 10 Love Walk is a 22 bedded care home for people with a physical disability. It is located in a quiet residential road in Camberwell. The home is situated close to local shops, public transport and services and has a small car park. The home was purpose built and each of the bedrooms is single and has a large ensuite toilet /bathing facility. There is a lift to enable residents who use wheelchairs to access the first floor. At the time of the Inspection there were twenty one residents at the home, eight of whom were aged over 65 years. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, took place over two days – 25th April and 3rd May 2005 - and lasted approximately 14 hours in total. The inspection methods included: discussion with approximately nine residents; interviews with three members of staff, discussions with the Manager and the Clinical Director; sampling two lunch-time meals; observation of care practices, a handover meeting and an activity session. The inspector toured the building, accompanied for part of the tour by the manager and examined a range of records. The manager had ensured that residents and relatives and other visitors were informed about the inspection so that they could contribute to the Inspection process should they wish to do so. Comment cards were received from seven residents, three relatives / visitors and three visiting professionals. The manager who was in post at the time of the Inspection has since left to take up another post within Mission Care. Another manager has been employed at the home and has submitted to the CSCI an application for registration under the Care Standards Act 2000. What the service does well: What has improved since the last inspection? Admissions have been more appropriate to the home’s statement of purpose than was previously the case. The home has worked with placing social workers to arrange placement reviews to make sure that residents’ needs are being met. When residents’ needs have changed reassessments have been carried out. Staff supervision is taking place at regular intervals. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 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. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Standards Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitablity of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 and 5 The assessment information provides both the home and the prospective resident with sufficient information in order to make a decision as to whether the placement is suitable. EVIDENCE: The inspector viewed assessments which had been carried out by placing social workers and by senior staff at Love Walk. Each assessment had included the input of the resident. The documents showed that sufficient information about potential residents’ needs is available to the home before a place is offered. Potential residents and their families have the chance to visit prior to admission. The two most recently admitted residents had taken up this opportunity. Statements of terms and conditions which included appropriate information to protect the residents were viewed on files. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14, and 33 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 and 9 Residents’ personal goals and cultural needs were not adequately reflected in the care plans viewed. Residents have had limited opportunities to contribute to the running of the home as meetings have not been held as frequently as was previously the case. One resident was protected from excessive risk by restricting his activities. Further protection of his rights is needed by making sure that the decision to do so is documented and regularly reviewed. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 10 EVIDENCE: Residents are part of the care planning process, both through the initial planning and through inclusion in regular reviews of the plans. Residents’ views were recorded on the files. Significant changes in residents’ care needs have been the subject of review involving placing authorities and other involved professionals. A programme of reviews of placements for all residents has been arranged. Some residents had a reported desire to move to more independent living situations. There was no indication in the care plan as to how the resident might be helped to achieve this aim. A number of residents stated that they felt confident in the care provided by the staff members who they know well and trust. They also spoke of the good humour, kindness and caring attitude displayed by staff. There was insufficient information recorded about service users’ cultural needs and how they will be met. One of the comment cards received expressed a wish for the food provided to reflect the resident’s cultural background. Meetings of the resident group are arranged and the Inspector was informed that a meeting had taken place during the week prior to the Inspection. The last minutes seen of a residents’ meeting were dated October 2004 although previous Inspections noted that the meetings had been held more frequently. Three of the seven respondents who sent comment cards prior to the Inspection stated that they would like to be more involved in the decision making processes in the home. Consideration should be given by the Registered Person to how those residents who wish to do so can increase their participation in the running of the home. Each of the three residents’ files seen included a risk assessment form. However, they were incomplete in some respects. For example, the Inspector was told of the behaviour of one resident which had been very dangerous. The home had taken appropriate action to address the matter. However, there was no documented risk assessment or risk management strategy in place. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experiencd in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 While there are some opportunities for residents to maintain skills, some of the residents did not have the appropriate equipment available to them to aid independence and personal development. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 12 The activities programme does not promote residents’ opportunities to engage in a range of leisure activities in the home and the community. Residents are supported to maintain their relationships with family and friends through the visiting policy. The meals provided are healthy but further attention needs to be paid to ensure that cultural needs are reflected in the menu. EVIDENCE: There is a self-contained flat within the home where one resident lives with a greater degree of independence and privacy. Some of the bedrooms within the main home are equipped with microwave ovens and kettles so that snacks and drinks can be made. This allows for the maintenance of skills. One resident stated that their bedroom was not equipped with a microwave oven. An audit of the bedrooms and the equipment they hold should be conducted to ensure that they are in keeping with the residents’ needs and preferences. Residents who choose to do so attend places of worship locally. This is generally facilitated by friends and family providing transport to enable them to do so. There is an accessible minibus available to the home but there are few drivers on the staff team so access to it is limited. Some residents attend day centres and adult education classes in the local area. Those residents who are able to do so use the local shops independently, others are assisted to do so by staff. Visiting tutors run a music and movement session and an art class in the home, each is held weekly. Residents informed the Inspector that they enjoyed these activities although one resident said that she missed the previously organised bingo sessions. The feedback from comment cards was that only one respondent expressed satisfaction with the activities. Four people felt that suitable activities were not provided and two stated that they were provided only sometimes. Visitors confirmed that they are welcomed to the home by staff and are able to visit at all reasonable times. Residents can see their visitors in their bedrooms or in the communal areas. There is a pay telephone available to residents, and many have had private telephones fitted in their bedrooms. There is flexibility about routines in the home and residents are encouraged to maintain as much independence as they wish. Several residents choose to prepare and eat their breakfasts in their bedrooms. Laundry facilities are located so that residents who wish to do their own laundry can do so independently. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 13 Although most residents are able to lock their rooms one resident stated that he had not been issued with a key. All residents should have a key to their rooms. In addition a resident felt his privacy was compromised as net curtains were not fitted at the bedroom window. Other feedback from residents was that staff respect their privacy and that they are free to spend time alone if they wish to do so. The feedback received about the food provided was mixed. During the Inspection some residents said that they liked the food and were appreciative of the cook’s efforts to provide meals in keeping with their needs and preferences. Of the seven residents who provided written comments two said that they like the food, three said that they liked the food sometimes, and two said they did not like the food. An additional comment concerned the wish for the meals to be culturally appropriate. The menu includes few ethnic dishes. Although the cook prepares additional meals to reflect residents’ preferences, the feedback indicates that further care must be taken to ensure that consideration is given to all residents’ cultural needs in relation to meals. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 The residents benefit from the care of a staff team with whom they are familiar and trust. The records about residents’ health care needs are insufficiently detailed to assist the staff to provide appropriate care. There are some aspects of medication practices which are unsafe and do not protect residents. EVIDENCE: Residents spoken to during the Inspection stated that the staff are respectful when they provide care and respect their dignity and privacy. The care staff team is mainly female, with only two male staff members. As a result the opportunities for same gender care to be provided to the twelve male residents 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 15 are limited. Wherever possible those residents who have a preference are cared for by staff members who they know well and trust. Residents were appropriately dressed and groomed during the Inspection. They have the opportunity to attend a hair-dresser who visits the home every fortnight. Residents’ medical conditions were recorded on files although there was scope for further development of the records. For example, one resident’s file examined included ‘diabetes’ as a factor on a form headed ‘risk’. However there were no details included about the implications for care or what the risks are. The daily notes on the care files examined were infrequently completed. This does not allow for adequate monitoring of service users’ conditions. For example, one resident’s notes had an entry on 16th April stating that the person had remained in bed until lunch time, was quiet and ate little. There was no further entry until 22nd April and that gave no indication of any reference to the previous entry. This indicates a need for further guidance for staff about the purpose and value of recording. Some of the residents manage their own medication with the agreement of the GP. One person who self medicates has neither a lockable space within his bedroom in which to store the medication nor a key to the bedroom. The Registered Person must ensure that safe facilities are available for the storage of medication within the bedrooms of those people who self medicate. Records of medication administration (MARs) were examined with the assistance of the Registered Manager and a member of staff. There were several unexplained gaps. Although a requirement of the previous Inspection was that the application of external preparations, such as creams, is recorded, this was not the case on the MARs examined. One resident was being given an item of prescribed medication in a hot drink. The advice of the resident’s GP must be sought about this and the Registered Manager must be sure that residents’ consent is always obtained for the administration of medication. Exceptions to this must be subject to consideration of a ‘best interests’ meeting including the input of the resident’s representative, as well as that of the GP and involved professionals. This was the subject of discussion and correspondence with the Registered Manager during and shortly after the Inspection. The Registered Provider must send to the CSCI their policy on covert administration of medication. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16, 18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are sageguarded. (OP NMS 35) The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 16, 18 and 35 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The majority of residents are confident that their concerns are listened to and acted on. The records of the investigation of complaints do not give all of the details of the action taken in response to a complaint. The procedures for dealing with concerns about abuse have been used to benefit and protect residents. EVIDENCE: The complaints procedure is displayed in the hallway of the home. The majority of residents giving feedback, both verbally and in writing, were aware of how to raise concerns. However, two of the comment cards received from residents stated that that they would not know who to speak to in the event of a concern about care. Records of complaints showed that there had been six complaints in the twelve months before the Inspection. The outcome of four of these complaints was not clear. Of the remaining two, one was upheld and the other was not upheld. Complaints records must include the outcome of the complaint and details of any action taken to address the concern. There is an adult protection procedure which is in keeping with the standard. The policy states that input on adult protection issues is provided for staff 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 17 during the induction period and followed up by training during the staff member’s first year of employment. There is a whistle-blowing policy which includes the details of the Commission for Social Care Inspection (Southwark) with whom concerns may be raised. Staff who were interviewed as part of the Inspection were clear about the action to take if they had concerns about the welfare of any service users. The home has co-operated with an adult protection investigation undertaken by placing authorities in the last year and taken appropriate action in response. There were no unresolved issues of this nature at the time of the Inspection. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 18 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30 Although the building is generally clean, the premises are in poor condition and do not ensure that residents have a homely, comfortable and safe environment. Equipment has not been provided consistently to ensure that residents’ independence is promoted. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 19 EVIDENCE: There are a number of shared spaces on the ground and first floors and a garden area that is wheelchair accessible. The dining room is large and welllit. There are also separate television and smoking lounges and a large activities room. However, the premises are in a poor decorative state although most areas were satisfactorily clean. Some specific issues noted as needing attention are as follows: • • • • • • The telephone room had cobwebs and is in need of redecoration The smoking room and dining room need to be redecorated A small shelf in the battery charging area was detached from the wall The gas meter outside the smoking room had a detached cover which needed to be replaced Some radiator covers in the smoking room were broken An unattached, possibly broken, roller blind was on the window ledge of the window on the stairway near the smoking lounge. This was noted at the Inspection of October 2004 and pointed out to the Registered Manager in correspondence A fire notice in the smoking room was detached from the wall There was a ladder propped up against the wall in a first floor bathroom. This would have hindered mobility in the room for both service users and staff The garden was in a poor state, for example there was an abandoned wheel-chair in the court yard The drains outside the laundry were overflowing with water Radiators were not adjustable There was a cracked window in the bedroom in the flatlet The activities room was untidy and had a broken window • • • • • • • The Inspector viewed several bedrooms on each floor of the home. Each of the bedrooms is single and en-suite. There is a range of sizes of bedrooms, all of which meet the required space requirements. The majority of the bedrooms are personalised and very comfortable. One resident is dissatisfied with his room and the Registered Manager stated that this will be subject to review. Bedrooms are equipped with a range of equipment which promote residents’ independence, for example aids to assist with transfers, grab rails and bath aids. However, one resident was unable to use the en-suite bathroom off his room as the bath aid was not suitable for his needs. Although this issue had been raised at a previous Inspection and by the resident with staff it had still not been resolved. This was the subject of correspondence with the Registered Manager shortly after the Inspection who, in response, stated that a suitable aid has now been ordered. An audit of the suitability of equipment for all residents must be carried out so that shortfalls can be addressed. These issues 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 20 should be regularly addressed at key work meetings and a system established for dealing with them so that in future such delays do not occur. The Registered Person must establish a system so that repairs are dealt with promptly, that decoration and other improvements are carried out to ensure that the home is made comfortable, homely and safe for residents. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 34 and 35 (Adults 18-65) and Standards 27,29 and 30 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35, 36 There are enough staff who have worked at the home for a significant period and are familiar with the residents’ needs. However, staff need more training, support and development. EVIDENCE: In addition to the Registered Manager the care staff team consists of two senior care officers, twelve care officers as well as five care officers who are part of the staff ‘bank’ covering shifts. There are two vacancies on the staff team, one at care officer level and one at Deputy Manager level. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 22 Staff turnover is low and the majority of the staff team members have worked at the home for several years and so are very familiar with the needs of the residents. Generally there are five members of staff on duty each morning and four members of staff each evening. Two waking night staff provide care at night time. These staffing levels are in keeping with the needs of the service users. The Management Support Officer deals with recruitment records in the home. She has implemented a system to ensure that all of the checks and references required are in place. This contributes to the protection of residents. The home meets the required standard in relation to NVQ training as more that 50 of the team has achieved NVQ level 2 in care. An assessment of the staff team’s training needs has not been carried out although this has been the subject of a recommendation of Inspection reports for a significant period. The Clinical Director for Mission Care acknowledged that there has been little training over the last year and stated that the assessment is being undertaken. There is a supervision system in place and staff interviewed stated that they receive supervision, usually on a monthly basis. An appraisal system has not been introduced and is recommended. Records of staff meetings were not seen beyond December 2004. These meetings are an important focus for communication within the staff team and should be held at least six times a year. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 39 and 42 (Adults 18-65) and Standards 33,35 and 38 (Older People) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 42, The quality assurance systems are not adequate to ensure that residents’ views are represented in the running of the home. Residents’ health, safety and welfare are not being protected and promoted. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 24 EVIDENCE: The Registered Manager has left his post at the home since the Inspection and a new Manager has been employed. Formal notification to the CSCI about the change has not been received and is required. The newly appointed Manager confirmed that he has submitted an application for registration to the CSCI. There are a significant number of issues to be addressed by the new Manager as indicated by the findings of this Inspection. The Registered Person must ensure that internal quality monitoring systems are employed with the aim of ensuring that there is progress towards improving the service provided at the home. There is evidence that this is not currently the case. For example, there were no reports of visits made on behalf of the Registered Person as required by Regulation 26 of the Care Homes Regulations 2001 between November 2004 and March 2005. There was evidence that the findings of visits that were made were not acted upon. For example, reports made in September and November 2004 and March 2005 all make reference to the poor state of the premises. Despite this there have been no improvements made to the building since then which have had an impact on the experience of those people who live there. Assessments made on the visits should contribute to the development of the service as part of an effective system of quality monitoring. The Clinical Director informed the Inspector that Mission Care’s policies and procedures are being reviewed between June and September 2005. In the light of these they were not examined at this Inspection and will be inspected when the exercise is complete. Residents’ individual records are kept securely in the home with due regard for confidentiality. The lack of entries on care notes indicates a need for staff to review recording practices as part of their supervisory function. In relation to health and safety matters in the home the inspector identified a number of issues which raised concerns. They were detailed to the Registered Manager at the time of the Inspection and in correspondence. These are listed below: The inspector and Registered Manager found two bottles of chemical handwash in a communal area. The substance is very dangerous if ingested and must be kept safely. • Two records were being kept of checks of the fire alarm system. This makes management monitoring unnecessarily difficult and introduces inconsistencies to the system of recording. This was first noted at the Inspection of October 2004. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 25 • • Fire drills are not being conducted at quarterly intervals as required by the home’s fire risk assessment. Although a drill was carried out on 18.4.05 the last recorded drill prior to this took place on 5.8.04. • A fire door leading from the ground floor into the garden was stiff to open and may hinder exit in an emergency • A disposal box for sharps disposed after use for injections was found on the floor of an open cupboard in the laundry. The number and variety of the issues indicate a need for increased awareness of health and safety matters in the home, which must be addressed by the Registered Person. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 26 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 Score 2 3 Score ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 2 x 2 2 2 2 3 2 2 Standard No 24 25 26 27 28 29 30 STAFFING 1 3 2 2 3 2 3 Score 11 12 13 14 15 16 17 Standard No 31 32 33 34 35 36 x 3 2 3 2 2 x x 2 x x 1 x Version 1.40 Page 27 CONDUCT & MANAGEMENT PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 10 Love Walk Score 3 2 1 x 37 38 39 40 41 42 43 G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15(1) Requirement The Registered Person must ensure that care planning systems are improved by the recording of service users’ aims and goals and strategies employed by the home to support them to achieve them. The requirement was first made in the report of the announced Inspection in May 2004 with a timescale of 1st October 2004. It was not examined at the Inspection of October 2004. The Registered Person must ensure that activities are arranged in keeping with service users’ interests and preferences. (Previous timescale of 01/02/05 not met) The Registered Person must ensure that visits are made each month as required by Regulation 26 of the Care Homes Regulations 2001. The registered person must ensure that reports of these visits are forwarded to the home and to the Commission. (Previous timescale of 01/01/05 not met) The Registered Person must Timescale for action 1 October 2005 2. 12, 13, 14 16(2)(n) 1 October 2005 3. 39 26 & 17(2) schedule 4 para 5 1 August 2005 4. 42 17(2) 1 August Page 28 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 schedule 4 para 14 5. 20 17 & 18 (1)(c)(i) 6. 11, 26, 27 16(2)(c) 7. 16 12(4)(a) 8. 7, 17 12(4)(b) 9. 19 12(1)(a) 10. 19 18(1)(c) (i) & (2) ensure that records of tests of the fire alarm system are kept accurately. (Previous timescale of 01/01/05 not met) The Registered Person must ensure that all staff who handle and administer medication have formal training in medication and that the application of external preparations is recorded. (Previous timescale of 01/01/05 not met) The Registered Person must ensure that an audit is conducted to ensure that equipment provided meets residents needs, expectations and wishes. These issues should be regularly addressed at key work meetings and a system established for dealing with them so that delays do not occur. The Registered Person must ensure that all residents bedrooms are lockable and that residents are given a key to their bedrooms. The Registered Person must ensure that further consideration is given to the range of needs which arise from residents cultural backgrounds and that this is included in care planning documents. The Registered Provider must ensure that notes on residents welfare and progress are made at appropriately regular intervals. The Registered Person must ensure that staff receive management input on the purpose and value of recording systems, and that these are monitored through supervisory and other quality control 2005 1 October 2005 1 October 2005 1 October 2005 1 December 2005 1 August 2005 1 October 2005 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 29 11. 20 13(2) 12. 20 12(3) 13(2) 13(2) 13. 20 14. 15. 24 24 23(2)(b) 23(2)(d) 16. 37 38 17. 39 24 18. 42 23(4)(e) systems. The Registered Person must ensure that in relation to the administration of medication in a drink to a resident that (a) advice from the resident’s GP is sought. (b) agreement obtained from the residents relatives/ next of kin, GP and others as necessary (b) the homes policy on covert administration of medication is sent to the CSCI The Registered Person must ensure that residents permission is always sought for the administration of medication. The Registered Person must ensure that safe facilities are available for the storage of medication within the bedrooms of those people who self medicate. The Registered Person must establish a system so that repairs are dealt with promptly. The Registered Person must ensure that decoration and other improvements are carried out to ensure that the home is made comfortable, homely and safe for residents. In particular the matters raised at page 20 of this report must be atteended to. The Registered Person must ensure that notifications required by Regulation - specifically the absence of the Registered Manager - are made to the Commission. The Registered Person must ensure that effective quality assurance systems are introduced in the home. The Registered Person must ensure that fire drills are conducted at quarterly intervals. 1 August 2005 1 August 2005 1 August 2005 1 October 2005 1 January 2006 1 August 2005 1 January 2006 1 August 2005 Page 30 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 19. 42 13(4)(c) 20. 42 13(4)(c) 21. 42 23(4)(b) (c)(v) 22. 9 13(4)(b) 23. 35 18(1) (c)(i) The Registered Person must ensure that staff receive management input on safe working practices in the home and that systems are introduced to ensure that safe practice is followed. The Registered Person must ensure that items which pose a risk to residents are kept with due regard for safety. The Registered Person must ensure that the operation of fire exits is included in the homes weekly checks of the fire safety systems. The Registered Person must ensure that risk management strategies are fully documented, recorded in care plans and reviewed. The Registered Person must ensure that a training needs assessment is carried out for the staff team,and that each member of staff has a training and development assessment and profile. 1 August 2005 1 August 2005st 1 August 2005 1 October 2005 1 January 2006 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 35 Good Practice Recommendations The Registered Person should ensure that a training needs assessment is carried out for the staff team,and that each member of staff has a training and development assessment and profile. This recommendation is carried forward from previous Inspection reports. Although at the Inspection of October 2004 the Manager stated it would be addressed by January 2005 it has not yet been completed. The Registered Provider stated at this Inspection that she is aware of the need to complete the exercise. G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 31 10 Love Walk 2. 3. 4. 5. 33 8 36 40 The Registered Person should ensure that staff meetings are held at appropriate intervals to contribute to effective communication systems within the home. Consideration should be given by the Registered Person to how those residents who wish to do so can increase their participation in the running of the home. The Registered Person should ensure that a staff appraisal system is introduced. The Registered Person should introduce a system of more regular review of policies and procedures to be sure that they are still relevant and meet the current needs of the home and legal requirements. This recommendation was made in October 2004. The review of policies and procedures has not yet been completed . 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 32 Commission for Social Care Inspection 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. 10 Love Walk G52 G02 7105 Love Walk 217122 250405 Stage 4 .doc Version 1.40 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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