Inspection on 18/10/05 for Medora Road, 67

This inspection was carried out on 18th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Medora Road, 67 23/11/06

Medora Road, 67 17/02/06

Medora Road, 67 17/02/05

Medora Road, 67 18/11/04

Medora Road, 67 31/03/04

Medora Road, 67 20/01/04

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

CARE HOME ADULTS 18-65 Medora Road, 67 67 Medora Road Brixton Hill London SW2 2LW Lead Inspector Ms Rehema Russell Unannounced Inspection 18th October 2005 10:30 DS0000022742.V257796.R01.S.doc Version 5.0 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 DS0000022742.V257796.R01.S.doc Version 5.0 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. DS0000022742.V257796.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Medora Road, 67 Address 67 Medora Road Brixton Hill London SW2 2LW 020 8678 6645 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) Southside Partnership Mr D Ebrahim Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places DS0000022742.V257796.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2005 Brief Description of the Service: Medora Road is a residential service for five adults with mental health problems. It is one of a number of homes where the care is provided by a voluntary organisation called Southside Partnership, which provides housing and support services to adults with learning disabilities and mental health problems. The building is owned and maintained by Hexagon Housing Association. Medora Road is a few minutes walk from local shops and buses and a short bus ride away from a very busy shopping centre with full community and transport facilities. The ground floor has the lounge/diner, kitchen, 2 bedrooms, a bathroom with toilet and the utility room. The first floor has a toilet, a bathroom with toilet and three bedrooms. The office is on the top floor. There is a small garden at the rear of the house, accessed from the kitchen, and there is unrestricted street parking at the front of the house. Staff liaise closely with the mental health services by use of person centred planning to enable service users to sustain a positive self-image and good mental health. DS0000022742.V257796.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the late morning and afternoon of 18th October 2005. There were no vacancies at the home. Three service users were at home during the inspection and two were out all day. The inspector spoke with three service users, one in depth, three support workers, the manager and the deputy manager. All communal areas of the premises were seen, and documentation and records examined. There had been a new manager temporarily at the home since July 2005, Mr. Peter Machado. He was managing the home whilst the registered manager was temporarily setting up a pilot service elsewhere. During this period there had been some significant improvements at the home. What the service does well: What has improved since the last inspection? What they could do better: A requirement was made for the Registered Provider to install a ventilation system for the lounge which meets health and safety/environmental health recommendations, thereby reducing the high levels of smoke and residual smoke in this area. However the requirement had been implemented before this report was written and so there are no requirements arising from this report. DS0000022742.V257796.R01.S.doc Version 5.0 Page 6 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. DS0000022742.V257796.R01.S.doc Version 5.0 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 DS0000022742.V257796.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 There is a thorough assessment process which ensures that prospective service users’ individual aspirations and needs are assessed. Prospective service users have opportunities to visit and “test drive” the home. EVIDENCE: Assessments files were seen and found to be very thorough. The Southside Partnership assessment form is completed for all prospective service users and is comprehensive. It areas such as current problems, risk factors, medication, family, communications, cognitive ability, thought patterns, social relationships, social skills, domestic skills, life skills, leisure activities and challenging behaviours. It includes a summary, core needs and requirements, recommendations for action and is signed and dated. From this information and initial care plan and a weekly programme are devised. In addition, evidence was seen of the home obtaining referral information from relevant specialists such as discharge care programme approach, South London & Maudsley risk assessment tool, contingency and crisis plans, community cared plans and discharge summaries. Evidence of advocates being involved in the assessment and trial period was documented, in one case a nurse visited with the user and in another both the community psychiatric nurse and a family member. Prospective service users are invited to visit the home and to undertake trial visits which take the form of day visits, several weekend visits and then a one week trial. A service user spoken with confirmed that they had had several DS0000022742.V257796.R01.S.doc Version 5.0 Page 9 visits to this and another home before making a decision to come to here. They had also had a trial period and were happy with the decision they had made. DS0000022742.V257796.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 and 9 Each service users has an individual care plan which reflects their assessed and changing needs. Service users are consulted on, and participate in, all aspects of life in the home and are supported to take risks as part of an independent lifestyle. EVIDENCE: Three care plans were seen. They were found to be thorough, clearly written, well laid out and containing all necessary information. Each care plan had at least 4 care components which each stated the need, short term goal and long term goal and then outlined the action needed, the person responsible for this and the evaluation date. Each care plan component was evaluated monthly and each component was signed and dated by the service users and the key worker. Detailed daily progress reports are kept, which were very informative and gave a very good overall picture of each service user’s health, social interaction, indoor and outdoor activities and relevant incidents in their lives. In addition, care plan files also included a Life Plan which the service user completes themself and which is reviewed every year, a weekly programme of activities, very detailed and clear key worker evaluation meetings and minutes of CPA review meetings. The majority of the documentation seen was very well kept but in some cases the daily programme report notes were confusing DS0000022742.V257796.R01.S.doc Version 5.0 Page 11 to follow as staff had used the back of sheets for non sequential dates and it is recommended that care is taken to keep these important and informative notes in sequential order. A Tenants Meeting File is kept in the lounge and this was found to contain minutes from regularly held meetings where service users can discuss, comment upon and make suggestions about day-to-day decisions within the home such as health and safety, household duties, activities and outings and outcomes from service user involvement at social clubs and the Partnership’s Service User Committee. These meetings are held monthly and are attended by all service users. Minutes were clear, easily accessible and showed that any issues raised are acted upon or carried forward to the next meeting. Documentary and verbal evidence, plus observation on the day of inspection, demonstrated that service users are encouraged and supported to make independent decisions and to take responsible risks in their daily lives. One service users spoken with on the day of inspection was going to collect their allowance but had decided that they were too tired to continue on to the dropin and so was returning to the home to rest. The service user is completely independent in regard to all physical care and household chores but gave several examples of where staff had given advice and support around difficult decisions and choices that the service user had made. The service user said that staff were always willing to help and that they “couldn’t have got through” without the help and support staff gave. Risk assessments were seen on care plan files and were found to be very detailed, tying in with care programme assessments and hospital plans, and regularly reviewed. DS0000022742.V257796.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 17 Service users take part in age, peer and culturally appropriate activities and are as part of the local community as they choose to be. Service users have appropriate personal and family relationships. Service users are advised and supported to choose a healthy diet and to enjoy their meals and mealtimes. EVIDENCE: Two service users attend college, both undertaking courses which will prepare them for the employment of their choice, and one also does paid work arranged by a day centre. The second service user attends a drop-in centre once a week. The other three service users choose not to attend colleges or day centres. One of the latter keeps himself very busy during the day, going to the gym, attending saunas and massages, swimming and visiting the cinema, and he has an active social life in the evening. All service users use the local community for cafes, shopping, banking, cinema, transport, and health services. Care plans and discussions with service users and staff showed that staff support and encourage service users to maintain family and friendship links according to choice and appropriateness. Service users confirmed that they are DS0000022742.V257796.R01.S.doc Version 5.0 Page 13 able to choose whether to visit friends and family or to invite them back to the home. Visitors received at the home are offered refreshments and occasionally stay for a meal. Four of the five service users have contact with family and relatives, varying from regular weekly to occasional once or twice annually visits. Only one service user has no contact with family, by their own choice, which staff respect. All service users cook their own meals, supported by staff as appropriate or requested. Staff will cook for individuals if they are having a bad day, and will cook a group meal on special days such as bank holidays, festivals and Christmas. Service users have decided that they do not wish to have a group meal on Sundays but once a week four of the five service users visit a pub to have a meal together. As service users generally lead independent lives they are not always around at mealtimes so staff are not able to monitor comprehensively what service users eat, although records are kept wherever possible. However staff offer support and advice about healthy eating and will involve a dietician in educating and advising service users if there is a need. Following this type of intervention one service user now uses less fat to cook and sweeteners instead of sugar. One service user described the types of meals cooked, which seemed balanced and nutritious, and the inspector observed another service user eating a simple but nutritious meal at lunchtime. DS0000022742.V257796.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 Staff operate a very thorough medication system and service users are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Medication storage, administration and recording was checked and found to be very thorough. The checking and recording of all incoming and disposed of medication was detailed and thorough with staff obtaining a pharmacist signature or stamp for disposals, which is very good practice. The medication file has a full list of staff sample signatures, including agency and bank staff, and each individual service user record has a photograph and detailed medicate profile. No gaps were found in administration recordings and a tablet count is carried out twice weekly, with a separate sheet which records crosschecks undertaken. This sheet also highlights when any medication supply is getting low so that this can be entered into the staff communication book (with a repeat prescription form) and diary and the service user can be reminded to go to the GP for further supplies. One service user currently self-medicates and staff described the thorough procedure that has been put in place to monitor this. DS0000022742.V257796.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service user views are listened to and acted upon and service users are protected from abuse, neglect and self-harm. EVIDENCE: There is a clear, detailed, easily understood and effective complaints procedure, which is easily accessible to service users. No formal complaints had been received by the home but there was verbal and documentary evidence that staff had discussed the use of mental health advocacy services with all service users. Three service users had agreed to meet with the advocate, and have now done this several times. The advocate brought literature to the home and one service user now corresponds regularly with him. One component of the complaints procedure given to service users is now out of date because the Quality Manager cited has left the organisation. A recommendation has therefore been made that the complaints procedure is updated to incorporate this change. All staff have had abuse training, both during induction and then as a separate one day course. In addition, the manager, deputy and two support workers have undertaken “Welcoming Diversity” training. Staff spoken with were aware of the many different forms of abuse and the procedures to be followed should abuse be suspected. Four of the five service users manage their own finances. One service user is helped to budget by leaving a sum of money in a wallet in the office weekly, with a measured amount of it received daily. Records of these transactions were seen and were found to be all signed by the service user and in good order. DS0000022742.V257796.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 28 and 30 Service users live a homely, comfortable and safe environment. EVIDENCE: The home’s premises and location are suitable for its stated purpose, accessible, safe and well maintained. It is an ordinary end of terrace house that has three floors and no lift and so is not suitable for people with mobility problems. It is attractively decorated, fitted and furnished and very homely throughout. There are three communal areas in the home, the lounge/diner, the kitchen and the garden, and all three are very attractive and well maintained. The lounge has a leather sofa and chairs, coffee table, fish tank, sideboard dresser, music system, new widescreen television with DVD and digibox, large mirror, clock, positive images, magazines and television programme book and new carpet. The sideboard dresser has an area for books which also has the tenants meeting file, tenants charter, complaints information, policies for consultation with service users and directory of local services, so that all of these are readily accessible to all service users. Unfortunately, as most of the service users smoke, the lounge gets extremely smoky and at the time of the inspection the extractor provided was not of sufficient effectiveness to keep the air in the room reasonably clean. The inspector found it very difficult to stay in DS0000022742.V257796.R01.S.doc Version 5.0 Page 17 the room for more than several minutes and so do staff, and this detracts from quality time that staff can spend with service users. The service user who no longer smokes told the inspector that the poor quality of the air often prevented them from using the lounge. A requirement was therefore made for the extractor to be upgraded to the standard recommended by environmental health and at the time of writing this report the requirement had already been implemented. The kitchen has been refurbished and is of very high quality. It has been redesigned with very good quality fixtures, fittings and equipment and the new design has even created more space. It is cleaned by service users and on the day of the inspection was found to be very clean and tidy. Service users said they were very happy with the new kitchen. The garden has also been improved and was very well kept and attractive. There were outdoor table and chairs provided, which service users had used during the summer months. Other areas of the home seen included the toilets and bathrooms, the staff office, one service user’s bedroom, the hallways and the laundry room. All areas were found to be clean and hygienic, with no unpleasant or offensive odours. DS0000022742.V257796.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 35 Service users’ individual and joint needs are met by appropriately trained staff. EVIDENCE: The inspector spoke with three support workers at the home, whose service at the home varied from 10 months to several years. They all demonstrated approachability, good communication skills, a good knowledge of mental health issues and thorough understanding of individual service users needs, interest, motivation and commitment. This was also observed in their interactions with service users during the day. Service users spoken with said that they felt comfortable with staff, felt that they cared about them and said that “staff are OK”, “staff are lovely”, “I couldn’t have got through it without them” “staff help all the time” and “if there is a problem I talk to staff about it and they always get back to me”. Examples were also given of where staff had approached mental health problems and potentially difficult situations with sensitivity and tact. The home has exceeded the 2005 NVQ Level 2 training recommendation, with the majority of staff holding an NVQ Level 2 or 3. All staff undergo an induction and training programme on commencement of employment. Initial induction covers all of the basic policies and procedures at the home, including medication and health and safety, plus training in fire safety, food hygiene, infection control, basic first aid and mental health. From then on individual training needs are identified through supervision. The Registered Provider runs a very well organised and comprehensive training DS0000022742.V257796.R01.S.doc Version 5.0 Page 19 programme, providing individual training profiles for staff and regular reminders to homes when refresher courses are due. Staff profiles showed that staff undergo a full range of relevant training and on the day of inspection two staff were undertaking a fire safety refresher course. Training for the team as a whole is often done during team meetings and occasionally a professional, such as a pharmacist, is invited to give guidelines or advice. Staff personnel files are kept at Head Office so CRB checks could not be examined. These will be checked at a forthcoming visit to Head Office. DS0000022742.V257796.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38 and 39 Service users benefit from the ethos, leadership and management approach of the home. Service users views underpin the self-monitoring, review and development undertaken by the home. EVIDENCE: The Registered Manager demonstrated a comprehensive knowledge of mental health issues and the policies and procedures at the home, and a sensitive and supportive understanding of individual service user’s needs, characteristics and aspirations. This was supported by a service user spoken with who gave an example of the manager’s concern and sensitive handling of a potentially difficult situation. The management style at the home creates an open, positive and inclusive atmosphere. Staff said that they were “very happy here, “feel very much part of the team” and found the management “open and welcoming”. DS0000022742.V257796.R01.S.doc Version 5.0 Page 21 The Tenants Meeting File was seen and showed that monthly service user meetings are held. Each meeting had a staff member present with minutes taken by a service user. Areas covered included health and safety, household duties, client activities, cooking in the house and service user involvement. Suggestions and issues raised by service users were actioned and carried forward for feedback to the following meeting. Minutes evidenced that service users’ views are sought and influence the day-to-day running and policies and practices of the home. The Registered Provider uses the Practical Quality Assurance System for Small Organisations (PQASSO) to monitor and review the quality of services provieded at the home. The Registered Provider also operates a Service Users’ Committee, which service users can choose to attend, and whose minutes are discussed at tenants meetings. DS0000022742.V257796.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 x Standard No 22 23 Score 4 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X x 4 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 4 X X 4 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 4 x Standard No 37 38 39 40 41 42 43 Score X 3 3 X X X x DS0000022742.V257796.R01.S.doc Version 5.0 Page 23 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA22 Good Practice Recommendations The Registered Manager should ensure that all staff record daily progress report sheets in sequential date order. The Registered Person should ensure that reference to the Quality Manager in the complaints procedure is updated. DS0000022742.V257796.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 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 DS0000022742.V257796.R01.S.doc Version 5.0 Page 25 - 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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