Inspection on 15/06/05 for Palace Road, 18-18a

This inspection was carried out on 15th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Palace Road, 18-18a 24/03/10

Palace Road, 18-18a 31/05/07

Palace Road, 18-18a 30/01/06

Palace Road, 18-18a 11/01/05

Palace Road, 18-18a 21/06/04

Palace Road, 18-18a 19/02/04

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

CARE HOME ADULTS 18-65 18-18a Palace Road Streatham Hill London SW2 3NG Lead Inspector Mary Magee Unannounced 15th June 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Palace Road, 18-18a Address 18-18a Palace Road, Streatham Hill, London SW2 3NG 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) 0208 671 7849 Metropolitan Housing Trust Mr Neil Whitelam VO Voluntary 19 Category(ies) of PC Care home only registration, with number of places 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2005 Brief Description of the Service: 18 Palace Road is a purpose built care home registered to provide care and accommodation for 19 men and women who have mental health and alcohol related problems. The premises are owned and managed by the Metropolitan Housing Trust. The care management provider is Stepforward a part of the housing trust. The home is located in a quiet residential road between Tulse Hill and Streatham Hill railway stations. The majority of the communal rooms are located on the ground floor. There are nineteen bedrooms located both the ground, the first and second floors. A passenger lift is provided to enable access to all three floors. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken on the morning of 15 June 2005. It lasted for four hours. Five service users were spoken to. Two members of staff including the registered manager, were interviewed. A number of personnel records were viewed, these related to service users and staff as well as records for the maintenance of the premises. What the service does well: What has improved since the last inspection? Service users now have the opportunity to enjoy an annual holiday arranged by the home. Fire evacuation procedures are undertaken regularly at the home to make sure that staff and service users are familiar with the correct procedures. Service users have made further progress in developing independent living skills since the last inspection with some awaiting suitable housing. Service users that take responsibility for administering their own medication do so in a safer manner. Stakeholders have been invited to contribute to further developing services at the home and are invited there to an open day. Additional stimulating activities such as discussion groups at the home have been introduced for service users. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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 standard(s) 1 2 3 4 The home is successful in supporting those service users who were homeless or who had left hospital to rebuild lost confidence, to regain social and daily living skills and to prepare for living more independently in the community. EVIDENCE: The registered manager provided the inspector with the records of a prospective service user due to be admitted shortly. A young man currently hospitalised had been referred for admission. A member of staff had attended the CPA and visited him in hospital. A psychiatric nurses report as well as records of the CPA were forwarded to the home to enable them complete a full assessment and prepare for admission. Arrangements were in place for him to come to the home overnight and experience life there as part of a phased admission process. The service users’ guide has been updated to reflect all the necessary information. A service user that has lived at the home for a number of years has progressed very well. At her last review and following OT assessment it was determined that she was now ready to move to more independent living accommodation. She spoke positively to the inspector of her time at the home and how much it had helped her gain confidence and coping mechanisms. She said that she was at rock bottom and could see no way forward before she came to the home. The registered manager informed the inspector that once suitable accommodation was found she would be supported to move. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 9 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 standard(s) 6 7 8 The arrangements for delivering care and support at the home are very good. Service users are supported and enabled to take control of their lives. EVIDENCE: The inspector examined care plans for two service users. Risk management strategies were recorded with individual care plans. Care plans developed with service users reflected individual needs and goals. Good written records were maintained of individuals’ progress and evidenced success in the delivering of support that met the assessed needs. It was evident that staff monitored the progress and recorded any relapses or setbacks. On one of the plans there was guidance on what to look out for as a relapse indicator. Daily logs were viewed that included events that impact on individual service user and their progress. An example was recorded of the care and support given by staff when a service user was mugged recently when out shopping. For one service user a recent report by the key worker was unavailable. The registered manager informed the inspector that the member of staff had not completed it. It is recommended that reports are written up promptly and included on service user’s files. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 10 Two service users said that staff were very supportive and encouraged them to participate in interests outside the home and to take reasonable risks to restore their confidence. From discussions with a member of staff there was evidence that staff were aware of service user’s needs and recognised any slight changes to service users psychological condition. Service users are encouraged to be as independent as possible and are encouraged to participate in all aspects of life at the home. Meetings are held weekly to which all service users are invited. Breakfast is self service allowing service users the opportunity to choose and prepare breakfast of his/her choice. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 11 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 standard(s) 12 16 17 Service users live fulfilling lifestyles both inside and outside the home. EVIDENCE: A large number of service users attend college courses and day centres. A small number attend clubs that have special provision for people with mental health related issues. The home is conveniently located enabling easy access for service users to the local shopping area. Service users also participate in many group outings. These include shows and the cinema, shopping trips, museums and the local cinema. Service users had enjoyed a short stay holiday recently. Service users were observed listening to music and watching television, playing snooker. Two service users spoke of the regular discussion groups held which were popular with the majority of people. They said that “interesting topics from politics to science are discussed”. This they said gave people enjoyment as well as developing their confidence. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 12 Staff should continue to encourage and promote more activities to suit service users capacities and preferences. Each day there is a minimum of three choices available for the main meal which is served in the evening. The menu is displayed on the notice board with service users ticking their choice. The home employs a qualified chef to prepare meals. Service users prepare their own breakfasts and have a choice of whether to prepare their own sandwich lunch or choose the lunch provided by the home. Three service users said that they were happy with the food served. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 13 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 standard(s) 18 19 20 The support provided at the home is reliable, consistent and responsive to individuals changing needs. Service users are supported to manage their own medication within a risk management framework. EVIDENCE: None of the current service users require support with personal care. Some service users require prompting to encourage them to maintain a satisfactory standard of hygiene and to contribute overall to their well-being and self esteem. Progress has been achieved by a large number of service users in this area. Staff have provided the necessary support in a sensitive and non obtrusive manner that takes into account their feelings and emotional well being. One service user spoke of how much more interest she had in getting her life together. She said that, “life was not worth living” as she had, “hit rock bottom” before she came to the home. She said that she now had hope and could see that life was more rosy. The inspector observed a significant change in the interest she takes in her appearance. Staff at the home monitor service user’s physical and emotional health. Records demonstrated the instances where individuals experienced medical and emotional problems and of the necessary referrals made to doctors and 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 14 CPNs. Service users are registered with a local GP practice. Staff encourage service users to attend appointments there and at the hospital. A number of service users attend the community mental health centre for regular appointments. Records are maintained of appointments with staff aware if service users miss appointments. The registered manager was observed discussing a future appointment with one service user. A CPN visits the home every two weeks to monitor individuals progress. A service user suffered a relapse recently involving alcohol abuse. Records and discussions with the registered manager demonstrated that the appropriate action had been taken to address this issue. Clear guidelines were in place on the use of alcohol in the home according to individuals needs and conditions. A number of service users self medicate. At the previous inspection a requirement was made that an assessment and monitoring process was necessary to enable those service users to self medicate safely. This has been actioned. Medication procedures were observed to be adhered to with no errors identified. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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 standard(s) 22 23 This is an environment where service user’s views are important and listened to carefully. EVIDENCE: Three service users spoken with said that staff were, “kind and that they were very good listeners”. During the inspection the interaction observed between service users and staff was good. In a situation where a service user was becoming a little agitated a member of staff was dealing with the situation in a calm and encouraging manner. The complaints records were viewed. Two complaints relating to minor issues raised by service users were logged. The follow up action indicated that both had been responded to promptly and addressed. The progress observed by a number of service users demonstrated that emphasis was placed on encouraging and supporting individuals to promote dignity and self esteem. Service users previously at risk of self neglect had become interested in their appearance. Staff have received training in Adult protection procedures. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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 standard(s) 24 25 28 30 The environment is pleasant and comfortable with plans to provide additional communal accommodation. EVIDENCE: The home is comfortable and safe. It has a large array of communal space. On the ground floor there is one large lounge with television and a music centre and comfortable seating that includes sofas and chairs. There is another comfortably furnished lounge with a snooker table located off the dining room. On the first floor there is a quiet room that includes a library. A garden with grass and paved area is to the rear of the premises. The smoking lounge is used extensively and has caused some difficulty with smoke entering the corridors if the door is left open. Service users are reminded to keep it closed. It is recommended that positive steps are taken to encourage service users to keep the door of the smoking lounge closed. An application has been made to CSCI for an extension to the premises that includes a conservatory. It is proposed that the additional space will accommodate a smoking lounge to alleviate this problem. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 17 Carpets on the ground and first floors were badly marked and stained in places. These were replaced last year as part of the refurbishment programme. These carpets must either be cleaned or replaced. Two bedrooms were viewed. These were comfortable and had been personalised by the occupants. One service user spoke of how much she loved her bedroom and how she valued her own personal space. She had experienced homelessness for many years before moving to the home. Bedrooms are monitored monthly to ensure that satisfactory standards of hygiene are maintained. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 35 Service users have their needs met by a competent and experienced staff team. EVIDENCE: Rotas were viewed of the numbers of staff available on duty. There were sufficient numbers of suitably qualified and experienced staff on at all times to meet the assessed needs of service users. During the day two members of staff are on duty until 10pm. Security checks are undertaken between 9.30 pm and 10pm. There is one sleeping in member of staff on duty from 10pm until 7.30 am the following day. The registered manager spoke of the plans in place if there were any concerns identified. If additional concerns are identified before the day shift finishes an additional member of staff is engaged for the night. The home treatment team is on call for any emergencies at night time too. A member of staff spoken to said that he enjoyed his role and got great satisfaction in enabling people make progress and develop more confidence and independent living skills. The home has a training and development programme. It was recommended that topics relating to the care of older people be included on this. Copies of the programme confirmed that this had been done. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 38 40 41 42 Service users live in a home that is well run. The premises are safe, secure and promote the health and safety of service users. EVIDENCE: The experiences and skills of the registered manager have made a significant difference to the effective day-to-day running of the home. He is motivated and has good leadership skills. He holds a management qualification and NVQ Level 3 in care and promoting independence. He is currently completing the NVQ 4 Registered Managers award. New written policies and procedures have been produced to comply with current legislation. The registered provider should ensure that all staff have access to copies of these and understand and apply all policies procedures and codes of practice. Record keeping at the home is good with accurate details recorded for service users and the premises. CSCI has received notifications of incidents as well as copies of Regulation 26 visits. Copies of Regulation 26 visits have not always 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 20 been received on time. The registered manager spoke of the plans for the future of the home to improve delivery of services. An open day to which all stakeholders such as MHT and GP are invited has been organised for August 2005 to gain their views and look to future development. A number of records were viewed relating to the maintenance of the premises. These records demonstrated that the environment is safely maintained. Monthly health and safety checks are completed for the home. Fire fighting equipment as well as emergency lights are regularly serviced. The home undertakes regular fire evacuation procedures. A recent check was undertaken by the LEFPA, no recommendations were made. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 21 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 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 x x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 18-18a Palace Road Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 3 x G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 22 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. 1. Standard 24 30 Regulation 23 (2) d Requirement The registered person must ensure that stained carpets on the ground and first floor are cleaned or replaced. Timescale for action 30 August 2005 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. 4. 5. Refer to Standard 6 12 40 41 30 42 Good Practice Recommendations The registered person should ensure that diary notes for service users are written up promptly The registered person should continue to encourage and promote more activities to suit service users capacities and preferences. The registered person should ensure that all staff have read, understand and apply all policies procedures and codes of practice. The registered person should ensure that copies of Regulation 26 visits are forwarded regularly every month to CSCI. The registered person should encourage service users to keep the doors to the smoking lounge shut when it is in use. 18-18a Palace Road G52-G02 S22746 Palace Rd V233916 150605 stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection SELondon 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. 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