Inspection on 30/01/06 for Palace Road, 18-18a

This inspection was carried out on 30th January 2006.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

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

Palace Road, 18-18a 15/06/05

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 Palace Road, 18-18a Streatham Hill London SW2 3NG Lead Inspector Mary Magee Unannounced Inspection 30th January 2006 10:00 Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Palace Road, 18-18a Address Streatham Hill London SW2 3NG 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) 0208-671-7849 www.stepforward.org.uk Metropolitan Housing Trust Mr Neil Whitelam Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 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 on the ground, the first and second floors. A passenger lift is provided to enable access to all three floors. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was undertaken over four hours during the daytime. It was unannounced. The inspector attended an open day at the centre some weeks earlier hosted by service users and staff. Comments were received at the event from five service users and three members of staff and members of the community mental health team. These are included in this report. The registered manager and two members of staff met with the inspector and contributed further to the inspection findings on the unannounced visit. A selection of staff personnel files was examined at the head office. The inspector toured the premises. All communal areas were viewed as well as three bedrooms. What the service does well: What has improved since the last inspection? More stimulating and educational group work has been introduced for service users. Service users are involved in policy committees that help shape how the organisation plans services. These sessions have provided service users Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 6 with information on the codes of behaviour society finds acceptable and assists with their successful return to independent lifestyles. New carpets have been fitted to the ground floor. Service users found that these made great difference to the overall appearance of the home. Recordkeeping continues to improve, in particular key workers notes. 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. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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): 1245 The home is successful in supporting service users develop and rebuild the confidence and self esteem that they need to develop independence. EVIDENCE: There is an up to date statement of purpose and a service users’ guide provided for prospective service users. It gives a good detail of the services available at the home. Historically the home has accepted and provided services to people in the older age group. Frequently the assessed needs related more directly to housing rather than health needs. Plans are in place to readdress this and to relocate service users identified as ready for living in supported housing. These plans will take into account group dynamics and in particular the fact that service users choose to remain in groups they prefer and are familiar with. Two service users spoke of their optimism in moving on to supported housing. Records viewed and discussions with service users and staff showed the phased admission process. Trial periods for up to three nights are part of the staggered procedure. There is a trial period of three months for all new service users. Service users have individual contracts detailing terms and conditions of tenancies. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 the following standard(s): 6789 Service users are empowered to take control of their lives by taking appropriate risks while feeling safe and protected. Care and support arrangements are well organised for service users. Staff respond to individuals’ changing needs and take appropriate action such as seeking the opinion of other professionals when required. EVIDENCE: Care plans are in place to support service users at the home. The plans reflect individual needs aspirations and goals and the services required to meet these goals and needs. Records are maintained of individual’s progress and of their response to services delivered. These daily and monthly records show that appropriate support is delivered and that additional help and expertise is sought as necessary. Staff monitor closely the conditions of service users and are prompt at seeking appropriate help if there are signs of relapses. Service users are allocated individual key workers who know and understand their needs. Staff at the home link up with the CPA coordinator where applicable. At the open day the inspector met with professionals from the mental health team as well as with service users that were busy and involved in hosting the Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 10 event. Service users were keen to demonstrate the measures put in place to safeguard them from neglect or abuse. One service user said staff helped him “back on his feet at a difficult time”. He found that staff helped service users to focus on their strengths and not on the weak points. Positive feedback was received from five service users on “the open day”. Service users were proud of the home and of the progress that they had made while living there. They felt keen to demonstrate to others interested how secure they felt during this period. They spoke of how staff respected their rights to making decisions but that they received assistance as necessary having their decisions. Risk assessments are agreed with care plans and are constantly reviewed. These contain evidence of limitations to prevent self-harm or neglect and made in the best interests of the service users. Service users are kept informed of and receive assistance to participate in mental health projects in the community. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 the following standard(s): 11 13 14 15 Service users are supported to prepare for the future and for moving to lower level support units. They receive education and training on areas of behaviour that are unacceptable and that can offend, isolate or hurt individuals. EVIDENCE: Service users participate in a range of activities that enables them to influence decision making at the home. Weekly meetings are held, service users are encouraged to put forward their views and affect how services are delivered. Service users are involved in the recruitment and selection of staff and in policy making. Discussion groups and debates are other areas that service users organise. A service user spoken to found these debating sessions to be very informative and help him to engage in conversation. A reward/loyalty scheme has been introduced at the home to encourage group participation and development and prevent social isolation. Service users that regularly attend benefit from building up points that can be exchanged. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 12 Other group activities promoted at the home and proving to be beneficial to service users include agendas on anti social behaviour and policy committee meetings and tolerances. Service users are given the opportunity to discuss what they consider antisocial and advice on how to deal with negative behaviour by young people that single them out in the community. Some service users have experienced social exclusion prior to moving to the home. With educating and training they received they found that they could integrate into the community more easily. A number of service users attend gardening projects and day centres. Annual holidays that they help choose are enjoyed by service users. Other new initiatives that involve service users have commenced at the home. The inspector attended the Open Day some weeks earlier. A service user expressed a view that this played a vital role in him developing self-confidence and improving his communication with others. He took on the role of greeting visitors and showing the facilities available. A number of service users had contributed to a video made promoting the service. Attending the promotions day were outreach workers from the mental health team. They spoke of the work that they had begun with service users that were moving to supported housing. Arrangements were in place to support one service user during the transition from the home to her new supported housing environment. Service users have their rights and privacy respected and are supported to have appropriate personal and family relationships. Service users choose whom they see and when they want to see them in communal areas or privately in their rooms. . Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 the following standard(s): 18 19 20 Service users receive the necessary support that is flexible and consistent and responsive to their changing needs. Service users are protected by the home’s policies and procedures on dealing with medications. EVIDENCE: As part of the programme in supporting people to moving to independence focus is on encouraging and promoting service users to manage their own personal hygiene. It was evident that for many service users as they had grown in confidence they had become aware of maintaining satisfactory standards of hygiene. Service users receive additional support from psychiatric services, some receive weekly visits from a CPN. Others attend the mental health clinic. The physical and emotional needs of service users are closely monitored. Emphasis is placed on monitoring without being obtrusive. A local GP surgery provides medical services to service users. Medication profiles are held for service users. Records are well maintained of medications received into and returned from the home. It is recommended that the dispensing pharmacist stamps the receipt to acknowledge unwanted medication returned from the home. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 14 Service users following assessment are able self medicate. The conditions of service users and their response and compliance with medication is closely monitored. An occasion arose recently that necessitated a service user that was non compliant with medication requiring a short hospital stay. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 23 The service ensures that service users are safeguarded from neglect and abuse. Training and guidance is given to service users on recognising and dealing with patterns of behaviour that are anti-social and that can impact on their recovery. EVIDENCE: The service focuses on promoting and seeking service users’ views and developing services that they want and need. Much work has been done on involving service users on shaping developments at the home. Numerous group meetings are held weekly and monthly to listen to service user views and respond to their requests. The centre has made progress on developing awareness for service users on safeguarded themselves from abuse or neglect. Items on agendas for service users to discuss include policies and procedures for the home. Service users sit on policy committee meetings. Education and training provided include topics on what service users look out for both in the home and after discharge are discussed. The views of service users and what they identify as causing problems to their recovery are discussed. Expert advice is also sought from guest speakers on dealing with sensitive issues that arise. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 25 26 Service users live in a clean and safe environment. An extension is under development to provide additional communal areas for service users that smoke. EVIDENCE: The home is clean and well maintained. New carpets have been fitted on the ground floor that has enhanced the overall environment. Work was in progress on providing additional communal accommodation in the form of a conservatory. The plans are for this room to accommodate service users that wish to smoke and to safeguard other service users from the harmful effects of smoke. Bedrooms are monitored monthly to support service users maintain satisfactory standards of hygiene. Three bedrooms were viewed. For one service user it was evident that he should have additional support with maintaining his room to satisfactory standards. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 17 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): 31 33 34 36 Members of staff are clear about their roles and responsibilities. They are well supported and supervised. Some development is required in the recruitment procedures. EVIDENCE: Staff are aware of their roles and responsibilities. There are sufficient numbers of suitably qualified staff on duty during the day. At night there is one member of staff on sleeping night duty. The manager explained an event recently when an additional member of staff was allocated for the night. Following changes to an individual’s condition it was assessed that an extra staff member was required. It is recommended that staff levels are constantly reviewed and that they reflect the changing needs of service users. The inspector visited the head office to view staff files. Two references were available on all three staff files, there were occasions when a third reference was sought when the organisation was unhappy with the content of the other references. Application forms were completed thoroughly with no gaps left unexplored in employment records. While all the necessary information was available on file on the day of inspection, there was some confusion about recruitment practices. Staff had commenced employment at the home before a POVA check or a new CRB enhanced disclosures was available. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 18 The registered person must ensure that all the necessary information as detailed in Schedule 1 including Enhanced Criminal Record Disclosures and POVA checks are available for members of staff before they commence work. Three members of staff were spoken to at the Open Day. A further two staff members were spoken to on the inspection day. It was evident that received regular and consistent supervision and support. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 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): 37 39 40 41 42 Service users benefit from living in safe secure and well managed service. The service is totally focused on achieving the best outcome for service users. EVIDENCE: The home is well managed. The registered manager is competent and qualified. He has made a significant difference to the quality of life experienced by service users since his appointment. He is keen and interested in the service users and the service they receive. He motivates the team as he is constantly striving for improvements in the service. There is an effective quality assurance system to monitor the effectiveness of the service and measure success in delivering it’s aims and objectives. MHT and Stepforward are constantly striving to further develop services for people with mental health. The home has an annual development plan. The future planning involves group placements for older service users in a supported housing environment. The emphasis is to be placed on accepting service users for shorter stays. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 Page 20 At the Open there was a good illustration of how all the groups are working together from day care services to outreach workers and staff from supported housing. Outreach workers and housing departments meet with service users prior to discharge and continue supporting them in the community as necessary. Policies and procedures are regularly reviewed to keep in line with current and changing legislation. It is recommended that staff keep themselves regularly updated and apply all policies procedures and codes of practice. Record keeping is good and shows continued improvement. The health safety and welfare of service users are promoted and protected. Records showed that regular health and safety audits are undertaken for the premises. At the previous inspection the servicing and maintenance records for equipment for the home were viewed. These are adequately maintained. Records confirmed that regular fire evacuation procedures are undertaken and that fire fighting equipment is serviced and safely maintained. Staff spoken to were knowledgeable on how to deal with accident and emergencies. A number of staff has up to date first aid certificates. Records are maintained of accident sand incidents at the home and forwarded to relevant authorities. Appropriate notifications are received by CSCI, these include regulation 26 and 37 visit reports. Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 3 3 x 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 3 32 x 33 3 34 2 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 4 12 x 13 4 14 x 15 3 16 3 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 x 4 3 3 3 x Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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 YA34 Regulation 7 9 19 Schedule 2 Requirement The registered person must ensure that all the necessary information as detailed in Schedule 2 including Enhanced Criminal Record Disclosures and POVA checks are available for members of staff before they commence work. Timescale for action 10/03/06 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 YA19 YA25 Good Practice Recommendations The registered person should ensure that the pharmacist stamps to acknowledge returned medications. The registered person should ensure that individuals requiring it receive additional support with maintaining their bedrooms including bed linen to satisfactory standards The registered person should ensure that staff levels are constantly reviewed, in particular those for night times and that they reflect the changing needs of service users The registered person should ensure that staff keep themselves regularly updated and apply all policies DS0000022746.V280698.R01.S.doc Version 5.1 Page 23 3 4 YA33 YA40 Palace Road, 18-18a procedures and codes of practice Palace Road, 18-18a DS0000022746.V280698.R01.S.doc Version 5.1 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. 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