Inspection on 31/05/07 for Palace Road, 18-18a

This inspection was carried out on 31st May 2007.

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 30/01/06

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 25th & 29th May 2007 10:00 Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 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 0208 683 9591 nwi@mht.co.uk www.stepforward.org.uk Metropolitan Housing Trust Mr Neil Whitelam Care Home 20 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.V327760.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2006 Brief Description of the Service: 18 Palace Road is a purpose built care home registered to provide care, support and accommodation for twenty people that have experienced mental health related conditions. The premises are owned and managed by the Metropolitan Housing Trust. The care management provider is Stepforward, part of the housing trust. The home is located in a quiet residential road between Tulse Hill and Streatham Hill railway stations. Public transport links are good. The majority of the communal rooms are located on the ground floor. There are twenty single occupancy bedrooms located over the ground, the first and second floors. A passenger lift is provided to enable access to all three floors. Fees range from £ 471.25 to £499.00 per week. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over two half days. Prior to the inspection the inspector received a completed pre inspection questionnaire. Also received was a copy of the organisation’s improvement plan and quality assessment tool developed by the previous manager. Present for the inspection on day one was a senior support worker who has been acting manager since the end of March 07. He supplied the inspector with information and written records that are maintained for the service and for residents. On day two the inspector met the newly appointed manager who had just taken over the role. Also spoken to during the inspection were two staff members. The inspector met with five residents individually to find out how the service is meeting their needs. The care, support needs and progress of these residents were case tracked. Four other residents also spoke to the inspector over the inspection period. Two of the residents invited the inspector to view their rooms. All the communal areas were toured including the garden. Residents receive regular weekly visits from CPN service. Two of the community psychiatric nurses were asked for feedback on the service. Personnel files for two new members of staff were examined. The inspection findings in the report are based on evidence gained from examining all the documentation supplied, feedback from residents and health professionals and staff at the home. What the service does well: This is an excellent service. It is run in the best interests of residents. Changes have taken place to the objectives of the service. Instead of long term placement the organisation has remodelled the service. It now focuses on admitting people for stays of no longer than two to three years. The home has embraced the remodelled service well. It now plays a lead role in empowering and supporting residents during their stay to develop the necessary skills for personal development. Emphasis is placed on successful rehabilitation with the view to resettlement within a set period. Residents are monitored closely to ensure that any potential complications in mental health are recognised and responded to promptly. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 6 Medication procedures are good with residents supported to develop the capacity to self medicate. Staff at the home work closely with other key players in mental health and housing. This cooperation and good working relationship helps facilitate the discharge of individuals at a suitable time to more appropriate accommodation. The home continually strives for further improvements, setting targets that focus on continuous development. These improvement plans are outcome based, and linked to the reviews of residents support needs. The environment is inclusive and involves residents and stakeholders in all areas, shaping services for the present and for the future. Equality and diversity is promoted throughout the service. From time of referral to admission the service monitors closely the referrals and admissions so that they are fair and reflect the needs of the local community. Staff also encourage residents to have an awareness of equality and diversity and demonstrate this in residents involvement meetings. To make sure that services are as seamless as possible management work jointly with external groups, these include the PAMS (mental health) team and the BME (black and minority ethnic) group. Staff at the home are good at communicating with all relevant bodies and keeping specialist informed of any concerns. Reports of visits made in accordance with regulations demonstrate that these visits are thorough, examining the core objectives. They seek to ensure that any areas for improvement are identified and responded to appropriately. Although the home has experienced the loss of an experienced manager two months prior to the inspection the interim management arrangement has been effective and ensured stability in the service. What has improved since the last inspection? Changes to the service user’s guide reflect all the changes as a result of the remodelled service. The process for admitting new residents is good with an increased number of individuals admitted to the home and availing of the good service. A number of long stay residents following ongoing consultation and reassessments have moved on to more supported housing. Appropriate housing has been identified for a number of other long stayers with plans in place for discharge when appropriate. The home makes sure that every consideration is given to the transition of new residents to the home. Each person referred has a full assessment of need before receiving an offer to live at the home. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 7 A trial period of up to three separate days with overnight stay is part of the admission process. Recruitment procedures have become more robust with all necessary documentation available before a new member of staff commences employment. All residents are now issued with licence agreement that gives more security when living at the home. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 8 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.V327760.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. 1245 This judgement has been made using available evidence including a visit to this service. The home provides good information on the service available. Open days are also held with residents involvement in welcoming visitors to the home. To avoid poor placement the home completes a thorough needs assessment to ensure that the home is able to meet residents before they move to the home. The home is good at ensuring that residents are enabled to move on to more appropriate accommodation when they are discharged. EVIDENCE: The service has produced a new service user guide that is well developed and provides all essential information on the services and support available at the home. The home publicises the services available by hosting open days. Prospective residents, placement bodies and staff from the mental health team are invited. Residents at the home are consulted on this and involved in this event. The service has undergone restructuring in the last year. The changes are reflected in the Statement of Purpose and the service user’s guide. These include the changes in the objectives of the home. The emphasis is on enabling residents to move on within two to three years of admission. Targets have been set whereby 50 of the long stay residents will have moved on to new more independent style living within the first year. Management have worked closely with placement and reviewing panel on move on developments. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 10 All residents of the home were consulted on the changes and involved in discussions before any change took place. A number of residents that had lived at the home long term have been reassessed and following suitable placements moved to other establishments. Plans were in place at the last inspection to relocate residents identified as ready for living in supported housing. Moving on groups were established including all residents on future planning and to make suitable arrangements for moving to appropriate placements. CMHT were fully involved in the assessments process. The plans for moving on considered individual needs both mental and physical as well as housing, they also considered group dynamics and in particular the fact that individuals choose to remain in groups they prefer and are familiar with. A large number have moved on to suitable housing, plans are in place for remaining long stay residents to move too. Placements found include supported housing to care establishments for older people. Some are still in the process of moving on. One resident in the older age group said that she was looking forward to moving to a care home where people of the same age lived. She visited establishments and was satisfied that the new home was suitable. She has valued her time at this home and feels that it has improved her lifestyle. One of the strengths of the home is the attention given to pre admission preparations as well as to discharge or moving on arrangements. The organisation strives to promote equality and diversity within the service. Referrals are monitored to gauge if they reflect the needs of local community groups. The organisation jointly works with Black and ethnic minority groups to make sure that there is an awareness of the service and that there is fair representation. Prospective residents are fully assessed before admission. Joint placement panels that include the PAMS team and management of the service meet to discuss referrals and look at eligibility criteria. The inspector examined how residents are admitted. For two residents recently admitted the needs assessments were examined, there were also medical reports from psychiatry. Risks were identified. It was identified in the needs assessments how care and support services could be met at the home. The trail period took place over a period of short stays ranging from day time to overnight stays. Both residents said that they found this had given them a good chance to get a feel of the home first and that a staggered admission worked well for them. Ongoing assessments took place during trial periods, records are held of these and included on individual files. Alongside assessments and support plans are licence agreements between residents and the home. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 6 7 8 9 This judgement has been made using available evidence including a visit to this service. Needs and risk assessment involve residents and take into account their views, targets and aspirations. Systems are in place to regularly review progress. Residents find that care and support is provided as agreed in support plans. Arrangements are in place to manage risks appropriately. Residents are included in all aspects of life and contribute to development of policies and procedures. EVIDENCE: Ongoing pre admission assessments are completed for all residents before admission. These combined with care management assessments, personal histories and reports from mental health team assist with the formulation of good support plans that meet health, social and mental health needs. The support plans for five residents were case tracked. Two of these residents were recently admitted. The support plans were at various stages of development according to length of time since admission. The inspector found that all of the residents consulted are satisfied with how their needs are met. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 12 Some of those recently admitted had lived at long stay psychiatric hospitals and had become institutionalised. One resident found the change quite beneficial, she said “so far the staff appear very approachable and are aware of the help I need, it is good”. Another resident said that he was used to more rigid environments and that the home seemed fine so far. This resident’s support plan was under development as he was two weeks residing at the home. A short term plan was in place to provide guidance to staff on the short term needs. Records were maintained daily of observations made, these included reports on mental state and of response to prescribed medication. Another resident moved to the home some three months earlier, the support plans in place reflect all the support he needs. His personal history and social interests were recorded. This plan of support was reviewed recently. Key working records were read. These gave a good indication of how he is responding to the present support he receives and the outcome for him since the last review. He is responding well and feels that he is likely to achieve his long-term objective of moving to more independent style living. All five residents’ files contained risk assessments. These provided valuable information for staff to follow and to safeguard residents and staff. In the majority of cases risk assessments are based on reports received from medical bodies as well as to the observations made and the findings of the home. All this essential information is used to assess risk and is incorporated into risk management control. Risk assessments are agreed alongside care plans and are constantly kept under review. These contain evidence of limitations to prevent self-harm or neglect and made in the best interests of the service users. Unnecessary restrictions are not placed on residents. However the home has rules regarding smoking and the misuse of alcohol or the use of illegal drugs, residents are given this information in the licence agreement. Random tests are done in the light of suspicion of the use of illegal substances. Staff are knowledgeable on supporting residents with enduring mental health problems. A range of training has been given to staff, also provided was training on mental capacity act. Within the staff team there are working groups that focus on measuring outcomes for residents with emphasis on constantly reviewing support planning. 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 residents and are prompt at seeking appropriate help and consult with external mental health professionals. Residents are allocated individual key workers who know and understand their needs. remark from some residents that more choice is needed of allocated worker Staff at the home link up with the CPA coordinator where applicable and reports are maintained on file of CPA meetings. A CPN was visiting one resident during the inspection. She finds that the resident is settling in, although it is very early days since admission. Another CPN spoken to finds Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 13 that the staff at the home are good at supporting residents with mental health and will always refer back if there are any setbacks. The service is user focused with residents consulted on all aspects of life at the home. Residents receive opportunities to participate in all areas of planning. The home has policy working groups for residents, involvement in selection of staff, part of service user forums nationally. According to records held of how residents manage finances, all residents manage their own finances with help. They collect their income at post offices or banks as part of daily activity programme. On returning to the home some residents request that staff hold monies in safekeeping. The system in place to hep individuals manage finances is good. The inspector observed how staff assist residents with this. There is a clear audit trail with records and signatures of each transaction. The names and phone numbers of advocacy services is displayed on notice boards. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. 12 13 15 16 17. This judgement has been made using available evidence including a visit to this service. Residents find that the home offers plenty of opportunity to grow as individuals and to manage conditions associated with mental health status. The home promotes residents to develop confidence and self esteem by enabling them participate in many forms of activities both at the home and externally. EVIDENCE: The service is run in the best interest of residents where every individual is given opportunity for personal development. Residents are enabled to fulfil their spiritual needs. Activity plans are in place for residents that consider needs, preferences, ethnicity, and capacity. The inspector observed how a newly admitted resident had received information on the availability of day centre activities. She has previously spent long periods in cafes and remained detached from engaging with others in-group settings. She finds that the environment is positive and supportive and that it suits her needs. She told the inspector that she looks forward to Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 15 attending something worthwhile. Staff have also encouraged her to retain contact with her family. Staff recognise the importance of stimulation and strive to encourage and engage residents. This can often be difficult, many residents experience low self esteem and have not developed their social skills as a result of long standing mental health related issues encountered. It is a slow process but staff recognise the difficulties individuals experience and respond well to this. Support staff work at a pace suitable to individual’s capacity and ability. During the inspection it was observed that a newly admitted resident was supported to visit a further education programme where she could develop more practical skills. The key worker was encouraging and supportive as she spoke with the resident of the experience following the first visit to the college. Some residents have part time employment and find this therapeutic. A resident told the inspector of his pleasure from attending cookery groups that take place at the home. Residents take responsibility for housekeeping tasks that are confined to their bedroom area, bed line and personal clothing are laundered with the support of the key worker. Some residents show little interest in these duties and are slow to develop some practical skills. A recommendation is made. Internally residents meet to discuss menu planning. Group debates are held about lively and topical subject which residents enjoy and find to be confidence building. The home has purchased a computer, residents are given training in developing IT skills. All residents have a freedom pass for public transport. Many residents frequent local day centres and mosaic club ( club for people with mental health needs). Those that choose to attend local churches and mosque. Last year residents had holidays that they had chosen. Some attend the gym, museum and local parks. Routines are flexible but there is some structure to enable the service operate effectively and to comply with prescribed medication and plans of activities that are therapeutic. Residents are encouraged to keep contact with family and friends, relatives are welcomed and invited to events. Residents find that their rights and privacy are respected and they get support to have appropriate personal and family relationships. Residents choose whom they see and when they want to see them in communal areas or privately in their rooms. All residents receive keys to their bedrooms and are encouraged to keep them locked. A menu committee is in place with residents choosing the food they like and assisting the chef with planning ahead for meals. There are two choices daily of main meal. Consideration is given to meeting the dietary and cultural needs of residents, ackee and green banana was seen as a second choice instead of Sunday roast. Residents are satisfied with the food provided. All five residents involved in case tracking plus four more residents said that the food is generally good, if they find that is not they are able to feedback their Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 16 dissatisfaction via menu meetings. On the daily menu displayed in the home residents write down their choice of meal so that the chef can make good provision in preparing the appropriate meals required. Meals are available within fixed periods. Residents have the choice of having lunch at the home or dining out. If they choose not to eat at the home they are reimbursed the cost of lunch. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a service that is supportive and reliable, consistent and responsive to their changing needs. Residents receive prescribed medicines when they are due, those assessed as competent are supported to manage their own medication within a risk management framework. Any issue of non compliance is responded to appropriately. EVIDENCE: None of the current residents receive direct support with maintaining personal care. However a number require much prompting and encouragement to improve their capacity to self care and to promote good personal hygiene. This is dealt with sensitively but constructively. The inspector found that effective mechanisms are in place between the service and external agencies to facilitate and enable joint working. Joint assessment procedures are ongoing with good communication. Reviews are ongoing with continuous development plans that are target and outcome based Reports were received from a CPN that visits the home several times a week. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 18 She finds that staff at the home are very good and quick to pick up on any issues that they identify, she said “ they do not hesitate to refer on to the mental health team when they have concerns”. Records are well maintained of how residents are progressing, key working sessions are held with records kept of each session. All residents are allocated key workers. From conversations with residents it was evident that some residents would like more choice in choice of staff that work with them. A recommendation is made. Another CPN was at the home visiting a resident when the inspector was present. She had been involved with the admission of the resident and found that the transition had gone well. The records maintained of progress demonstrate how effective monitoring is and how important it is for determining the move on process. Examples were seen of occasions when it was identified that residents had experienced set backs and plans to discharge to supported housing were suspended. Residents are supported and enabled to manage their own healthcare. Residents are registered with local GP practice that is conveniently located nearby. Records show that the health of residents is monitored and that referrals are made to appropriate professionals. A CPN reported on how successful staff are at making appropriate referrals to healthcare professionals. Residents attend independently for check ups and appointments; individual weights are recorded at GP health clinics. The district nurse sees those residents with diabetes and requiring insulin. A number of residents self administer insulin. Information on promoting health and managing diabetic conditions is displayed on the notice board. The home has up to date information available on recent alerts from MHRA. Evidence was available of residents’ consultations with the GP. Staff monitor the response to prescribed treatment and record how residents are progressing. There are some gaps in how health is promoted. Staff follow up on appointments but there is no link person from the home directly responsible for this task or designation for the promotion of healthcare. The emphasis is on supporting residents to manage their own healthcare but with the current system it has the potential for complications to develop. The acting manager spoke of plans that the organisation have that seek to address how the health of residents is promoted. Confirmation was seen of this plan in the development plan completed for the home. They have identified that a designated nurses is required and that plans are in place for this to commence in the Summer of 2007. A recommendation is made in regard to implementing a more effective system to promote the health of residents. The inspector recognised that progress has been made for a number of residents in the self administration of medication. This has been determined Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 19 following assessment of ability to self medicate, appropriate checking mechanisms are in place to ensure compliance. Residents find that they receive medication at the prescribed times, one resident spoke of feeling secure in the knowledge that he received his medication when it was due, “ I have a problem remembering when my medicine is due but I know staff will always make sure that I receive it on time”. Medication reviews are conducted jointly with mental health team and the GP. MAR sheets are held and recorded accurately for all medicines administered. A system is in place to record medicines received and returned from the home. Staff at the home seek advice promptly if any compliance or refusal issue arises for a resident. Medication procedures are good, staff ensure that all prescribed medicine is received on time and that it is stored safely. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The approach and attitude of staff encourages residents to express themselves and put forward their views. The home has procedures in place that are robust and that safeguard adults from abuse. EVIDENCE: This is an inclusive service. Peoples’ views are welcomed, listened to and responded to appropriately. Each individual matters, this is the view of residents spoken to. Some have experienced long stays at large institutional style settings previously and have not been encouraged to speak up for themselves. Four residents in conversation said they find the home to be an excellent place to live and that staff are approachable and kind. They feel that they would not be afraid to speak up if they had any issues to raise. The complaints records showed a low number of complaints recorded. Appropriate action is taken to respond and investigate, also seen are lessons learned from experiences and systems implemented to prevent reoccurrence. No complaints were received at CSCI. The inspector received many favourable comments both from residents and external professionals about how the service listens to people. The home provides suitable opportunity for residents to raise any issues individually, regular residents forums are held to put forward any ideas. All residents hold their own benefit and bankbooks. Some choose to place small sums of money for safe keeping within the office safe. This also enables them develop better budgetary skills and manage their finances more effectively. The inspector observed the procedure when a resident requested Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 21 some money from the safe. Staff maintain clear records of transactions with signatures of all parties for each transaction. The inspector observed plans of future training. It included training in safeguarding adults from abuse to be provided to all staff within first six months of employment. Staff spoken to indicated a good knowledge of how to implement safeguarding adults procedures and demonstrate that they are familiar with local authority procedures. There have been no allegations of abuse or neglect at the home for the past four years. The inspector observed from records of training received that some refresher training on safeguarding adults is due for staff in 2007. A recommendation is made Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are clean homely and well maintained. There is an abundance of shared space that complement and supplement residents’ individual bedrooms. EVIDENCE: The premises are well maintained, clean and homely and attractively decorated. Furniture is serviceable but comfortable. All the communal areas were observed. The inspector chatted with a number of residents during her time at the home. Residents utilise all these areas of the home as they prefer. Some sat in the lounge, others used the smoking room/conservatory or dining areas. Others were seated in the garden enjoying the fine weather. The only rules are those relating to designated smoking areas, signs are displayed to remind people of this. The home benefits from the addition of good sized conservatory in 2006. Staff have experienced some difficulties when residents leave the door ajar to the conservatory/smoking area. The acting manager spoke of the plans to supply an automatic closure to this door in order to resolve the problem. On the second day of the inspection it was observed that Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 23 a member of staff was busy cleaning, polishing and restoring the communal areas to the high standard when she left the premises the day before. The inspector commends staff for the consistently high standard of hygiene maintained. Records supplied in Regulation 26 visit reports supply confirmation this are is monitored on visits. Records show that kitchen equipment is checked for effectiveness, fridge and freezer temperatures are recorded, weekly kitchen checks are up to date. Pictures and ornaments are displayed in the lounges that make it more attractive. One resident told the inspector that some of the pictures were his art work. There appropriate numbers of toilets, bathrooms and shower facilities conveniently located for residents. Records were seen to confirm that hot water temperatures were tested and that water was checked for compliance with Legionella. A recommendation is made regarding the frequency of testing hot water from outlets in bathrooms and showers. Residents lock their bedrooms, staff do not enter unless with permission or in the case of an emergency. Two residents invited the inspector to view their bedrooms. One bedroom appeared a little stark as there were no items on display. The resident said that he did not like any pictures displayed in his room. On checking with staff why the room appeared less homely staff confirmed that the resident’s preference had been considered. Residents take responsibility for housekeeping duties in their bedrooms and caring for personal laundry. Standards of housekeeping skills vary according to capacity and self motivation of individuals. While acknowledging and respecting the rights and choices of individuals it is important to support residents develop the ability to manage housekeeping tasks more effectively. The inspector recommends that staff should endeavour to support residents in order that they develop basic housekeeping skills. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 33 34 35 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an effective staff team in place and meets residents’ needs. . Although it relies on regular agency staff to supplement vacancies plans are underway to recruit to permanent vacant posts. Staff receive a good range of training that equip them with the skills necessary for their role. EVIDENCE: As the service has been remodelled a number of changes have taken place within the staff team to make sure that an effective staff team is in place. A number of vacancies are carried while recruitment is underway to two vacant posts. These are covered by regularly agency staff. Interviews were underway on day two of the inspection. Some of the regular agency staff had applied for the post. The home ensures that equality and diversity is promoted both for residents and for staff. One of the ways this is achieved is making sure that applications are welcomed from all groups that are representative of residents and local communities. The home requires a minimum of NVQ Level 2 plus experience from all candidates. All new staff are put forward for NVQ level 3 after completing satisfactory probationary period. The inspector saw how staff are supported during probation. Supervision sessions are more frequent during this period, all Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 25 new staff complete a Skills for Care induction. Work books are completed as evidence of this. The home currently meets the NVQ levels, some support workers are currently completing NVQ Level 3. Two new support workers have commenced employment since the last inspection. The recruitment procedures were examined. The personnel files for the two new support workers were examined. The application forms were fully completed with full details of employment history. Records were faxed from human resource department. These showed appropriate documentation with CRB enhanced disclosures was received prior to commencing employment. The home has Skills for Care Induction programme, which includes core elements, new members of staff are currently completing this. There is evidence that staff are regularly supervised and supported, senior staff are allocated to supervise support staff. Appraisals are completed annually and link to training and development plans. A range of training relevant for the roles of staff is provided. Records were seen of training delivered in the past twelve months, these include, working with challenging behaviour, needs and risk assessment, accredited medication training, resettlement and rehabilitation, diversity, quality assessment framework, mental capacity act. Plans of future training were also seen. Presently support staff are engaging in person centred training. Two support workers were spoken to. Both displayed an empathy with residents conditions and demonstrated a clear commitment to enabling them manage more effectively their conditions. Staffing levels were examined. There is always experienced staff on duty. Three support staff are available during the day as well as the manager. At night time there is one member of staff on sleepover duty with a manager on call. Day staff finish the shift at 9pm. Should there be any indications of changes or concerns about a resident becoming unsettled additional staff members are engaged to work after 9pm. This has worked successfully in the past. However with the remodelled service there is an increased likelihood that situations arise that necessitate increased staffing levels. The acting manager spoke of plans to redress this with increased members of staff working at night permanently. A previous recommendation stated at the last inspection is repeated regarding staffing levels. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 40 41 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. . Residents reap the benefit of living in a stable, safe and welcoming environment. It is a well managed service and is totally focused on achieving the best outcome for individuals. The home acknowledges the importance of quality control and is continually evaluating services, working with other key players in mental health to identify areas for further improvements EVIDENCE: The home has continued to deliver a high standard of support to residents through the effective management in place. It constantly strives to develop further the service with strategies in place for residents and other stakeholders to voice their views and shape the way the service is delivered. It is user focused service where every individual matters. Equality and diversity is promoted through recognising differences in cultures , beliefs and striving to make sure that all of these are responded to fairly and appropriately. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 27 Management work closely with other professionals to ensure the best outcome for residents. Although the home experienced the loss of a very good manager at the end of March 07 the service has remained consistent. A senior support worker has been acting manager in the interim with effective management support from the organisation. The inspector met with the newly appointed manager on the second day of the inspection. She has a number of years of experience of working with and managing services for this client group. She is also a qualified RMN. She will need to register with CSCI and complete the RMA. A requirement is stated. Examples were given by some of the long stay residents at the home of the way the service has developed, “ I find that this home has become much better in recent years”, “ I am more settled in myself since coming here” were some of the comments from residents. The home has policies and procedures that comply with current legislation. From information received in the pre inspection questionnaire completed by the outgoing manager there is evidence that these are regularly reviewed and updated to reflect any changes that are required. The care files helf for residents show that individual needs and any associated risks are reviewed ath appropriate frequency. Both staff and residents are involved in policy development, a policy committee operates which includes residents on the panel. The home has an improvement plan that identifies areas for development, included are providing a system to evidence that the manager has reviewed and signed the policies. Dates shown on the development plan indicate that this task was completed in February 07. The standard of record keeping is good, with all records kept confidentially and stored securely. Records showed that regular health and safety audits are undertaken for the premises and that all necessary actions are taken to minimise risks. The health safety and welfare of residents and staff are promoted. All notifications to relevant bodies are made as appropriate. Records show a low number of accidents. Records were seen confirming procedures are carried out and that servicing of equipment is completed. These records are evident that effective systems are in place. These systems are evaluated regularly to make sure that safe working practices are operated and that the building is maintained to a safe standard. Repairs are responded to promptly. The home carries out all necessary procedures that comply with fire regulations. The most recent fire inspection was completed in November, the report stated that the home met with current fire regulations. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 28 The organisation has developed a good quality assurance system. Evidence was supplied of how this quality assessment framework monitors and reviews the progress in meeting the core objectives of the service. From observations of this report it demonstrates how the residents and staff are fully involved in this evaluation process and of the outcomes. Feedback is also actively sought from the key agencies as part of the planning and reviewing process for the service. The home has set targets on how it plans to meet the objectives of the remodelled service while considering sensitively and appropriately the move on arrangements for some of the current long stay residents. Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 29 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 4 2 3 3 3 4 4 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 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 4 3 3 3 x Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 30 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 YA37 Regulation 9 Requirement The registered person must ensure that the manager submits and application form to register with CSCI. Timescale for action 30/08/07 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 Refer to Standard YA18 YA19 YA23 YA25 Good Practice Recommendations The registered person should ensure that residents are involved in choice of key worker. The registered person should ensure that more effective systems are introduced to promote and improve the health care needs of residents. The registered person should ensure that all staff where identified receive refresher training in safeguarding adults. The registered person should ensure that staff endeavour to support and encourage residents in order that they may develop more basic housekeeping skills The registered person should ensure that systems are reviewed for the frequency of testing temperatures of hot water in outlets in bathroom and toilets. The registered person should ensure that staff levels are DS0000022746.V327760.R01.S.doc Version 5.2 Page 31 5 6 YA27 YA33 Palace Road, 18-18a constantly reviewed, in particular those for night times and that they reflect the changing needs of service users 7 YA37 The registered person should ensure that the newly appointed manager completes the RMA Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Palace Road, 18-18a DS0000022746.V327760.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!