CARE HOME ADULTS 18-65
Portway (200) 200 Portway Stratford London E15 Lead Inspector
Seka Graovac Unannounced Inspection 11th October 2005 10:00 Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Portway (200) Address 200 Portway Stratford London E15 020 8552 9164 NO FAX 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) East Living Limited Miss Asha Jama Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 27th July 2005 Brief Description of the Service: Portway is a care home for up to six people with learning disabilities and challenging behaviour. The same service users have been living together for over 10 years. The home is registered with the Commissions for Social Care Inspection and inspected accordingly. The building is a Victorian house situated opposite of West Ham Park and close to local amenities and Stratford Shopping Centre. There is a garden at the back with a beautiful wooden garden house, as well as a separate glass-house. The Registered provider of the service is East Living. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted over four hours. The previous inspection was also conducted as unannounced in July 2005. At that time, concerns were identified regarding confusion about the management of the home. It was not clear if the Registered Manager continued to be seconded or if she was back in the home. Meanwhile, it has been clarified that the current arrangement of the Deputy Manager acting up is in place until mid December 2005. The Commission and the home are still unclear about the longer-term future of this arrangement. The inspector was informed that while the Deputy Manager was acting up, the acting Deputy Manager has not been available for over three months. At the same time time, the home was dealing with two potentially serious protection issues. The main aim of this inspection was to identify the effect of unresolved management situation and ongoing Protection of Vulnerable Adults (POVA) investigations on the service provision. The inspector focused on the key National Minimum Standards and also followed up on compliance with the requirements made at the previous inspection. The inspector saw all the service users. She exchanged greetings with all of them and had short conversations with some of them. She interviewed the Acting Manager and two permanent staff members who were on duty on that day. She also saw all the communal areas of the home (including bathrooms) and two bedrooms. The inspector examined the following records: statement of purpose and service user’s guide, individual service users’ files, staff files, complaints-log, fire-safety log and general risk assessments. What the service does well:
The service users were well groomed and appeared contented in their own ways. They happily pottered around the premises including the garden. Although the service users had complex needs regarding communication and social skills (including Autistic Spectrum Disorders), they related to the staff and the inspector with ease and trust. The staff who were on duty were experienced, competent and qualified. They talked passionately about their work and expressed their deep commitment towards provision of individually tailored care based on a holistic and humanistic approach. The home was well maintained and the garden was beautiful on a sunny early autumn day. The appropriate garden furniture was available outside and in the wooden garden house. One service user used the glass-house to smoke and enjoy sunshine. The inspector was informed that the service users helped watering the plants and also were engaged in various activities outside the home.
Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 6 The home was appropriately dealing with two potentially serious protection issues via Social Services POVA protocols. What has improved since the last inspection? What they could do better:
The inspector was satisfied that the unresolved management situation, lack of Deputy Manager and ongoing protection related investigations did not have too adverse effect on the overall direct care provision as far as the inspector could ascertain at the time of the inspection. However, the situation was unsettling and requirements were made regarding various issues listed bellow. One Anglo-Indian woman was sitting in a traditional oriental cross-legged way in her special chair in the lounge during the inspection. She told the inspector that she watched the television. However, the TV set was positioned at approximately 70 degrees to her right. It meant that she would sit for prolonged periods of time with her neck twisted to her right. It also added strain to her eyes. The inspector was informed that this arrangement arose from the challenging behaviour management strategy, but also that the problem had been identified by staff and would be resolved shortly. The inspector found it to be unacceptable and made the requirement in the respect of the issue. The formal reviews were outstanding for some service users and this must be addressed. The inspector noted that yellow bags containing incontinence waste were left in the front of the house, unsecured. This is considered to be an environmental risk of spreading infection. The home must keep the hazardous waste securely stored. One service user’s bedroom strongly smelt of urine. This must be addressed within the agreed target. All the staff (including management) must receive appropriate support. The home must have a Registered Manager who is actually managing the home. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 7 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. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 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 Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Adequate information about the home was available to the stakeholders, but the inspector recommended that the admission procedure is further developed. EVIDENCE: The inspector viewed the home’s statement of purpose and the service user’s guide that contained information as listed in the Schedule 1 of the Care Homes Regulations. The mission statement was displayed in the office. She also saw the admission procedure for the organisation that referred to care and support needs assessment process. However, further details of the assessment process were not available. The inspector was informed that the current service users have been living in the home for over 10 years. At this time, the inspector recommended that more information regarding pre-admission assessment is made available in the home. If not appropriately actioned this recommendation will become a requirement in the future. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7. Although the service users appeared to be well cared for, the home needed to improve its reviewing of the care plans and the frequency of service users’ meetings. EVIDENCE: The service users have been living in the home for a long time. They appeared well cared for and comfortable. Their individual files contained a wealth of information regarding their care and support needs and how to meet them. However, the formal reviews were outstanding on some files and the requirement was made in respect to this. One Anglo-Indian woman was sitting in a traditional oriental cross-legged way in her special chair in the lounge during the inspection. She told the inspector that she watched the television. However, the TV set was positioned at approximately 70 degrees to her right. It meant that she would sit for prolonged periods of time with her neck twisted to her right. It also added strain to her eyes. The inspector was informed that this arrangement arose from the challenging behaviour management strategy, but also that the problem had been identified by staff and would be resolved shortly. The
Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 11 inspector found it to be unacceptable and made the requirement in the respect of the issue. The inspection process indicated that the service users were given choices. For example: one person had her own keys for her bedroom and the front door, as she wanted them. The inspector was informed that the other service users did not want the keys. The Acting Manager stated that all service users had their own individual bank accounts and were supported to manage their money. The inspector viewed the minutes of the service users’ meetings and found four available for the last 12 months. The Acting Manager stated it was the home’s policy to hold them monthly. The inspector was also informed that “People First” sometimes organised and chaired the meetings in the home as well. The inspector recommended that the meetings with the service users were arranged more often. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 15, 16 and 17. The service users were supported to lead active lives. EVIDENCE: The service users happily pottered around the premises including the garden that looked beautiful on a sunny early autumn day. The appropriate garden furniture was available outside and in the wooden garden house. One service user used the glass-house to smoke and enjoy sunshine. The inspector was informed that some service users helped watering the plants and also were engaged at times with cooking and cleaning in the home. All service users had individual activities plans that reflected their interests. As the inspector was leaving, an external activities leader came into the home. The service users also attended various community facilities. Discussions that the inspector had with the staff indicated that the activities programme was seen as part of the therapeutic process, providing opportunities for service users to learn, develop and experience joy and fulfilment in their lives. The Acting manager stated that the home organised holidays for service users in Dawlish and Bognor Regis in the summer this year.
Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 13 The inspector saw two service users enjoying their lunch with a staff member. Pictorial menu was displayed in the kitchen. The kitchen was clean and the food was well organised and appropriately stored. The inspector was informed that new flooring has been laid since the previous inspection. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The service users were well looked after. EVIDENCE: The service users were well groomed and appeared contented in their own ways. They indicated only positive feelings about the home in their communications with the inspector. Their files also indicated that their health and personal needs were fully met. They were also under care of a psychiatrist. The inspector was informed that in addition to learning disabilities and challenging behaviour, two service users suffered from Autistic Spectrum Disorder and one was diagnosed with a mental disorder. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The home had and implemented the appropriate procedures on dealing with concerns, complaints and protection. EVIDENCE: The appropriate policies and procedures on concerns, complaints and protection were available in the home. The examined individual service users’ files contained pictorial representation of the procedures. The home was appropriately dealing with two potentially serious protection issues via Social Services POVA protocols at the time of the inspection. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. The environment was fit for its purpose, but requirements were made regarding incontinence waste and malodour in one bedroom. EVIDENCE: The inspector noted that yellow bags containing incontinence waste were left in the front of the house, unsecured. This is considered to be an environmental risk of spreading infection. The home must keep the hazardous waste securely locked. The inspector was shown around the home by a staff member. This included all communal areas, bathrooms, two bedrooms that had their doors wide open and the garden. The home was generally well maintained and clean but one service user’s bedroom strongly smelt of urine. This was discussed with the staff and the Acting Manager and the inspector was informed that new flooring was on order. This must be addressed within the agreed target. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 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, 32, 33, 35 and 36. The service users benefited from experienced, qualified and committed staff. The support provided to the staff could be improved. EVIDENCE: At the beginning of the inspection there were three support staff on duty, one of them being the designated person in charge until the Acting Manager arrived. Two staff were permanently employed and one staff was from an agency. The inspector interviewed individually the permanent staff members as part of the inspection methodology. Both staff were very experienced and qualified. One staff had a National Vocational Qualification (NVQ) in care and the other one had a BA in psychosocial studies and was working towards a Masters award. They talked passionately about their jobs and expressed the strong commitment to improve the quality of the service users’ lives in a way that respects their individual needs, wishes and feelings. The inspector observed that although the service users had complex needs regarding communication and social skills (including autism), they related to the staff and the inspector with ease and trust. The organisation’s training programme was displayed in the office. The Acting Manager stated that four staff had a care related NVQ and three were in process of obtaining it. However, some discontent was also expressed by the staff spoken to, regarding the ongoing POVA investigations and lack of permanent management arrangements. The examination of randomly selected staff files
Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 18 indicated that one-to-one sessions were not happening as regularly as required and related requirement was made. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 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, and 42. EVIDENCE: At the previous inspection that was conducted as unannounced in July 2005, concerns were identified regarding confusion about the management of the home. The Registered Manager has been seconded for a while to a different position within the organisation and the staff were unclear if she came back or not and who the manager of the home was. Meanwhile, it has been clarified that the current arrangement of the Deputy Manager acting up is in place until mid December 2005. The Commission and the home are still unclear about the longer-term future of this arrangement. The inspector was informed that while the Deputy Manager was acting up, the acting Deputy Manager has not been available for over three months. At the same time, the home was dealing with two serious protection issues. The inspector was satisfied that the unresolved management situation, lack of Deputy Manager and ongoing protection related investigations did not have too adverse effect on the overall direct care provision as far as the inspector could Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 20 ascertain at the time of the inspection. However, staff were worried and six requirements were made. The Acting Manager stated that her priority was care of the residents and she did well to hold the fort in, at times, quite difficult situations. Although she had years of experience, she was not qualified and was in process of obtaining NVQ level 3 in care. She stated that she hadn’t commenced the management training required of the care home’s managers. The organisation had a “Charter mark” and also “Investors in People” award. The Acting Manager stated that a Relatives meeting was due and would be organised shortly. Policies and procedures folder was kept in the office. The inspector viewed the home’s fire-safety log book that indicated that the appropriate records of the required tests were held. The London Fire and Emergency Planning Authority visited the home in May 2005 and found the fire-safety arrangements to be satisfactory. General risk assessments were in date. Filled in Health and Safety poster was displayed in the office. The Registration and Insurance certificates were also conspicuously displayed. Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 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 2 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X 3 3 X 2 Standard No LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 3 16 3 17 31 32 33 34 35 36 Score 3 3 3 X 3 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 Score 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 X 3 3 X 3 X
Version 5.0 Page 22 Portway (200) DS0000022846.V257703.R01.S.doc 21 x Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 12 Requirement The Registered Person(s) must ensure that the home is conducted so as – to promote and make proper provision for the health and welfare of service users. Assess the environment in the lounge and position the TV so that all service users can watch it in comfort. The Registered Person(s) must ensure that there is evidence available to demonstrate that the service users’ individual care plans are formally reviewed on a regular basis, and at least annually. The Registered Person(s) must ensure that clinical waste is securely kept while awaiting to be collected by a registered contractor. The Registered Person(s) must ensure that all areas of the home are free from offensive odours. The Registered Person(s) must ensure that all the staff (including management) receive appropriate support and supervision and that the minutes of at least six meetings a year
DS0000022846.V257703.R01.S.doc Timescale for action 31/10/05 2 YA6 15 31/01/06 3 YA30 16 30/11/05 4 5 YA30 YA36 16 18 30/10/05 30/11/05 Portway (200) Version 5.0 Page 24 are available for inspection. 6 YA37 8 The Registered Manager must return to her post of managing the home or another appropriate person must apply for registration with the Commission for Social Care Inspection. 31/01/06 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 Refer to Standard YA2 Good Practice Recommendations The inspector recommended that more information regarding pre-admission assessment is made available in the home. If not appropriately actioned this recommendation will become a requirement in the future. The inspector recommended that the service users’ meetings are held on a more regular basis and that the minutes are available in the home. 2 YA7 Portway (200) DS0000022846.V257703.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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