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Inspection on 20/08/05 for Prince of Wales Respite - Emergency Unit

Also see our care home review for Prince of Wales Respite - Emergency Unit for more information

This inspection was carried out on 20th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users feel relaxed and at home whilst staying at the unit. Staff pay close attention to meeting their individual needs. Staff have developed positive relationships with the service users. Meals are varied and offer choice and variety. Service users with special dietary needs are well catered for. Staff manage the admission and discharge process in a planned way.

What has improved since the last inspection?

There is a protocol in place to cover staff giving rectal medication in an emergency. Service users are protected by the homes policies and procedures for administering medication.

What the care home could do better:

This is a bust unit and as such staff are concentrate on the personal care for the service users and this can be at the detriment of their recording responsibilities. Some of the care plans and risk assessments need to be updated.

CARE HOME ADULTS 18-65 Prince of Wales Respite/Emergency Unit 174 Prince of Wales Road Kentish Town London NW5 3QB Lead Inspector Pippa Treadwell-Smith Unannounced 20 August 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Prince of Wales Respite/Emergency Unit Address 174 Prince of Wales Road, Kentish Town, London, NW5 3QB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7485 5606 020 7485 5606 a.lorentson@talk21.com Local Authority Ms Anderson Lorentson Care Home 6 Category(ies) of LD Learning disability (6) registration, with number of places Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: No conditions Date of last inspection 11th February 2005 Brief Description of the Service: Prince of Wales is a care home providing a short stay service (respite) for people over the age of 18 years with a learning disability. Although the primary need of the service users is a learning disability some service users may have a physical and/or sensory impairment. Generally all service users who use the service are living at home with a parent or carer. In addition to the planned respite care service, the unit has two places designated for emergency admissions. The unit also provides transistional stays for service users who are moving from one service to another and require a period of assessment prior to a suitable placement being identified. The service is opaerted and managed by the London Borough of Camden. The homes ethos is to enable and support people with a learning disability to independence, tro access community services and to socialise with their peer groups. Access to the property is both private and secure. Parking is limited, however the home is close to all public transport , shopping areas and leisure facilities. The nearest underground station is Chalk Farm. The home has been purpose built and can accommodate six people at any one time all in single bedrooms. There is shaft lift and further aids and adpatations have been installed in toilets, bathrooms and bedrooms to assist service users with physical disabilities. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one Saturday morning and lasted for about four hours. A partial tour of the premises took place and the inspector had the opportunity to talk to three members of staff, meet four of the service users and look at three sets of care records, medication administration sheets and health and safety documents. What the service does well: What has improved since the last inspection? 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. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 There is a clear, referral and assessment process in place, which is sufficient to provide staff with the relevant information they need to care for the service user. EVIDENCE: The inspector met with four of the service users who looked relaxed and comfortable in their surroundings. One service user said that he liked the home and found the staff to be very helpful and friendly. The care records of three service users were looked at and each one contained a needs assessment. Each service user is allocated a key worker and discussions with one of these showed that they had up-to-date and relevant information about their key resident. They gave clear examples of how service users are supported in they way they prefer. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 There is a care planning and risk management system in place, which will provide adequate information for staff if it is kept up-to-date. EVIDENCE: Each service user has a key worker allocated. The records of three service users were looked at. Generally the care records are well–presented and organised. Each care file one had a plan of care however at least two of these had not been updated. Discussions with staff highlighted that getting sufficient administration time to update care plans is not always easy. It was apparent that staff had up-to-date information about service users. An instance of this is the plan of one service user said that they are to wear spectacles at all times however this information is now out of date and the service user only requires them for watching television. On another care record, the last updated care plan was shown as 14/05/04 and showed that the service user was to be encouraged to do exercises. However there is no further record of this being achieved after 06/06/04 or whether the exercises are still necessary. Support workers confirmed that various methods are used to determine the wishes and choices of service users. This may be verbally, using objects of Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 9 reference or being alert to particular behaviours. The inspector was able to see this in practice and to see some of the choices made be service users in relation to food, drinks and a social activity. Care records gave clear indications of how service users communicate. Support staff confirmed that all activities are risk assessed through a risk management system. Two of the care files contained an assessment of any areas considered to be any risk to the service user, how these risks were to be dealt with and how to minimise the danger. However for one service user risk assessments were not available and the person’s care plan was dated 27/11/2003. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 17 There are satisfactory arrangements in place to meet the social needs of service users. Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Support workers on duty confirmed that the rota is organised so that the third person on duty from 9am to 5pm is allocated to take service users out. On the day of the inspection of the service users was attending a Salvation Army luncheon club and other service users had been offered the choice to attend. Staff said that sometimes it is difficult to arrange social activities when there are a high proportion of service users admitted with high dependency needs but this is an area that the staff group are trying to address. The daily recording is expected to cover leisure interests, communication and interaction. An inspection of the daily recording shows that service users are generally receiving some stimulation during their stay at the unit. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 11 The meal monitoring forms clearly identify the likes and dislikes of the service users as well as their dietary needs and any special equipment needs. This information is known to staff. Discussions with staff confirmed that they shop daily and cook each evening once they have established what service users want to eat. They are aware of the need to include healthy option choices. The inspector observed service users being offered choices through the morning. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 20 Personal support is offered in a way as to promote and protect service user’s privacy, dignity and independence. Although this may be reflected in care practice, it is not always reflected in the care records. The medication in this home is well-managed and promoting good health. EVIDENCE: Where possible service users are able to receive the same gender personal care. This is in place for female service users but it is not always the case for male service users. Care records contain information, which details how service users prefer to be cared for. Discussions with staff highlighted that they have a sound understanding of the likes and dislikes of the service users and to ensure promotion of their wellbeing. Some of the terminology in the care records was considered to be inappropriate. The room planner for one service user referred to the use of a “baby alarm” and in another file, the key points for working with a service user referred to using a baby’s bottle for drinks. There are policies and procedures in place that are designed to ensure that service users receive consistent care with best practice in the area of medication. Staff confirmed that they have attended a useful course on the Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 13 administration of medication. Discussions highlighted that staff are clear about the safety issues around giving medication. They will not accept poorly labelled or badly presented medication from parents and carers. The policy is to accept medication in blister packs or in their original containers. There is a medication received and returned form. These are completed clearly and in detail. There is a list of sample signatures and initials of the permanent staff and agency workers. Support workers who have been appropriately trained may be responsible for administering rectal diazepam. There is a protocol in place and the General Practitioner must confirm the dosage and the criteria for administration. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Service users are protected from abuse by the home’s policies and procedures. EVIDENCE: The home has a copy of the adult protection procedures. London Borough of Camden operate a thorough recruitment and selection process, which includes all the relevant safety checks. Staff have attended training on adult protection and have access to policies and procedures including a whistle-blowing process, which is confidential. There are records of service user’s monies on admission, an account of expenditure is kept which includes two staff signatures; and all monies are counted and checked at each handover. Each room is allocated an accounts book and a lockable tin. This means that the same book is used to record the financial transaction of every service users who has used that room. An inspection of one of these book shows that the same page had been used for different people. It would be more appropriate from a confidentiality issue that a page per person is used. Service users said that they felt safe while staying at the unit. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The premises provide a safe and homely environment for the service users. EVIDENCE: The home has been purpose built and is a detached property that stands in its’ own garden. The building stands back from the main road and can be considered to fit in with the neighbourhood. Access to the premises is both private and secure. Nothing marks it out as being a care home. There is access to local shops and community facilities. It can accommodate six people at any one time, all of whom will have a single room. Information about the size of the bedrooms can be found in the statement of purpose. Bedrooms contain essential items of furniture as well as aids and adaptations for service users with physical disabilities. Service users are able to bring in personal items for their short stay. Staff confirmed that service users are able to choose their preferred room. One of the service users said that he was comfortable and liked his room. Service users have access to all parts of the building. There is a shaft lift and further aids and adaptations have been installed in bathrooms and toilets to assist service users with physical disabilities. These were in use the day of the weekend. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 16 Radiators have low surface temperatures and thermostatic control valves are fitted to hot water outlets to prevent scalding. There are sufficient bathrooms and toilets to meet the needs of the service users. There is a call bell system installed as well as an integrated fire alarm system. The home is registered as a food business and is expected to comply with food safety regulations. A partial inspection of the communal areas, kitchen and bathrooms found the home to be clean and tidy. Staff have access to protective clothing such as gloves and aprons and understand the prevention of infection measures. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) This standard was not inspected EVIDENCE: Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 Service users are kept safe and secure whilst staying at the unit. EVIDENCE: A wide range of records were looked at, including fire safety and accident reports. These records were found to be detailed, up-to-date and accurate and confirmed that the home is being run responsibly with essential checks being made and acted upon. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x x 3 Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Prince of Wales Respite/Emergency Unit Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 20 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 6 Regulation 15(2)(b) Requirement Timescale for action 30.11.05 2. 9 13(4)(b) All care plans must be reviewed and kept up-to-date to reflect the current needs of service users. Risk assessments must be 30.11.05 completed for all activities in which service users are engaged. these must be reviewed and updated on a regular basis. 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 18 Good Practice Recommendations It is strongly recommended that appropriate terminology is used in care records. The terms baby monitor and babys bottle are not conducive with mainatining th edignity of service users. Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Centro 4 20-23 Mandela Street London NW1 0DW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Prince of Wales Respite/Emergency Unit G58 s37258 Prince of W v210277 200805 Stage 4.doc Version 1.40 Page 22 - 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. 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