Inspection on 23/06/06 for Radcliffe House

This inspection was carried out on 23rd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Radcliffe House 15/10/07

Radcliffe House 18/11/05

Radcliffe House 28/04/05

Radcliffe House 06/04/04

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

CARE HOME ADULTS 18-65 Radcliffe House 11 Radcliffe Road East Croydon Surrey CR0 5QG Lead Inspector Peter Stanley Key Unannounced Inspection 23rd June 2006 9:30am Radcliffe House DS0000025828.V299278.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 Radcliffe House DS0000025828.V299278.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. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Radcliffe House Address 11 Radcliffe Road East Croydon Surrey CR0 5QG 020 8680 4586 020 8680 4586 NO EMAIL 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) Quality Care Choice Limited Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th November 2005 Brief Description of the Service: Radcliffe House is set in a large well-maintained garden and has nineteen single and two double bedrooms, in addition to a communal lounge, smoking and dining room. The home is conveniently sited for local transport (buses and trams) and within walking distance of the centre of Croydon. The nearest mainline station is East Croydon with easy access to London and the South Coast. The home provides care for 23 service users with long term mental health needs. Some residents have a history of additional problems concerning substance abuse. If these continue once they are admitted to the home they would be asked to leave. The aim of the home is to rehabilitate service users so that they can move on to live independently or on a more independent living scheme. The home aims to rehabilitate service users within a two-year period at which point the home will reassess the appropriateness of the placement. Historically the home has had problems moving service users on to more appropriate placements where it is clear that rehabilitation is not appropriate for particular users. Radcliffe House DS0000025828.V299278.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 was conducted over half a day and involved discussion with the registered provider, Phillip Peters, and the deputy manager, Janice Leonard. The home does not presently have a registered manager. The inspector spoke to a number of service users, and to staff on duty. Records and staff rotas were examined together with documentation relating to the admission of a recently admitted service user. The home was evidenced to provide a generally good standard of care, with service users providing very positive feedback regarding the home and support provided by staff. Assessments and care plans are generally being completed to a high standard. There is, however, the need for an appropriate interim person-centred care plan to be put in place for a recently admitted service user. Staff members who spoke to the inspector demonstrated an awareness and knowledge of service users’ needs and indicated that they feel well supported in terms of their training and practice. There were, however, concerns relating to the involvement of staff in regular staff meetings, and staff supervision, that must be addressed as a priority. As a result of this inspection, there are 15 requirements, of which 5 are unmet from the previous inspection. 15 reqs, incl 5 unmet reqs, and 1 rec. What the service does well: Prospective service users are provided with all the information they require, and the opportunity to visit, and stay overnight if they wish, before deciding whether the home is likely to meet their needs. Generally, the home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 6 However, for one recently admitted service user, an interim care plan needs to be put in place. Each service user is provided with a service user agreement. This is written in a format which is appropriate to service users living at the home. Generally, service users are having their health, personal and social care needs set out in an individual plan of care, and are fully involved in the care planning process. Reviews are taking place on a regular basis. Service users are assisted to participate fully in the day-to-day life and routines of the home, and are supported by staff in making decisions for themselves in their daily activities. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Service users can be assured that information about them is being handled appropriately and confidentiality respected. Service users are provided with a range of opportunities for recreational and social activities, which are in accord with their social, cultural and religious needs. Service users are enabled to participate fully, and to exercise choice and control in their daily routines and activities. Service users are encouraged to maintain contact with their family and friends, and to maintain links with the local community. Service users’ rights and responsibilities are being respected and recognised in their day-to-day lives. Service users are being enabled to be as independent as possible within the constraints associated with their disabilities. There is choice and flexibility with meal arrangements. The quality of food is wholesome, nutritious and varied, with meals being taken in a pleasant and congenial setting. Service users’ personal support and health care needs are being well met in this home, and in the way that service users prefer and require. Service users are being safeguarded by the home’s policies and procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Accredited medication training has been provided for all staff that administers medication. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns they may have. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 7 Generally, service users are found to be living in a homely, comfortable and safe environment. However, two health and safety concerns are identified. Service users have access to safe and comfortable communal facilities. The home has sufficient bathing and toilet facilities, which generally meet individual needs. However, on the day of inspection, two of the home’s toilets did not have fitted toilet seats and were not appropriate for use. The home presents as clean, pleasant and hygienic. There has been recent training in infection control for all staff. Staff have clearly defined roles and responsibilities, and are sufficient in numbers to meet service users’ needs. Service users are having their needs well met by an appropriately trained and qualified staff group. The home has appropriate recruitment policy and practices in place, which are providing the required level of protection for service users. The home needs to demonstrate, through the development of its quality assurance processes, that it is obtaining widespread feedback regarding the extent to which the home is meeting its aims and objectives. Service users rights and best interests are being safeguarded by the home’s record-keeping policies and procedures. What has improved since the last inspection? Service users’ wishes regarding their ageing, illness and death are being handled with respect. Staff training in bereavement and loss has recently been provided. Service users have the specialist equipment they require to maximise their independence. An occupational therapist assessment of the home has recently taken place. The home’s record keeping, policies and procedures are safeguarding service users’ rights and best interests. A policies and procedures checklist, for monitoring their review, has been put in place. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 8 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. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 9 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 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 10 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 to 5 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users are provided with all the information they require, and the opportunity to visit, and stay overnight if they wish, before deciding whether the home is likely to meet their needs. Generally, the home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. However, for one recently admitted service user, an interim care plan needs to be put in place. Each service user is provided with a service user agreement. This is written in a format which is appropriate to service users living at the home. EVIDENCE: The home has compiled a statement of purpose outlining the aims and objectives of the home, and the facilities and services it provides. The Statement of Purpose includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). The home has developed an excellent service user’s guide, which is written in a format/language suitable for the service Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 11 users and contains all the elements of regulation 5(1)(2)(3). The inspector was advised that these documents are reviewed 12 monthly, and evidenced that they have been reviewed and updated in 2006. The home has admitted two service users since the last inspection. The inspector examined the service users files and found all necessary assessments and risk assessments to be in place. However, for one service user, who has just been admitted, an interim care plan needs to be put in place, for which a requirement applies (standard 6). The inspector met both service users who, following their admission, are settling in well. Both service users indicated that they are happy with the home and that the support being provided is meeting their needs. Admission to the home is carefully planned. Following referral, the manager (or deputy manager) visit to complete assessments with the potential service user. He/she is then encouraged to visit the home, with short visits being followed by overnight and weekend stays, if appropriate. Placements are reviewed on a day-to-day basis and are not confirmed as permanent placements until a CPA meeting takes place after three months of placement. The home only admits emergency or short-term placements if the service user meets the homes admission criteria. The home has a service user agreement in place; following an earlier requirement, this has been amended so as to refer to a three-month ‘trial period’. The agreement is now written in a more appropriate format for service users living at the home. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 12 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 to 9 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Generally, service users are having their health, personal and social care needs set out in an individual plan of care, and are fully involved in the care planning process. Reviews are taking place on a regular basis. Service users are assisted to participate fully in the day-to-day life and routines of the home, and are supported by staff in making decisions for themselves in their daily activities. Service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. EVIDENCE: The home has a comprehensive and thorough approach to care planning, with care plans being based on the Care Planning Approach. Generally, files include Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 13 comprehensive service user plans, which provide detailed information evidencing how service users’ needs are being addressed, and evidencing the involvement of service users in contributing to their care plans. Risk taking plans (based on risk assessments) have been drawn up, with any restrictions being clearly identified and agreed by the service user. Contingency and crisis plans are also in place. The inspector looked at the files for two recent admissions. For both admissions the initial assessments were obtained from the referring agency and the home’s own assessments and risk assessments completed. Whilst a service user plan has been drawn up and reviewed for one service user, admitted in January 2006, and a review held, for a very recently admitted service user, no interim care plan has yet been put in place. This must be addressed as a priority; a requirement applies. The inspector spoke to a number of service users regarding their involvement in the day-to-day running of the home. Feedback indicated service users feel, generally, that they are being consulted on issues relating to the home and services provided. Service users are consulted in a variety of ways during their stay in the home. This includes service user meetings, key-worker meetings, care reviews and through questionnaires completed for quality assurance purposes. Service users are encouraged to be as independent as possible in their day-to-day living and, with the support of their key workers, to be fully involved in making decisions relating to their daily recreation and activities. The inspector found, however, that service user meetings have not recently been taking place on a sufficiently regular basis. Meetings, which have previously been facilitated on a monthly basis by the manager, have, since his departure at the end of March 2006, declined significantly in frequency, with only very brief notes being kept. These meetings should preferably revert to being held on a monthly basis, and should at the least, be held two-monthly. The minutes must provide a fuller record of the issues discussed. A requirement applies. There was evidence that service users are supported to take risks in developing independent skills and abilities. One of the stated aims of the home is to enable service users to take responsible risks wherever possible. Prior to their admission prospective service users are thoroughly assessed regarding potential risks relating to their day-to-day living inside and outside the home. The inspector spoke to a number of service users. This indicated that service users are encouraged and assisted, where necessary, to participate fully in daily routines and activities, to use public transport, and access local recreational and shopping facilities. Service users are also encouraged to look after their own monies and collect their own benefits. Service users spoken to Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 14 by the inspector expressed a general sense of satisfaction with their routines, and of being able to exercise a fair measure of independence and choice. The inspector examined a sample of risk assessments that have been completed for service users living at the home. These provide a comprehensive risk assessment of each service user, with risk-taking plans and individualised care plans having been developed to detail the actions required to minimise risks and hazards. The home has a comprehensive ‘missing persons’ policy/procedure document. This clearly states the actions which staff are required to take in the event of an unplanned absence of a service user. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 15 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 to 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with a range of opportunities for recreational and social activities, which are in accord with their social, cultural and religious needs. Service users are enabled to participate fully, and to exercise choice and control in their daily routines and activities. Service users are encouraged to maintain contact with their family and friends, and to maintain links with the local community. Service users’ rights and responsibilities are being respected and recognised in their day-to-day lives. Service users are being enabled to be as independent as possible within the constraints associated with their disabilities. There is choice and flexibility with meal arrangements. The quality of food is wholesome, nutritious and varied, with meals being taken in a pleasant and congenial setting. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 16 EVIDENCE: The ethos of the home, as outlined in the Statement of Purpose, is very much orientated towards promoting independence and maximising choice and opportunities for service users. Service users are encouraged to take responsibility for undertaking daily tasks such as tidying their rooms, doing their laundry, and preparing drinks, food and snacks. The daily routines of the home were observed to be flexible and accommodating of individual needs and preferences. This was evidenced in care plans and review notes. Staff at the home work with service users with the aim of increasing their motivation and confidence, and developing their independent living skills. The inspector observed that staff were interacting in a caring and enabling way with service users, and that there was respect for individuals’ privacy and sensitivities. The inspector spoke to a number of service users who indicated that they are encouraged to participate fully in the day-to-day activity of the home, ranging from domestic tasks to developing learning and work-related skills. Some service users were participating in an art therapy session on the day of inspection. Three service users have their own personal computer and there is a computer in the home for general use. While service users are encouraged to access local educational facilities including basic literacy and numeracy classes and vocational/skills-based courses, there has been little recent take-up of these courses. All service users are encouraged to register on the electoral role in order to vote if they wish. The home also offers in-house activities, such as art therapy and head massage therapy. The art therapy sessions have aimed to develop creative self-expression, and a sense of personal fulfilment, and, from the feedback received, have proved popular with a number of service users. There is a wide range of games and activities both within and outside of the home, including table football. Some service users go swimming once a week. Activities and events are publicised on the home’s notice board and at service users’ meetings. Comments from service users regarding the opportunities available for social and leisure activity were generally favourable, with most service users feeling that their individual needs and choices in this area are being well met. The home has a mini-bus and organises day trips to seaside resorts such as Bognor Regis, Brighton or Bournemouth. These do not involve any additional cost to the service users and, from the views expressed, are very much looked forward to by both the service users and staff who accompany them. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 17 The home actively encourages service users to maintain family links and friendships both inside and outside of the home. Service users can see visitors in their rooms and in private. Service users are also encouraged to maintain intimate personal relationships. Family and friends can be invited to barbecues and other events that take place at the home. The inspector spoke to a number of service users, who indicated that they are encouraged to maintain contact with their family and friends, and that staff are welcoming to visitors and respectful of their privacy when they receive visits. The inspector sampled the food served for lunch and spoke to service users. Feedback from service users, regarding the food, was very positive, there being satisfaction with the quality and quantity of food served. The dining area is pleasantly laid out and provides a relaxed and congenial setting for taking meals. Service users are encouraged to prepare their own breakfast, and to assist with food preparation and other tasks if they wish. Lunch and an evening meal are provided. Mealtimes are flexible and take account of individuals’ work and activity schedules. Menus evidenced a wide choice of foods offering a varied and nutritional diet. Service users are consulted as to which foods they would like purchased, and are able to have an alternative dish provided if the menu options do not appeal. A detailed record is kept of the food provided. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 to 21 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users’ personal support and health care needs are being well met in this home, and in the way that service users prefer and require. Service users are being safeguarded by the home’s policies and procedures for the receipt, recording, storage, handling, administration and disposal of medicines. Accredited medication training has been provided for all staff that administers medication. Service users’ wishes regarding their ageing, illness and death are being handled with respect. Staff training in bereavement and loss has been provided. EVIDENCE: The inspector examined a number of service users’ files. These evidenced that both personal support and general health care needs are being generally well met. The range of personal support needs presented by service users, as outlined in assessments and care plans, is varied with support being tailored Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 19 according to individual needs and goals. Staff provide very flexible support with the focus being on encouraging and assisting individuals to undertake tasks such as maintaining personal hygiene, preparing their own breakfast and doing their own laundry. The deputy manager advised that all of the present service users are registered with a local group practice. All service users are seen by community psychiatric nurses and receive treatment from medical, dental and optician services as required. An art therapist visits the home weekly, and head massage has been provided, though this is not currently available. The inspector spoke to a number of service users, and examined a sample of service user files. This indicated that there is regular contact with health care professionals, and that personal support and healthcare needs are being well met. Service users’ mental and physical health needs are closely monitored, and individuals are reminded to receive visits and attend appointments as and when these are required. Service users are able to receive visits from visiting professionals in the privacy of their own rooms. The home has appropriate medication policy and procedures in place. All staff have received accredited medication training, and there has been some recent additional training provided by the visiting pharmacist, who also completes an audit every three months. The inspector viewed the report of the most recent visit, on 21/3/06; this did not indicate any problems with procedures. Medication charts for a number of service users were examined and found to be in order. Other records relating to receipts and returns of medication are being satisfactorily maintained. The wishes of service users regarding the eventuality of terminal illness or death are recorded on service user files. The notes indicate that service users have been consulted about their wishes and that religious and cultural aspects are recorded. One service user has died since the last inspection, following a terminal illness. The inspector was satisfied that arrangements relating to the service user’s death had been dealt with appropriately by the home. Following a requirement from the previous inspection, there has been staff training in bereavement and loss. This needs, however, to be evidenced with the relevant training certificates. The inspector spoke to a staff member who stated that she had recently experienced a family bereavement. She indicated that the training had proved very helpful in helping her to come to terms with her own sense of loss, and had provided her with useful insights and skills with which to support others. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 20 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and service users and their relatives/friends are encouraged to raise any concerns they may have. The home’s policies, procedures and practice indicate that service users are being protected from abuse and are living in a safe environment. However, for service users to be sufficiently safeguarded, all staff must complete statutory adult protection training. EVIDENCE: The home has an appropriate complaints policy and procedure in place. A summary is included in both the service user guide and the statement of purpose. There have been no complaints since the last inspection. The inspector spoke to a number of service users. No concerns were expressed, but service users feel that they are listened to and acted upon when problems or concerns arise. The home has an appropriate adult protection policy and procedure, which is in line with Croydon’s Vulnerable Adults procedures. All but two staff have now attended this training; a requirement for the remaining staff to do so remains to be met. With the recent departure of the manager, it is recommended that the new manager or deputy manager complete this training; this can then be cascaded to other staff. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 22 No allegations of abuse have been recorded since the last inspection. When complaints relating to service users’ mental health needs are made these are recorded in the service users care notes and discussed with the C.P.N. The home has a safe that is fixed to the floor for the safekeeping of service user’s money and valuables. All staff have undertaken accredited physical intervention training in accordance with Department of Health guidelines. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 23 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 to 31 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Generally, service users are found to be living in a homely, comfortable and safe environment. However, two health and safety concerns are identified. Service users have access to safe and comfortable communal facilities. The home has sufficient bathing and toilet facilities, which generally meet individual needs. However, on the day of inspection, two of the home’s toilets did not have fitted toilet seats and were not appropriate for use. Service users have the specialist equipment they require to maximise their independence. An occupational therapist assessment of the home has recently taken place. The home presents as clean, pleasant and hygienic. There has been recent training in infection control for all staff. EVIDENCE: Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 24 The premises were inspected and found to be homely, comfortable and safe. Fittings, adaptations and equipment are of good quality, and domestic in scale. The home was decorated to a reasonably high standard throughout and presented as being comfortable, bright and warm. There is a planned programme of maintenance for the redecoration and renovation of the home. Two health and safety concerns were, however, identified. Two toilets were found without fitted toilet seats, which made them both inappropriate and unsafe for use. The home must ensure regular monitoring in this regard. A loose internal phone cable on the top floor was found hanging down over the outside of a service user’s bedroom door, presenting a potential risk. Requirements apply. The laundry room has been completely renovated and refitted provides safe, hygienic and efficient laundry facilities. This is used by both staff and service users. The laundry facilities are suitably positioned so as to ensure that any soiled laundry is never carried through areas where food is stored, prepared or eaten. Following a requirement from the previous inspection, an assurance was given by the registered provider that heating is being maintained at a comfortable temperature throughout the home. Being a warm day, for the inspection, it was not possible to substantiate this claim. The home has a bathroom on both the ground floor and on the first floor. The existing ground floor bathroom has been renovated, with a new bath having been installed. The home also has three shower units, and seven toilets all near service user’s bedrooms and communal areas. While toilets and bathrooms were found to be clean and safe, the inspector was concerned to find that two toilets, on the ground and first floors, were found with toilet seats removed from their base, the toilets not being fit for use. A requirement applies. Radcliffe House has several communal spaces for service users, and the house has a very homely feel. There is room for all the home’s service users to sit together, or to receive visitors in private, in either of the home’s two lounges or in the dining room. The home has a large well-maintained garden with a patio area and lawn. In addition, the kitchen area is clean and domestic in scale, and service users are encouraged to make use of the facilities if they wish. The inspector spoke to a number of service users who expressed their satisfaction with the communal facilities provided. The home does not accommodate people with significant physical disabilities and is not suitable for people who are wheelchair dependent. There are, however, a number of older service users who have some physical impairment. Since the last inspection, the home itself has been assessed (on 29/3/06) by Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 25 an Occupational Therapist for any adaptations or aids that would assist in meeting the collective needs of service users. The requirement remains unmet until a copy of the OT assessment report has been evidenced, and any recommendations made have been implemented. The home presented as being clean, hygienic and free from any offensive odours. The homes policies/procedures manual contains various policies for the prevention and control of infection including dealing with spillages, HIV and Hepatitis B. Staff have recently undertaken updated infection control training, on 26/4/06. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 26 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 to 36 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staff have clearly defined roles and responsibilities, and are sufficient in numbers to meet service users’ needs. Service users are having their needs well met by an appropriately trained and qualified staff group. The effectiveness of the staff team is being compromised by the failure to hold regular staff meetings. The home has appropriate recruitment policy and practices in place, which are providing the required level of protection for service users. Whilst, generally, staff are being supported in meeting service users’ best interests, this is being compromised by the failure of the home to have provided staff with supervision in recent months. EVIDENCE: The staff rota indicated that the home has appropriate staffing levels. During the day, the home has 3 care staff on duty. There are two staff members on duty from 8pm until 12oclock. At night there is one sleeping and one waking staff member. In addition, the home employs one full time domestic and two cooks. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 27 The inspector spoke to a number of service users. Views expressed indicated that service users’ needs are being met, and that there is a high level of satisfaction with the support being provided. Staff were perceived as being caring and competent, and as being responsive to any issues or problems that arise. No concerns were expressed. The inspector observed staff interacting in a positive and enabling way with service users, and spoke with two care staff. They presented as caring, professional, and well-informed regarding the support needs of the home’s service users. There is a key worker system in operation. The effectiveness of the staff team depends on good communication and support. Whilst there are systems are in place for feeding back issues or concerns, the inspector was concerned to find that there had only been two staff meetings in the last seven months, these being held on 18/11/05 and 17/3/06. The home must, once again, aim to have regular, monthly meetings (and, at least, on a two-monthly basis). A requirement applies. Staff files and training records indicate that staff at the home are appropriately qualified and trained. The home has a comprehensive induction programme in place. This forms part of the probationary period of employment, and is signed and dated on completion. The registered provider indicated that of the 15 care staff, 14 have NVQ Level 2, with 4 staff studying for their NVQ Level 3, and 1 (the deputy manager) studying for her NVQ Level 4. There is an ongoing staff-training programme, with statutory training having taken place within the last six months in Food Hygiene, Health and Safety, Medication and Mental Health. There has also been recent training in bereavement and loss, and in the Principles of care. The inspector identified the need for a training checklist to be kept on each staff file. This should detail the training (with dates) which has been completed, and which is scheduled, for each staff member; a requirement applies. No concerns regarding the competency of staff were raised or identified, and this standard would appear to be well met. The home has appropriate recruitment policy and procedures in place. Since the last inspection, there has been one new staff appointment of a cook at the home. The inspector checked the staff file and found that the CRB (Criminal Records Bureau), identity and employment checks had been satisfactorily completed. The inspector was very concerned to find that staff had not been receiving supervision in recent months. Previously, supervision had been taking place on a regular, monthly basis, but with the departure of the manager in March 2006 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 28 no supervision has been taking place. The last recorded supervision sessions were recorded on staff files as having taken place in January 2006. The inspector addressed this with the registered provider and deputy manager, and made it clear that there must be regular supervision for all staff, and including the deputy manager. A requirement applies. The inspector evidenced that annual staff appraisals had been completed in January 2006. Generally, from the feedback received, there was evidence of staff being supported in carrying out their duties. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 29 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 to 43 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. While the home is generally being managed in the best interests of the home’s service users, the home’s present lack of a registered manager is adversely affecting its overall operation. The home needs to demonstrate, through the development of its quality assurance processes, that it is obtaining widespread feedback regarding the extent to which the home is meeting its aims and objectives. The home’s record keeping, policies and procedures are safeguarding service users’ rights and best interests. A policies and procedures checklist, for monitoring their review, has been put in place. Service users rights and best interests are being safeguarded by the home’s record-keeping policies and procedures. Generally, the health, safety and welfare of service users and staff are being appropriately promoted and protected. There are, however, two health and Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 30 safety concerns which need to be addressed, and fire safety training needs to be updated. While generally, service users are benefiting from competent and accountable management, the financial viability of the home needs to be demonstrated with an up-to-date set of audited accounts. EVIDENCE: The home has in recent months been managed by the home’s registered provider, Phillip Peters, and the deputy manager, Janice Leonard. The previous manager left the home in March 2006, this having impacted on the usually efficient day-to-day running of the home. Support for staff through regular supervision and staff meetings is currently lacking, and must be addressed. The provider is currently in the process of recruiting a new registered manager. Feedback from service users and staff, regarding the day-to-day running of the home was, however, generally positive though there is a sense of loss regarding the departure of an experienced and well-liked manager. There is an open and inclusive style of management in the home which it is hoped will continue under the new manager, once he has been appointed. The home has been developing its quality assurance processes over the two years with questionnaires having been developed by the managing company for canvassing the views of service users, relatives, friends and visiting professionals and other interested parties. These are designed to ensure that the home is meeting its aims, objectives and statement of purpose. The inspector was advised that a quality assurance audit is to be undertaken in July and that an audit report will then be produced. The requirement therefore remains outstanding at the present time. The home is annually reviewing its policies and procedures and has, since the last inspection, put in place a checklist detailing when each one has been reviewed. From the evidence of this and previous inspections, service users’ and staff records are generally being well maintained, and appropriate policies and procedures are in place. A policy is in place that informs service users how to gain access to their records and any information held about them. The service users are provided with the opportunity to contribute to their record keeping. All records are being kept securely. The home is generally promoting and protecting the welfare of service users, all health and safety checks being evidenced to have been completed within the last 12 months. Gas servicing is due again in July 2006. Health and risk assessments have been updated, together with the Fire Risk assessment, in Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 31 January 2006. The record of fire drills was inspected and evidenced that these are taking place on a regular, weekly basis. The last 3 monthly inspection of fire alarms and equipment was recorded as having taken place on 13/6/06. Six-monthly fire safety training, last held in November 2005, is, however, overdue, and needs to be updated. A requirement applies. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 2 3 3 2 2 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 33 Yes 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 15(1) & (2) Requirement An appropriate interim personcentred care plan must be put in place for a recently admitted service user. This must fully involve the service user and his/her nearest relative or representative. This must be appropriately reviewed following the initial six weeks of the placement. 2 YA8 12(2), (3) & (5) Service user meetings must be held on at least a two-monthly basis, and issues discussed fully recorded. The registered person must ensure that all staff are provided with training in bereavement and loss. Partly met. Training held needs to be evidenced with certificates. Copy of these to be forwarded to the CSCI, Croydon Office. 4 YA23 13(6) The registered person must 31/07/06 ensure that those staff who have not yet attended Croydon’s DS0000025828.V299278.R01.S.doc Version 5.2 Page 34 Timescale for action 30/06/06 30/09/06 3 YA21 18(1)a) & (c) 31/07/06 Radcliffe House statutory adult protection training, do so within the prescribed time-scale. Partly met. 2 staff still to complete this training. Evidence of dates booked to be forwarded to the CSCI, Croydon Office. 5 YA24 13(4)(a) A connecting internal phone cable on the top floor must be properly secured and made safe. All toilet seats in the home must be securely fitted, with regular checks to ensure that toilets are kept appropriately safe and usable. 30/06/06 6 YA27 13(4)(a) 30/06/06 7 YA26 16(2)c All service users’ bedrooms must 30/09/06 include a lockable drawer or facility (Rooms 3, 8 and 19 found not to have one). The registered person must arrange for the home to be assessed by an Occupational Therapist for any aids or adaptations that would assist in meeting the needs of service users within the home. Partly met. OT assessment visit on 29/3/06 needs to be evidenced with an OT assessment report, copy of which must be forwarded to the CSCI, Croydon Office. 31/07/06 8 YA29 23(2)(n) 9 YA33 21(1) & (2), 12(5)(a) 18(1)(a) & (c) Regular staff meetings must be 30/09/06 held (and recorded) on at least a two-monthly basis (33.8). The home must compile a training checklist detailing the training completed by each staff DS0000025828.V299278.R01.S.doc 10 YA35 30/09/06 Radcliffe House Version 5.2 Page 35 member, and the training that has been scheduled. 11 YA36 18(2) Individual staff supervision sessions must be implemented regularly for each care worker, on at least a two-monthly basis (six times a year). This must include regular twomonthly supervision for the deputy manager. 12 YA39 24(1)a) The registered person must &(b),(2&(3 ensure that a Quality Assurance audit is put in place, evidencing that information gathered from surveys, meetings and other types of feedback has been collated. This should be published and made available to service users, their relatives and representatives, the CSCI and other interested parties. Previous time-scale not met. 13 YA42 13(4)(a) & (c) The registered person must ensure that the home receives an up-to-date health and safety inspection. Partly met. H & S assessment visit on 29/3/06 needs to be evidenced with an H & S assessment report, copy of which must be forwarded to the CSCI, Croydon Office. 14 15 YA42 YA43 23(4)(a) & (d) 25(2)(a) Fire safety training must be updated, and held on a regular six-monthly basis. An up-to-date set of audited accounts for the year ending 2005 must be obtained, and a copy forwarded to the CSCI, Croydon Office. 31/07/06 31/10/06 31/07/06 30/09/06 30/06/06 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 36 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 YA23 Good Practice Recommendations The inspector recommends that the registered manager, or deputy manager, undertake the Croydon 3 day adult protection training for trainers course in adult protection. Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Radcliffe House DS0000025828.V299278.R01.S.doc Version 5.2 Page 38 - 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. 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