CARE HOME ADULTS 18-65
Radcliffe House 11 Radcliffe Road East Croydon Surrey CR0 5QG Lead Inspector
Peter Stanley Announced Inspection 28 April 2005 09:30 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. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Radcliffe House Address 11 Radcliffe Road, East Croydon, Surrey, CR0 5QG 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 8680 4586 020 8680 4586 Quality Care Choice Limited Mr Alfred Okine Care Home 23 Category(ies) of Mental Disorder (23) registration, with number of places Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: none Date of last inspection 11 October 2004 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 G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was conducted over one day and involved discussion with the registered manager, registered provider, team leaders, staff on duty and service users. The inspector noted that all but one of the requirements identified in the previous inspection report have been met. There are four new requirements and three recommendations from this inspection. All of the requirements were discussed and agreed at the time of the inspection with the registered manager. What the service does well:
The inspector found Radcliffe House to be a pleasant, relaxed and well managed home. The home works with people who have mental disorders, dual diagnosis and border line mental/learning difficulties. The staff on duty at the time of the inspection were observed to be interacting with the service users in a caring, respectful and professional manner. Service users spoken to at the home commented very favourably about the care and support they receive at the home and the caring attitude of the manager and staff team. The home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. The home has a thorough and ongoing process of assessment and review in place which involves social and health care professionals, and which focuses comprehensively on the range of personal, social, mental health and physical care needs presented. Service users’ health, personal and social care needs are set out in an individual plan of care, and they are fully involved in the care planning process. Care plans are evidenced to be taking place on a regular basis, with a CPA (Care Programme Approach) review, including the service user, his/her relatives/representatives and all the relevant care professionals, taking place after the first three months following admission. 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. Staff were observed to work with service users in an enabling and client-centred way, with service users being consulted regarding matters which affect them and their lives within the home. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 6 The home ensures that service users are thoroughly assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. The philosophy of the home is to promote the service user’s independence wherever possible. Service users are evidenced to be provided with opportunities for participating in a wide range of appropriate activities, and for developing a range of independent living skills. Access to local educational and recreational facilities, and the development of links with the local community is encouraged. The home actively encourages service users to maintain family links and friendships both inside and outside of the home. Feedback from service users and relatives indicated that visitors are made very welcome at the home and that privacy for service users to receive visitors is respected. Service users’ personal support and health care needs are evidenced to be well met in this home, with support being planned and tailored according to the individual needs presented. There was evidence of a clear commitment by the manager and staff to encouraging service users to develop their independent living skills, whilst ensuring that their mental health needs are appropriately monitored and addressed. The home has an appropriate complaints policy and procedure in place, with clear information being available for anyone who wishes to raise a complaint. No complaints have been recorded since the last inspection. The manager advised that service users are encouraged to raise any concerns they may have at an early stage. No concerns were raised during the inspection. Service users indicated that if problems or grievances did arise, these were listened to and acted upon. Service users are evidenced to have their needs well met by a sufficiently sized, and appropriately trained and qualified staff group. All staff receive appropriate induction, supervision and appraisal arrangements, and the home has a comprehensive training programme in place. The home is currently on track to meet the target of 50 of all care staff to have achieved an NVQ Level 2 by 2005. Service users who spoke to the inspector expressed positive views, indicating that their needs are being well met in the home and that staff are caring and supportive. The home was observed to be well-run and managed in the best interests of the home’s service users. Both staff and service users commented favourably regarding the atmosphere in the home. The management approach is perceived as being open and inclusive, with staff feeling that they are well supported in their work roles. There are regular monthly staff and service user meetings which the manager attends. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 7 What has improved since the last inspection?
The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. Two requirements were made at the last inspection. Following a concern which was identified by the inspector, the home has ensured that risk assessments have been put in place for all service users who self-medicate. The manager has also ensured that all staff who administer medication have received accredited medication training. Service users are evidenced to live in a safe, well-maintained environment, with access to safe and comfortable facilities. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities and needs. Since the last inspection there has been an upgrading of facilities available for service users. The laundry area has been renovated and re-fitted providing safe, hygienic and efficient laundry facilities for the use of both staff and service users. The owner has also upgraded the bathing facilities in the home. A shower room on the first floor has been converted into a second bathroom, while the existing ground floor bathroom has been renovated, with a new bath having been installed. In line with a requirement from the previous inspection, the steps from the conservatory to the garden have been repaired, and made safe. The home presents as being clean, hygienic and free from any offensive odours. Appropriate policies and procedures are in place. Following a requirement from the previous inspection, staff have recently undertaken accredited infection control training.
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 8 The home is evidenced to have appropriate recruitment policy and practices in place, which are providing the required level of protection for service users. Following a concern from an earlier inspection, the home is showing more vigilance in ensuring that all employment checks are being satisfactorily completed. What they could do better:
The service user agreement which the home draws up with the service user is couched in technical terminology and needs to be written in a more userfriendly format, a format/language which is appropriate to the communication needs of service users resident at the home. The home’s adult protection policies, procedures and practice evidence that service users are being protected from abuse and are living in a safe environment. The awareness of staff to adult protection issues is being raised through appropriate adult protection training. To this end, staff are attending the one-day Adult Protection course which is facilitated by Croydon social services, or by an accredited trainer. The inspector recommends that the registered manager attends a ‘training for trainers’ course in adult protection. Feedback from service users indicates that their views are being listened to and taken into account in the decision-making processes within the home. The home needs, however, to demonstrate, through developing its quality assurance processes, that it is meeting its aims and objectives. A quality assurance audit is in place and was last completed on 10 January 2005. An audit report needs to be compiled, and a copy forwarded to the CSCI. The inspector was generally satisfied that the health, safety and welfare of service users and staff are being appropriately promoted and protected. Safety
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 9 checks and certification are in place. A fire safety visit is, however, overdue and fire prevention training must be updated. 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 G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 10 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 Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 11 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, 3 and 5 The home is able to demonstrate that the range of needs presented by service users are being properly assessed, and appropriately met. The home has a thorough and ongoing process of assessment and review in place which involves social and health care professionals, and which focuses comprehensively on the range of personal, social, mental health and physical care needs presented The service user agreement which the home draws up with the service user needs to be written in a more user-friendly format, a format/language which is appropriate to the communication needs of service users resident at the home so that they can understand what services they can expect from the home. . EVIDENCE: The inspector examined a sample of service users files. These include copies of all relevant assessments and documentation. All service users are admitted following extensive assessment. The home has devised a comprehensive referral form which provides comprehensive details of service users’ needs. This is completed by referring agencies which is forwarded to the home with copies of the referrer’s assessments. This stage of the assessment focuses on mental health needs. The home then undertakes
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 12 their own pre-admission assessment which is undertaken by the manager of the home and includes all elements of standard 2.3. This focuses on mental health needs and daily needs such as physical care, abilities and interests. The third stage of assessment takes place during the introductory period of admission to the Care Home. All service users are subject to the Care Programme Approach (CPA), with a CPA review after 3 months following admission. The Registered manager indicated that service users are thoroughly assessed to ensure that their needs can be met in the home. The home works with people who have mental disorders, dual diagnosis and border line mental/learning difficulties. The home’s referral form states that admissions for respite or emergency care depend upon availability and the needs of the particular service user. Service users spoken to by the inspector expressed positive feelings about the home and the ability of staff to meet their needs. Staff were seen to be respectful and caring towards them, and to be enabling in their attitudes and actions. Information on advocacy services is displayed in the home. Following a requirement from the last announced inspection on 6/4/04, the service user agreement has been amended so as to refer to a three-month ‘settling in’ period, and the registration authority has been amended to the CSCI. The agreement still needs, however, to be written in a more userfriendly format, a format/language which is appropriate to the service users resident at the home. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 13 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, 7, 8 and 9 Service users have their health, personal and social care needs set out in an individual plan of care, and are fully involved in the care planning process. They 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 inspector examined a sample of service user files. These indicated that there is a comprehensive and thorough approach to care planning. The plans sampled all use the Care Planning Approach. This is a multi-disciplinary approach to care planning, fully involving the service user together with the care manager, CPN (Community Psychiatric Nurse) and the residential provider. Reviews were found to be up to date and taking place on a regular basis. Files include 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
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 14 restrictions being clearly identified and agreed by the service user. Contingency and crisis plans are also in place. The rights of service users to make decisions about their own lives is central to the ethos of the home, with support and guidance being provided in all areas so as to ensure that service users are making decisions which are in their best interests. Service users spoken to by the inspector indicated that they were able to make decisions for themselves regarding their day to day activity and involvement in education/training, work and social/leisure activity. Staff are perceived to be supportive and encouraging in assisting ‘independence’ and personal development. The inspector observed that staff were open and approachable in their contact with service users and were interacting in a purposeful and caring way. The inspector spoke to a number of staff during the inspection and found evidence of a high level of personal and professional commitment in working with this service user group. Service users were evidenced to be encouraged to participate in the day to day running of the home and to contribute to decision-making. There are regular monthly service user meetings which are facilitated by the manager, and service users spoken to indicated that they were consulted on issues relating to the home and services provided. 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. A risk taking plan and individualised care plan are in place for each service user. These 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. Service users are assisted to look after their own monies. Staff signatures were evidenced to be recorded on log sheets detailing service users’ financial transactions. Service users are able to make arrangements for opening bank accounts in their own name where this is felt to be appropriate. Risk assessments are in place to determine the level of support that service users need to manage their accounts. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 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 standard(s) 11, 12, 13, 14, 15, 16 and 17 Service users are evidenced to have opportunities for participating in appropriate activities and for developing independent living skills. Service users are encouraged to access local educational and recreational facilities, and to be involved in the local community. The home actively encourages service users to maintain family links and friendships both inside and outside of the home. Service users are consulted and involved in the purchase and preparation of food. There is choice and flexibility with meal arrangements, the quality of food is wholesome, nutritious and varied. Meals are taken in a pleasant and congenial setting. EVIDENCE: Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 16 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. 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 were observed to be encouraging and enabling in their interactions with service users, assisting the promotion of independence. 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. Staff at the home work with service users with the aim of increasing their motivation and confidence, and developing independent living skills. 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. One service user was observed to have a computer in his room and indicated that he had been able to achieve proficiency in developing relevant skills. Some service users were observed to be assisting with domestic and daily living tasks during the course of the inspection. The activities offered at the home are wide ranging, stimulating and fulfilling. Service users are encouraged to access local educational facilities including basic literacy and numeracy classes and vocational/skills-based courses designed to assist personal development, and develop work-related skills. The manager advised that the contact which he has had with the Disability Employment Advisor has not, as yet, resulted in any tangible job opportunities becoming available, though the advisor has visited the home and met service users. 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 inspector sat in on an art therapy session in which a group of seven service users participated. The session which was facilitated by a visiting art therapist enabled service users to express themselves through drawing and painting. This was observed to provide a valuable activity in enabling the development of creative activity, and in providing a focus for developing social and communication skills. The inspector spent time engaging with individuals in the group, and was impressed by the level of personal commitment shown, and the enjoyment which individuals derived from the session. The art therapist indicated the benefits which he felt individuals had gained from the weekly sessions. These included the development of creative self-expression, and a sense of personal fulfilment. There was also evidence from the session of how this type of activity can help to stimulate positive personal responses and social engagement, the group being observed to function in a very supportive and interactional way. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 17 The inspector was impressed by the wide and varied range of activities that are available in and outside of the home. These are publicised on the home’s notice board with service users being kept informed of activities and events at service users’ meetings. Comments from service users regarding the opportunities available for social and leisure activity were very favourable, with service users generally feeling that their individual needs and choices in this area are being well met. There are summer barbecues and occasional events held in the home’s garden. Many of the home’s service users are able to go out independently into the community, going to the shops, or visiting libraries. Staff offer support with outings and visits to community facilities such as local pubs, restaurants, swimming, bowling and the cinema. Golf, picnics and a wide range of other activities are also available. Staffing levels are sufficient to enable service users to be supported on outings, and there is no cost involved for those that choose to go. The home has a £250 therapeutic community activities budget which was commended as an example of good practice in the last inspection report. 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, according to the manager, are very much looked forward to by both the service users and staff who accompany them. 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. Service users spoken to by the inspector indicated that they were enabled and encouraged to maintain contact with family and friends, and that their privacy for visitors to the home was respected. The inspector sampled the food served for lunch and spoke to service users. 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. 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. Service users expressed favourable views about the food served and there was good interaction between the kitchen staff and service users, with service users being encouraged to assist with food preparation and other tasks if they wish.
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 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 standard(s) 18, 19, 20 and 21 Service users’ personal support and health care needs are well met in this home, with support being planned and tailored according to the individual needs presented. There is a clear commitment by the manager and staff to encouraging service users to develop their independent living skills, whilst ensuring that their mental health needs are appropriately monitored and addressed. The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. The home has put risk assessments in place for all service users who self-medicate and the service users safety is further enhanced by medication training being provided for all staff who administer medication. EVIDENCE: The range of personal support needs presented by service users, as outlined in assessments and care plans, is varied with support being tailored 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.
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 19 The inspector examined a number of service users’ files which evidenced that both personal support and general health care needs are well met. The manager confirmed that the majority of service users are registered with a local group practice though some service users are able to remain with their own GP where this is possible. All service users are seen by community psychiatric nurses and receive treatment from medical, dental and optician services as required. An art therapist and massage therapist also visit the home weekly. Service users spoken to by the inspector indicated that they felt that their needs in these areas were being well met, and no concerns were expressed. Service users are able to receive visits from visiting professionals in the privacy of their own rooms. The home has a clear policy and procedures in place for the receipt, recording, storage, handling, administration and disposal of medicines. The inspector was informed that two service users are currently self-medicating, a lockable space being provided for safely storing their medication. Following a concern from the previous inspection, the home has put risk assessments in place, with the service user’s consent to medication being recorded in the care plan. Medication records were examined and found to be in order. There is a clear record of all medicines received, administered and disposed of, with MAR sheets being satisfactorily maintained. The manager advised that the pharmacist visits the home every three months and undertakes a medication audit. No issues have been identified. All staff who administer medication have been evidenced to have undertaken ‘accredited’ medication training. The wishes of service users regarding the eventuality of terminal illness or death were evidenced to have been recorded on the service user files. The notes indicate that service users have been consulted about their wishes and that religious and cultural aspects are recorded. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 20 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 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 ensure that service users are being protected from abuse and are living in a safe environment. In order to ensure that this level of protection continues for service users all staff need to attend Adult Protection awareness courses. 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. Details of the Croydon and Sutton office of CSCI and the telephone number are included. 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 Adult Protection procedure, which is in line with Croydon Local Authorities procedures. The manager has attended an Adult Protection course facilitated by Croydon social services. Other staff are scheduled to be attending such training throughout the next few months. The manager has not yet been able to undertake the 3 day adult protection ‘training for trainers’ course, as discussed at the previous inspection. It is recommended that the manager completes this training as this can then be cascaded to other staff. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 21 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 G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 22 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26,27 and 30 Service users are living in a safe, well-maintained environment, with access to safe and comfortable facilities. Service users’ rooms were observed to be safe, comfortable and pleasantly decorated, reflecting service users’ personal identities, and being suited to their individual needs. The home presents as clean, pleasant and hygienic. EVIDENCE: The home is situated in a quiet residential area near the centre of Croydon. The home is within easy walking distance of local shops and amenities, including public transport links. 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. The manager confirmed that there is a planned programme of maintenance for the redecoration of the
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 23 home. The home has a large garden at the rear which is well used in the summer for barbeques and other events. It is well stocked with trees, shrubs and flowers. Since the last inspection the laundry room has been completely renovated and refitted with new washing machines and driers. This was observed to provide safe, hygienic and efficient laundry facilities. The laundry facilities are suitably positioned so as to ensure that any soiled articles/foul laundry are never carried through areas where food is stored, prepared or eaten. The manager advised that the laundry is used by both staff and service users. The backdoor to the laundry room has been replaced. In line with a requirement from the previous inspection, the steps from the conservatory to the garden have been repaired, and made safe. The home has 19 single bedrooms, 4 of which are en suite, and 2 double bedrooms. The bedrooms presented as being pleasantly arranged and decorated, reflecting individuals’ personalities and tastes. Individual lifestyles are reflected in the wide range of personal possessions which individuals bring with them. These include televisions and music systems. Service users are consulted regarding the decoration of their rooms. The inspector noted that one of the bedrooms (Room 2) did not have a bedside table lamp, and it was agreed by the manager that this would, with the consent of the service user, be rectified. A requirement applies. The manager advised that there is now an additional second bathroom in the home following the renovation of a previous shower room on the first floor. The existing ground floor bathroom has also 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. Toilets and bathrooms were found to be clean and safe. 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. The inspector noted that staff have recently undertaken infection control training, on 21/4/05. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 24 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 Service users are evidenced to have their needs well met by an appropriately trained and qualified staff group. Sufficient numbers of staff are on duty. All staff have appropriate induction, supervision and appraisal arrangements, and there is a comprehensive training programme in place. The home is evidenced to have appropriate recruitment policy and practices in place, which are providing the required level of protection for service users. Following a concern from an earlier inspection, the home is showing more vigilance in ensuring that all employment checks are being satisfactorily completed. Staff are evidenced to be appropriately supported, supervised and appraised. The inspector recommends that the supervision format is redesigned so as to provide more space for recording the issues discussed in supervision and the actions/decisions agreed. EVIDENCE: Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 25 Staff files and training records indicate that staff at the home are appropriately qualified and trained. No concerns regarding the competency of staff were raised or identified, and this standard would appear to be well met. The manager indicated that 3 of the 12 care staff are NVQ Level 2 qualified and are studying for their NVQ Level 3, while 3 other care staff are studying for their NVQ Level 2. The home is currently on track to meet the target of 50 of all care staff to have achieved an NVQ Level 2 by 2005. Staff records evidence that there is statutory training in Food Hygiene, Health and Safety, Fire Safety, Medication and Mental Health. There is an ongoing programme of staff training which was seen by the inspector. The staff rota indicated that the homes staffing levels comply with those agreed with the previous Registration Authority. During the day, the home has 3 care staff on duty. There are two staff members on duty from 10pm 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. Service users who spoke to the inspector expressed positive views, indicating that their needs are being well met in the home and that staff are caring and supportive. The inspector checked a number of staff files and found these to be in order, with all documentation required by Schedule 2 being in place. CRB checks are being completed for all new staff. All staff files inspected included the full name, address, date of birth, two written references, and the date when employment commenced. The manager advised that new reference forms have been developed. These provide more space for reference information. The home provides a structured induction programme for all new employees. This forms part of the probationary period of employment, and is signed and dated on completion. There is a comprehensive training programme in place for all staff. A requirement from the previous inspection for staff to be provided with equal opportunities and anti-racism training has been met, a trainer having visited the home and provided this training for staff on 24/3/05. The manager confirmed that there are regular supervision sessions for staff. These are now being held on a monthly basis and are facilitated by the manager and by one of the two shift leaders, who is responsible for the supervision of some staff. Supervision sessions cover the issues listed in Standard 36.4. The manager has advised that the home has close links with the local Community Mental Health Team and that CPNs (Community Psychiatric Nurses) offer specialist advice and support to staff when they visit the home. Staff members spoken to felt that they were being properly and fully supported in carrying out their duties. The inspector looked at the supervision format and recommends that this is redesigned so as to provide more space for recording the issues discussed in
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 26 supervision and the actions/decisions agreed. The format should also include a space for both the supervisor and supervisee to sign and date the record. The home has an appropriate staff appraisal system in place in which staff performance is appraised against job descriptions, with career development plans being formulated. Appraisal and appraisal target forms are in place. The manager advised that staff are asked to identify their strengths, learning and development needs prior to the appraisal session taking place. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 27 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) 37, 38, 39, 41 and 42 The home is evidenced to be well-run and to be managed in the best interests of the home’s service users. Both staff and service users commented favourably regarding the atmosphere in the home. Feedback from service users indicates that their views are being listened to and taken into account in the decision-making processes within the home. The home needs, however, to demonstrate, through its quality assurance processes, that it is meeting its aims and objectives. The inspection evidenced that the home’s records are being well-maintained, and that confidentiality is protected. The inspector was generally satisfied that the health, safety and welfare of service users and staff are being appropriately promoted and protected. Safety checks and certification are in place. A fire safety visit is, however, overdue and fire prevention training must be updated. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 28 EVIDENCE: The manager presented as qualified, competent and experienced. He has 18 years experience in community care and rehabilitation and is a trained mental health nurse. He has an excellent understanding of work with this client group and demonstrated an extensive knowledge of mental health issues throughout the inspection. The manager confirmed that he is currently undertaking a course of study leading to the NVQ Level 4 Registered Managers Award. Both staff and service users commented favourably regarding the atmosphere in the home. The management approach is perceived as being open and inclusive, with staff feeling that they are well supported in their work roles. There are regular monthly staff and service user meetings which the manager attends. The inspector recommends that the format for these meetings is revised so as to provide more detail regarding the discussion of issues and actions/decisions agreed. The home has developed its quality assurance processes over the last year 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 results of these surveys need to be published in an audit report and made available to service users, their representatives and other interested parties including the CSCI. An annual development plan for the home is published. Service users spoken to felt that their views are being taken into account in the decision-making processes within the home, and that they are able to raise issues that affect them. Service users had been made aware of the inspection and presented as able to talk freely about their views concerning the home. All records seen by the inspector were well maintained and up to date. 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 were observed to be kept securely. The home has in place a rolling programme of training in manual handling, food hygiene, first aid and medication. Certificates of which were available on request. A requirement from the last inspection for staff to undertake infection control training has been met, the training having been completed on 21/4/05. A fire safety visit is required, the last one having been undertaken on 3/9/03. All staff have received suitable fire prevention training from an accredited training company on 19th January 2004. This needs to be updated.
Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 29 Requirements apply. A risk assessment in respect of fire safety has recently been undertaken by the home. Hazardous substances are appropriately stored in a locked COSSH cupboard, and COSSH risk assessments are in place. Gas, PAT Testing and legionella checks have all been undertaken, with emergency lighting having been tested in March 2005. Following a requirement from the last inspection, the electrical systems in the home have been inspected (on 15/10/04) and the thermostatic electrical switch repaired. The registered person has ensured that requirements from the said inspection have been completed within the agreed timescales. A risk assessment in respect of safe working practices has been undertaken by the home. The home last received a health and safety inspection on 27/3/03. This needs to be updated. A requirement applies. Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 30 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 3 x 2 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 2 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Radcliffe House Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 2 2 x 3 2 x G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 31 YES (1) 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 YA5 Regulation 5 (1) & (2) Requirement The registered person must ensure that the service user agreement is written in an appropriate format/language for the service users resident at the home. The registered person must ensure that the service user occupying Room 2 is, with his agreement, provided with a bedside table lamp. Timescale for action Time-scale extended to 1.10.05 2. YA26 16 (2)c 1.06.05 3. 4. YA39 24 (1)(a) & (b), (2) & (3) The registered person must 1.12.05 ensure that a Quality Assurance audit is put in place, evidencing that information gathered from surveys, meetings and other types of feedback have been collated. This should be published and made available to service users, their relatives and representatives, the CSCI and other interested parties. The registered person must 1.10.05 ensure that the home receives an up to date fire safety inspection. The registered person must 1.10.05 ensure that all staff receive up to date fire prevention training from an accredited trainer.
Version 1.30 Page 32 5. YA42 23 (4)(a) & (c), 13 (4)(c) 23 (4)(d, 13 (4)(c) 6. YA42 Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA23 YA36 Good Practice Recommendations The inspector recommends that the registered manager undertakes the Croydon 3 day adult protection ‘training for trainers’ course in adult protection. The inspector recommends that the supervision record is redesigned so as to provide more space for recording the issues discussed in supervision and the actions/decisions agreed. The format should also include a space for both the supervisor and supervisee to sign and date the record. The format used for recording staff and service user meetings should be redesigned so as to provide more detail regarding the discussion of issues and actions/decisions agreed. 3. YA38 Radcliffe House G53 S25828 RadcliffeHouse V189132 280405 stage4.doc Version 1.30 Page 33 Commission for Social Care Inspection 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
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