Inspection on 24/08/05 for Rafael

This inspection was carried out on 24th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rafael 10/09/07

Rafael 19/06/06

Rafael 09/01/06

Rafael 02/11/04

Rafael 24/05/04

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Rafael 172 Stanley Park Road Carshalton Beeches Surrey SM5 3JR Lead Inspector Deborah Yapicioz Unannounced 24th August 2005 17:10 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. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Rafael Address 172 Stanley Park Road, Carshalton Beeches, Surrey, SM5 3JR 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) 0208 296 1016 Angel Home Limited Mrs Janice Nichol Farrar Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2/11/04 Brief Description of the Service: Rafael is a residential care home providing care for up to three adults between the ages 18 and 65 years in the category learning disability. There are currently three service users living at the home.The premises are on Stanley Park Road, which is busy through-route between Wallington and Sutton. It is within walking distance of local shops and transport links.It comprises three single bedrooms, a lounge, a dining room, kitchen, storeroom, bathroom, two toilets plus an office on the second floor. There is a large garden to the rear and a small front area with off-street parking for two cars. The three single bedrooms have been equipped and decorated to National Minimum Standards and include suitable furniture and fittings and décor, but no ensuite facilities. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected under the National Minimum Standards Care Homes for Younger Adults. The inspection was unannounced and took place in the evening when all the service users were at home. Methods of inspection included a tour of the premises observation of contact between staff and service users, meeting with the service users and discussion with the home manager. Records examined included service user plans; care manager needs assessments, risk assessments, medication records, complaints, staff files, health and safety and fire records. I would like to thank the service users and the home manager for their help during the inspection Overall the home continues to provide a good service to the service users. What the service does well: What has improved since the last inspection? What they could do better: The home is part of an organisation that has another small home in Sutton. The home manager explained that some members of the staff team work in both homes, with the result that paperwork required under schedule 2 cannot Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 6 be inspected as it is held at the other home. The records should be held in both homes. All new members of staff employed on a permanent basis receive a structured induction as part of their probationary period of employment. The file for the newest member of staff did not contain his induction record as it was held at the other home. The home manager must ensure a fire risk assessment is completed for the home. 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. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 7 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 Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 8 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) 1,2,3,5 The home provides good information and introduction opportunities for prospective service users and their families to make an informed choice about moving to the home. A comprehensive pre-admission assessment is undertaken so that service users and their families can be confident that their needs will be met by the home. Each of the service users is issued with an individual contract setting out the terms and conditions of the placement, which safeguards the interests of both parties. EVIDENCE: The home has an assessment format in place, which is completed for any prospective service user. The home manager informed the inspector that a member of the homes management team would usually visit the service users in their own home as part of the referral. A sample of care plans were seen which contained the homes preadmission assessments. Any prospective service user would have a gradual introduction to the home with a series of short visits and overnight stays. The time frame would be flexible depending on the service user. Compatibility with others already living in the home is also taken into account. The home has a statement of purpose and service user guide, which are regularly reviewed to ensure information about the home is up to date. The home has also put the service users guide into a tape format. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 9 The home has a varied training programme available to build on the skills of the staff team. The training is provided in a variety of ways, including links into local colleges and the London Borough of Sutton training department. The home has an induction programme linked to TOPSS as well a basic house induction. Each of the service users has a personal contract, specifying the terms and conditions of their occupancy that included periods of notice, fees charged, and the cost of ‘extras’ not covered by the basic cost of the placement. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7,8,9, The service users have individual care plans with contain information on their needs and personal goals. Individual care plans include consultation with service users and are regularly updated by the key-worker to reflect current and changing needs and ensure service users wishes are represented. The home operates a risk management strategy thus enabling the service users to participate in activities in the home and in the community with appropriate support. EVIDENCE: The home has recently introduced a new care plan format, which appears to be more detailed than the previous system. Care plans also include medical information. The service users have six monthly reviews as well as an annual multi disciplinary review. The home operates a key worker system. Part of the role of the key workers at the home is to ensure the service user individual opinions are put forward. The residents are offered the opportunity to participate in the day to day running of the home through regular meetings as well as the individual discussions with their key workers. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 11 The home operates a Risk Management Strategy. Service users at the home have individual risk assessments depending on their needs and goals. The home manager completes risk assessments for any new activities. Copies of individual risk assessments are kept on the service users file and cover a variety of situations including using electrical equipment, bathing, cooking and using public transport. The home manager has some concerns about one service user who has a preoccupation with electrical equipment. The staff team at the home are currently dealing with this by removing any electrical items from the service users bedroom. The home manager should consult with the local community team to request guidelines on the best way of dealing with this issue. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 The service users at the home are offered the opportunity to engage in age appropriate activities with an emphasis on using community based facilities. The service users have a varied programme of social activities, which reflect service users individual interests. The home has an open visitors policy to ensure friendships and family links are maintained. Dietary needs are catered for with meals that are nutritionally well balanced, nicely presented, and clearly based on the service users food and drink preferences, providing them with daily variation and healthy eating options. EVIDENCE: The service users all access various activities through the local day centre. These activities include candle making, educational skills, woodwork and gardening, music therapy, pottery and cookery. The service users also attend evening classes for cookery. The service users have a record of the activities they have taken part in on their files. The service users are involved is some household tasks such as changing their beds, hovering and washing up. The local community is well used by the residents and each of the service users has a bus pass. Service users weekly activities include going to pubs, bowling and shopping. One of the service users has also been to the theatre to see WWF wrestling. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 13 There is an open visitors policy and the home just ask that visitors phone to ensure their family member is going to be in before they visit. Visitors can be seen in any of the homes communal areas as well as the service users bedrooms. The staff team at the home encourage service users to remain in contact with their family members if it is appropriate. One of the service users who has little family contact has an advocate, another service users is on the waiting list for an advocate. Menus at the home are based on the service users likes and dislikes have been checked for their nutritional content. The manager stated that the service users are encouraged to participate in food shopping and preparation. The service users said that they enjoyed the meals at the home. All service users are on the electoral register, and support would be offered to the service users to access the poling stations and engage in their civic rights if they wished. The manager stated that the home has a good relationship with their neighbours and often arrange coffee mornings and other fund raising events. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ physical and emotional health needs are detailed in personal plans to offer consist care in this area. Residents’ medication is well managed to ensure good health. Service users have been consulted on their personal and cultural preferences in relation to illness, death and dying, thus ensuring their individual wishes are respected. EVIDENCE: The service users need varying degrees of assistance with their personal care although they are quite independent. Some service users just needs a prompt while others need a little more support. The level of support a service user needs would be detailed at Person Centred Plan meetings. As two of the service users at the home are male, the home has employed a male member of staff to reflect more accurately the gender mix at the home The home operates a key worker system, which takes into account the wishes of the service user. Service users said that they choose their own clothes and enjoy going shopping with their key workers for personal items of clothing or toiletries. The service users at Rafael are registered with a local General Practitioner. The service users are able to access community health facilities such as opticians. A chiropodist comes to the home. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 15 The staff team at the home monitor the health of each of the service users and would ensure they receive any treatment needed. One of the service users sees a neurologist due to her health needs. The home uses a nomad system for medication. The home manager explained that more members of the staff team are due to do a care of medication course. Medication is only given out by staff who have done the accredited medication course. Currently three staff at the home are able to administer medication. Since the last inspection the service users and their families (where appropriate) have been consulted on their wishes around death and dying and a record has been placed on their files. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 16 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, 23 There is complaints policy and procedure, which facilitates good access to the complaints system for the residents, their family or their representatives. The home has the appropriate policies in place to ensure the protection of vulnerable service users EVIDENCE: The home has a complaints procedure, which outlines how a complaint is dealt with and timescales for action. The home has not received any complaints in the last twelve months, nor has the Commission. A copy of the procedure was available in the home. Procedures for responding to issues of abuse were available in the office. The home has copies of The London Borough of Sutton multi disciplinary adult abuse procedures on site. The home also has a Whistle blowing policy The majority of the staff team at the home have undertaken training on the issue of adult abuse. Newer members of staff are booked on a course. The service users spoken to during the inspection said that they would tell the manager or a family member if they had a problem. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 17 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) 24,25,27,29,30 The home is homely, bright and clean thus providing the service users with safe, comfortable surroundings that meet their needs. The home has a planned programme of maintenance and redecoration, which should ensure the service users are living in a clean, comfortable environment. Service user’s bedrooms provide privacy and reflect individual interests and preferences. EVIDENCE: Rafael is an ordinary family home, which has been extended to provide care to people with Learning disabilities. It is a small family-like care home currently accommodating three service users. Each of the service users in the home has a single room on the first floor, which is decorated and personalised to reflect their individual taste. The office /sleep in room is on the top floor of the house There is ample communal space in the home, provided by a lounge, a kitchen, a dining room and garden; there are sufficient numbers of bathrooms and toilet facilities situated throughout the home. The home also has a large pleasant garden to the rear. The interior of the house is clean, bright, well ventilated and free from offensive odours. The home has covered radiators. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 18 The service users are fully mobile and there are no adaptations in the home. The washing machine in the home is capable of washing at high temperatures, which helps in the control of infection. Effective infection control measures are in place commensurate with the risks in this small home. For example in the kitchen there is clear guidance for staff and service users in maintaining good hygiene practices in this area. For example no washing is done in the kitchen when service users are cooking or eating. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 19 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) 31,34,35,36 The staff team at the home have a range of skills and abilities, which enables them to meet the needs of, the service users living at the home. The home manager must ensure that copies of all the information require under Schedule 2, 1 to 6 of the care home regulations 2001 as a safeguard to offer protection to the homes service users. EVIDENCE: The home is part of an organisation that has another small home in Sutton. The home manager explained that some members of the staff team work in both homes, with the result that paperwork required under schedule 2 cannot be inspected as it is held at the other home. All new members of staff employed on a permanent basis receive a structured induction as part of their probationary period of employment. The record of this is signed and dated on completion. The file for the newest member of staff did not contain his induction record as it was held at the other home. The home manager must ensure that all the necessary information about the staff team is held in the home, including a copy of staff inductions and Criminal Records Checks. The other staff files contained job descriptions, which were comprehensive in there content. There is one member of staff on duty on each of the daytime shifts. At night there is one member of staff on duty. The home arranges for additional staff to Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 20 be available when activities are organised for the service users outside of the home. The frequency of staff supervisions has increased since the last inspection. The staff team are now receiving monthly supervisions. The home also has monthly staff meeting which are minited. Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 21 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) 37,39, 42, The management style at the home appears to be open. There are clear lines of accountability, which is aimed at ensuring the interests of the service users, are safeguarded and their safety and welfare are protected. EVIDENCE: Jan Farrar is the manager of Rafael. She has been in operational day-to-day control of the home since 2002. She has worked for Angel Homes for several years in different care and management positions. There was a clear line of accountability within the home and the manager demonstrated a good knowledge of the service users and the staff team. The service users at the home also felt that the manager was someone they would talk to about any problems. The home has regular service users meetings and a key worker system. The home has a health and safety policy and an Infection control manual. Fire drills at the home were up to date on the day of the inspection, although the manager has not completed a fire risk assessment. This needs to be actioned Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 22 The home has thermostatic control values fitted to water outlets and radiators are covered. The water temperature is checked regularly and a record is kept. A first aid box and a fire blanket are situated in the kitchen. There are fire extinguishers throughout the house. Coloured chopping boards and knives were seen in the kitchen. There are locked “Control of Substances Hazardous to Health” cupboards. The staff team have access to training around health and safety issues and have undertaken moving and handling training, basic food hygiene and first aid Rafael G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 x 3 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x x 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rafael Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 3 x x 2 x G53-G53 S38904 Rafael unann V211354 240805 Stage 4.doc Version 1.30 Page 24 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. 2. 3. Standard 34 35 42 Regulation 19(1)(a) 18(1) 12(1) Requirement The home manager must ensure checks are availiable for inspection The home manager must ensure staff induction records are availiable for inspection The home manager must ensure that fire risk assessment is completed for the home Timescale for action 16.09.05 16.09.05 16.09.05 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 9 Good Practice Recommendations The home manager should request quidelines fron the community team for the service user who has an issue with electrical equipment. 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