Inspection on 09/01/06 for Rafael

This inspection was carried out on 9th January 2006.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rafael 10/09/07

Rafael 19/06/06

Rafael 24/08/05

Rafael 02/11/04

Rafael 24/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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 Inspection 9th January 2006 08:45 Rafael DS0000038904.V276937.R01.S.doc Version 5.1 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 Rafael DS0000038904.V276937.R01.S.doc Version 5.1 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. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rafael Address 172 Stanley Park Road Carshalton Beeches Surrey SM5 3JR 020 8296 1016 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) jan_farrar@hotmail.co.uk Angel Home Limited Mrs Janice Nichol Farrar Care Home 3 Category(ies) of Learning disability (0) registration, with number of places Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 DS0000038904.V276937.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the homes second inspection for the year 2005/6 and was unannounced. The inspection took place on the morning of 9th January 2006. The home was inspected under the National Minimum Standards Care Homes for Younger Adults. A previous inspection took place on the evening of 24th August 2005 when most of the standards that the Commission for Social Care Inspection considers as key standards were inspected. Methods of inspection included a partial tour of the premises, meeting with the service users and the manager, Jan Farrar and another member of staff. Records examined included the homes pre-inspection questionnaire, service user plans, risk assessments, medication records, complaints, staffing records, and health and safety and fire records. The inspector would like to thank the service users, the staff team and Ms Farrar for their help in facilitating the inspection. What the service does well: What has improved since the last inspection? What they could do better: Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 6 It is company policy that all new employees are not permitted to start work until two satisfactory references from their previous employees have been confirmed. Two of the staff files looked at during the inspection contained all the necessary information however one of the staff files checked during the inspection did not hold all the references to meet this standard. The home manager must ensure that references are held on all staff files. 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 DS0000038904.V276937.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Rafael DS0000038904.V276937.R01.S.doc Version 5.1 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 the following standard(s): 1,2 Generally 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. EVIDENCE: Rafael Home has a statement of purpose and service users guide in place. The home manager stated that the contents of both documents are reviewed regularly. The documents are currently being updated to reflect the changes in the homes staff team. Service users are only admitted to the home once a full assessment of their needs; compiled by their care manager or other relevant person has been received. The home also has a preadmission format that they complete. Preadmission documentation is kept on the service users files. Compatibility with others already living in the home is also taken into account. 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. One of the service users spoken to during the inspection talked about her introduction to the home and how she had come for visits before moving in. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 9 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): 6,9 The service users have individual care plans with detailed 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 needs and ensure service users wishes are represented. EVIDENCE: Each of the service users at the home has a care plan and an individual plan as well as Personal goals achieved form. These documents detail the service users goals, medical information, reviews, records of choices, and an assessment of care needs including any cultural or religious needs. The plans follow on from the initial assessments completed by their care manager. The home has a key worker system. The service users and their key workers regularly review individual goals. One of the service users said how much she likes her key worker and enjoys talking to her. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 10 The home operates a risk management system and individual assessments are on service users files. Risk assessments include using public transport and bathing. The home has a policy that a member of staff remains outside the bathroom when a service user is bathing (two service users have epilepsy) in this way privacy and dignity is preserved and the service users safety is maintained. At the last inspection the home manager had some concerns about one service user who has a preoccupation with electrical equipment. The service user has been referred to the Community Team for People with Learning Disability and an appointment has been booked for January 2006. The service users participate in the day-to-day running of the home, through regular service users meetings, and the homes key worker system. As the home is quite small with only three service users the home manager commented that it is also easy to involve the service users in the decision making in an informal adhoc way as issues a rise. The service users spoken to during this inspection and at the previous inspection in August 2005 felt that they were asked for their opinions and encouraged to make choices. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 11 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): 12,13,15 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 daily routines and house rules promote residents’ rights and encourage independence as far as possible. EVIDENCE: The home is supporting service users to access appropriate activities through local day centres where they participate in various activities including office /reception skills. The service users also attend evening classes at a local college for cookery. The service users have a record of the activities they have taken part in on their files. A weekly timetable of activity is also on display in the hall. One of the service users is currently doing voluntary work at the local ecology centre. An other service user at the home told the inspector how the staff at the home had helped her to get an appointment with a local job broker under the new deal for disabled people scheme. The appointment is for late January and she is hoping it will lead to some voluntary work in the future. The service users are involved is some household tasks such as changing their beds, hovering and washing up. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 12 The home is keen to maintain the service users family links. Visitors are welcomed and the service users families are invited to their reviews. The home has recently produced a newsletter for friends and family. The service users enjoyed making the newsletter and are hoping to produce the newsletter twice a year. Over the Christmas period two of the service users choose to divide their time between the home and visiting their families, which they said they enjoyed. The remaining service users invited friends to Christmas dinner and extra activities were organised including trips to the cinema. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 13 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): 18,21 Personal care is carried out in a way that residents prefer so that dignity and choice are maintained. Residents’ medication is well managed to ensure good health. EVIDENCE: The service users require varying degrees of assistance with their personal care. Some service users need more support, while others just need a prompt. The level of support a service user needs would be detailed and recorded at their review. Personal care is provided in private, and timings of this are also flexible, for example service users can have a bath when they wish. As mentioned before the home has a bathing policy and staff wait outside the bathroom so that if a service users had a seizure in the bath they can intervene. The home provides consistency and continuity through designated key workers. Service users have access to relevant professional support to maximise independence, including the Community Team for People with Learning Disability. Significant events and accidents are recorded and monitored. Staff members monitor service user’s health and maintain up to date records including seizure activity. The home has a policy and procedure in place for the receipt, recording, storage, handling, administration and disposal of medication. The service users are encouraged to self medicate, where appropriate. All medication records were complete at the time of the inspection. Four staff are trained in the administration of rectal diazepam. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following 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 and ensures that they feel confident that the issues they raise will be dealt with sensitively and in a timely manner. The home has the appropriate policies and staff training 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 Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 The home is homely, bright and clean thus providing the service users with safe, comfortable surroundings that meet their needs. 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 service users were planning to grow some vegetable for example tomatoes during the summer months. The interior of the house is clean, bright, well ventilated and free from offensive odours. Radiators all have safety covers. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 16 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): 31,34 The staff team at the home have comprehensive job descriptions, which provide clear guidance on their role and responsibilities and enable them to meet the needs of the service users at the home, however the staff files need to contain all the information necessary to safeguard service users. EVIDENCE: There is one member of staff on duty on each of the daytime shifts. At night there is also one member of staff on duty. There is a handover between shifts to ensure consistency. When activities are organised for the service users outside of the home, the home arranges for additional staff to be available. The staff team at the home are issued with job descriptions, setting out the role and responsibilities of the staff at the home. It is company policy that all new employees are not permitted to start work until two satisfactory references from their previous employees have been confirmed. It is company policy that all new employees are not permitted to start work until two satisfactory references from their previous employees have been confirmed. Two of the staff files looked at during the inspection contained all the necessary information however one of the staff files checked during the inspection did not hold all the references to meet this standard. The home manager must ensure that references are held on all staff files. Criminal Records Checks are undertaken and copies were available for inspection. New members of staff complete an induction programme covering various subjects including health and safety. Copies of staff induction were kept on file, Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 17 which were available for inspection. The home has regular staff meetings; records of the issues discussed are on file at the home. The staff team at the home receive supervision from the home manager. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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): 37,42 The management style is open with clear lines of accountability, which is aimed at ensuring the well being of the service users. In the main health and safety arrangements are adequate to ensure potential risks to service users health and safety are so far as reasonably possible identified and minimised. 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 as well as their key worker. The home has regular service users meetings. Records required for the safety and well being of service users are in place including accidents, water temperatures, risk assessments, complaints, incidents, food records, staff and service users case files, medication records and so forth Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 19 Staff meetings are held regularly which are recorded. Fire drills take place monthly and the home has completed a fire risk assessment since the last inspection. The home carries out fire drills at night as well as during the day. Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 20 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 X 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X X 3 3 X X X X 3 X Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 21 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 YA34 Regulation 19(1)(b) Requirement The home manager must ensure that staff references are held on staff files and are available for inspection Timescale for action 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 22 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 Rafael DS0000038904.V276937.R01.S.doc Version 5.1 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!