Inspection on 11/10/06 for Rame Close

This inspection was carried out on 11th October 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rame Close 08/10/08

Rame Close 28/11/05

Rame Close 14/06/05

Rame Close 27/01/05

Rame Close 22/12/04

Rame Close 02/02/04

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 Rame Close 34 Rame Close Wandsworth London SW17 9TT Lead Inspector Jon Fry Unannounced Inspection 11th October 2006 10:00 Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rame Close Address 34 Rame Close Wandsworth London SW17 9TT 020-8682-0096 020 8682 0096 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) www.thresholdsupport.org.uk Threshold Housing and Support Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th November 2005 Brief Description of the Service: 34 Rame Close is a care home for six adults with a learning disability. The home is located in a residential road in Tooting close to local shops and transport links. The home is run by Threshold Housing and Support. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one inspector on the 11th October 2006 over 4.5 hours. The inspector talked individually with two people living at the home. A number of records were examined and discussions took place with the manager and four staff members. Completed surveys were received from two people who live at the home. What the service does well: What has improved since the last inspection? What they could do better: A suitably qualified person should carry out a risk assessment for Legionella. All financial transactions should be checked and signed by two staff members. An application for registration of a manager must be submitted to the CSCI. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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 Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available to prospective residents about the home. The Guide for residents could be made available in other more accessible formats. Residents are assessed and support (care) plans put in place to address identified needs. EVIDENCE: The Guide for residents gives good information to both existing and prospective residents about the home. This document could be developed in other accessible formats such as audio and video. The manager said that this was part of his future plans for the service. There is one vacancy at the home and a prospective resident has already visited to see the home and meet the people who live there. Assessments are carried out by the home to make sure that individual needs can be met by the service. Support plans are then put in place once the person has moved into the home. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good support plans are in place and these address the identified needs of individuals. Residents make their own decisions about their lives with support from staff when needed. Individual risk assessments are carried out to support and protect residents in their daily lives. EVIDENCE: Residents are encouraged to take ownership of the home and to be as independent as possible in their daily lives. There are now opportunities for individuals to move on from the home if they wish to as part of their own development. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 10 Support plans are kept to a high standard and are used as ‘working’ documents. Daily monitoring forms are used to check on how support needs are being met and to address any shortfalls in the support provided. New plans are put in place as needs and goals change. More detailed notes are kept for individuals as needed to make sure that staff know current issues and are able to be consistent with residents. Staff spoken to had a good understanding of individual needs and behaviours and how to sensitively address these. Residents are fully involved in the day to day life of the home and are encouraged to take the lead in household tasks. Staff also support individuals in arranging and attending social events as part of building their independence and social networks. Assessments are completed for each resident to support them in taking risks as part of an independent lifestyle. These are kept under review and form part of the overall support plan for individuals. One example seen was the individual assessment completed for a person who takes their own medication each day. This clearly stated how the home would support the individual to do this whilst addressing any potential risks. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s independence is actively promoted by the home and individuals are encouraged to participate fully in the daily routines of the home. Residents are supported to attend activities of their choosing. Residents receive good support to plan and prepare their own meals. There are ongoing issues with anti-social behaviour in the immediate neighbourhood. Residents are supported to address these as part of the local community. EVIDENCE: The manager and staff have made real improvements in the way the service provides support to residents. The manager spoke of moving away from a ‘hotel’ model to one of ‘ownership’ and making sure that residents are given Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 12 the support and encouragement they need to lead independent and fulfilling lives. Care staff spoke very positively about the service and particularly about the changes in the way support is provided. Comments included “so much improvement” and “there is lots of encouragement for the residents”. Since the November 2005 inspection, one resident has moved to their own supported living flat and discussions are ongoing with other residents about moving on from the home. A good example of the progression in the service is the increased involvement of residents in the planning and preparation of meals. Individual menus are displayed in the kitchen area and the majority of residents now take responsibility for planning these each week. Support plans are completed and monitored by staff to help to effectively support each resident in developing their skills. Residents are able to take part in activities of their choosing. Weekly activities for individuals include attending work, day centres, places of worship and evening clubs. Some residents receive sessions of 1-1 support to go out whilst others prefer to go out independently with friends or family. Two residents recently returned from a holiday in Majorca. A support plan for one resident looked at how the person could go for meals out within their budget. A plan for another resident was to try and support them to increase their social time spent with other people. There have been a number of incidents in the immediate neighbourhood involving nuisance or anti-social behaviour. Residents are being supported to be part of the local community in trying to address these issues. Residents have attended meetings and a police officer was at the home during this visit gathering further information from residents and staff. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual health needs are met. Medication is well managed and residents can keep and administer their own medication as appropriate. EVIDENCE: Residents attend to their own personal care needs and little support is provided by staff which is by way of prompting only. Support plans make sure that individual healthcare needs are addressed with supported being given as required to visit the GP, dentist, optician and other health appointments as necessary. Medication is managed well. Good administration records are kept and items of medication are appropriately stored. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place. Residents know who to speak to if they have any problems. The homes procedures and training help to make sure that residents are protected from abuse. EVIDENCE: An organisational complaints procedure is in place that has been produced using pictures and photographs. One complaint has been received by the home since the November 2005 inspection. A record of all complaints, including the actions taken and the outcome, is kept in the office. Individuals living at the home said they would speak to the staff or to the manager if they were not happy with something and were generally confident their concerns would be listened to. One person responded in a survey “some staff are better at helping you out when you are not happy – they try to sort it out for you or just listen to you”. Staff receive training in Safeguarding Adults (Protection of Vulnerable Adults) and there are policies and procedures in place regarding abuse awareness and what to do in the event of this. A support plan was in place for one resident around their social network and this looked at any future issues where they may be vulnerable. The manager Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 15 had already made a referral to the local community team and was looking to access training in this area. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely and comfortable environment that is well maintained. The home is kept clean and hygienic. EVIDENCE: The home environment is comfortable and well maintained. Improvements made since the November 2005 inspection include new flooring and a walk-in shower on the first floor. One resident painted their own bedroom and another person helped staff paint the lounge. Future plans include updating the ground floor bathroom and changing the office to include a sleep-in area. One resident raised an issue about the fan in the upstairs shower saying “it is too noisy and stays on for a long time”. No other maintenance issues were highlighted or seen during this visit. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 17 All areas of the property were clean and hygienic at the time of this visit. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staffing levels are sufficient to meet the needs of residents. Recruitment practices protect the welfare of residents. Staff have regular 1-1 supervision with their manager. Individuals receive the training they need to do their job. EVIDENCE: The staff team at the home clearly know the aims of the service and work well as a team to achieve these. One resident said “the manager is good” and “I like all of the staff. Another person living at the home said communication could be “better” by some staff but also said “generally this is very good and helps me get along with the staff”. Staff spoken to felt that they received the training they required to do their jobs. Two newer care staff confirmed that they had received a good induction Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 19 to the home and were receiving mandatory training in areas such as First Aid and Food Hygiene. Staff members said that they felt there were enough staff on duty to support residents. One resident said that were “enough staff” whilst another person felt that staff spent “too much time in the office” doing paperwork. This was discussed as the individual felt that inspections caused a lot of this work that prevented staff spending more time with residents. The manager was also asked about this and said that staff were able to cope with the current amount of paperwork. Individual staff files were not looked at during this visit. Two new staff were spoken to individually and confirmed that they had to obtain Criminal Record Bureau checks as part of the application process. The organisation is well established and has its own recruitment procedures include necessary checks required by law. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from a well run home. The manager needs to be registered with the CSCI. The home seeks the views of residents and their representatives. Residents receive support as required to look after their finances. Health and Safety checks carried out protect the welfare of residents. EVIDENCE: The manager has made significant improvements in the service since being appointed in September 2005. Staff spoken to felt that they were well Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 21 supported by the manager and comments included “the manager has confidence in us and is open to discussion” and “I feel well supported”. The manager said that he had applied to be registered with the CSCI but there is no record of this application being received. The Requirement to register a manager for the service had been repeated to address this. Support is provided as required for individual finances. Some residents have support plans to help them budget their money. Good records are kept where money is held on behalf of residents and these are checked daily. It is recommended that two staff signatures be consistently recorded on these records. Monthly residents meetings are held at the home and any issues from these are discussed at the staff meeting. A development plan is in place for the service. The home makes sure that regular Health and Safety checks take place and encourages residents to take part in these. A full risk assessment for Legionella does however still need to be completed by a suitably qualified person. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 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 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 3 X Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 23 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 YA37 Regulation 8 (1) Requirement The Registered Persons must ensure that an application is submitted to the CSCI for registration of a manager for the home. (Previous timescale of 01.02.06 not met). The Registered Persons must ensure that a risk assessment is put in place for the home regarding Legionella. This must be completed by a suitably qualified person. (Previous timescale of 01.04.06 not fully met). Timescale for action 01/01/07 2. YA42 13 (4) 01/02/07 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 YA24 Good Practice Recommendations It is recommended that plans to provide a sleep-in area DS0000010219.V317428.R01.S.doc Version 5.2 Page 24 Rame Close 2. 3. YA27 YA41 within the current office be actioned as soon as possible. Investigate the issue raised by one resident concerning the fan in the first floor shower room. Two members of staff should sign all financial records for service users transactions. Rame Close DS0000010219.V317428.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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