Inspection on 14/06/05 for Rame Close

This inspection was carried out on 14th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 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 11/10/06

Rame Close 28/11/05

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 14 June 2005 10:30 am th 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. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 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 Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Threshold Housing and Support Mrs Rose Dundas CRH - Care Home 6 Category(ies) of LD - Learning Disability (6) registration, with number of places Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/01/05 Brief Description of the Service: 34 Rame Close is a service run by Threshold Housing and Support. It is situated in a quiet residential road within walking distance of local shops and public amenities. It is a residential care home for six adults with learning disabilities. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector on the 14th and 16th June 2005. The inspector spent approximately five hours in total at the home. The inspection included the examination of records, a tour of the premises and individual conversation with residents and staff. The inspector had the opportunity to speak with five residents and four members of care staff. What the service does well: What has improved since the last inspection? The care planning documentation was seen to have improved significantly since the previous inspection. The support plans in place for individual residents were observed to be monitored on a daily basis and are subject to a recorded evaluation process. Feedback from residents evidenced that the frequency of incidents of challenging behaviour involving one resident had decreased. Two residents reported that they felt this was due to the work undertaken by the acting manager in post. Staff members spoken to reported that the local community team had additionally provided increased support. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 and 5. Written information is made available to prospective residents regarding the service. This documentation requires further minor amendment to ensure the accuracy of information presented. A written procedure is in place to ensure that the needs of prospective residents are fully assessed prior to moving in to the home. A Statement of the applicable terms and conditions for the home is made available to residents. EVIDENCE: A Statement of Purpose and Service Users Guide are in place as required by the applicable national minimum standards. Both documents were seen to require minor amendment to ensure that accurate and up to date information is available to residents. This is with regard to details of the manager and the Commission for Social Care Inspection (CSCI). The organisational ‘referrals and admissions’ procedure ensures that prospective residents needs are assessed. Assessment documentation was found to have been updated for two residents whose care files were examined. No new residents have been admitted to the service in recent years. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 9 A statement of the applicable terms and conditions for the home was seen to in place with the Service Users Guide. Copies of tenancy agreements are supplied to residents and these were seen to be kept within the examined care documentation. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 and 9. Support plans in place for residents have improved. This will serve to ensure that individual needs of residents are able to be addressed on an on-going basis. Risk assessment documentation is in place as part of the enabling process for residents to be as independent as possible. Further detail should be added to assessments to ensure that they are specific to the individual. EVIDENCE: The inspector was impressed with the improvements made to the support plans in place at the home. The documentation for two residents was seen to be up to date and subject to ongoing evaluation and review. A monitoring file is maintained at the home that enables all care staff to record daily events and progress in achieving stated goals for individual residents. Objectives in place for two residents were observed to include positive selfimage, oral hygiene, resolving conflict and timekeeping. One resident stated that they had recently attended their annual review and were satisfied with the progress made in recent months. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 11 A new risk assessment format was seen to have been completed for both residents since the last inspection took place in January 2005. These addressed potential areas of risk and specified actions required to minimise these. It is recommended that individual assessments be completed for potentially high-risk activities to ensure that sufficient detail is recorded concerning the resident and activity undertaken. For example, an assessment regarding self medication should fully stipulate the medication taken, arrangements for secure storage and all potential risks to the individual. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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, 16 and 17. Residents are supported to take part in appropriate activities and to be part of the local community. The service promotes independence and individual choice for the residents accommodated. Individual dietary needs are well catered for. EVIDENCE: Residents participate in a variety of day and work activities. One resident reported that they were currently working in a large supermarket and another was undertaking voluntary work at a day centre for older people. Two other residents reported that they regularly attended a local day centre and a drama project. An activities book maintained recorded recent trips out to a museum, cinema and shopping. This record also referred to gardening being undertaken by individual residents. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 13 Two residents reported that they attended Church on a weekly basis. One resident was seen to be awaiting transport to attend ten pin bowling and stated that they were then going to see a band later that evening. The inspector identified that residents participated in the daily life of the home. One resident reported that they were attending to their chores and was observed to be cleaning the bathrooms and hoovering on the second day of inspection. Individual menus were displayed in the kitchen for three residents. One resident reported that they cooked for themselves with support but also sometimes enjoyed the communal meals being served. All residents spoken to were very positive regarding the food provided – comments included ‘ the food is good’, ‘I like the food’ and ‘one member of staff is excellent at cooking’. The communal menu for the home included dishes such as pasta with sardines, spaghetti and meatballs and spinach pancakes. A member of staff reported that they were encouraging healthy eating at the home and a picture cookbook was seen to be used to facilitate healthy choices. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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) 19 and 20. Residents receive appropriate levels of support to ensure their physical health needs are met. Records maintained to ensure the safe administration of medication to residents require improvement. EVIDENCE: Care documentation examined for two residents showed that appropriate support was provided to ensure that individual physical health needs were met. Records evidenced that individuals are able to access GP, dental and optician services within the local community. Care staff spoken to reported that the Community Assessment and Intervention team were providing support to the home with regards to the sometimes challenging behaviour of one resident. One staff member reported this to be ‘very positive’. The specialist team for people with learning disabilities additionally provides services such as psychiatric support for residents as required. Further improvements are required to medication systems in place at the home to fully ensure the heath and welfare of residents. Medication administration Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 15 records were seen to be generally well maintained but three instances were identified where the record had not been signed by care staff. All Items of medication were observed to be kept securely at the home at the time of inspection. Two items of medication were observed to be no longer in use and these must be returned to the pharmacist for disposal. As stated previously, risk assessment documentation in place regarding selfadministration of medication by residents must be detailed and fully address all potential risks to the individual. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 An accessible complaints procedure is in place at the home. This ensures that resident’s views are listened to and acted upon. EVIDENCE: The complaints procedure in place was seen to have been produced in an accessible format utilising pictures and photographs. Available records evidenced that no complaints had been made to the home since the last inspection. The inspector identified that a review date of July 2005 had been added to the record of one complaint made in January 2005. This had been required at the previous inspection visit. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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, 28 and 30. The standard of accommodation is good providing residents with a comfortable and homely place to live. Bedrooms provide satisfactory and personalised private space for individuals. The home is kept clean and hygienic by the residents themselves with support from the staff team. EVIDENCE: All areas of the home were seen to be clean and hygienic during the inspection. One resident was observed be cleaning bathrooms and hovering on the second day of inspection – this individual reported that it was their day for ‘doing their chores’. Communal space provided for residents includes a lounge on each floor and a good sized kitchen / dining area. A small well maintained garden is provided to the rear of the property. The ground floor lounge is utilised as a sleep-in room with a sofa bed provided for staff. Two members of staff reported that the bed was uncomfortable and required replacement. It is recommended that the use of the lounge as a sleep-in facility be reviewed and consideration be given to the provision of a dedicated office / sleep-in room at the home. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 18 All five residents spoken to reported that they were satisfied with their bedroom accommodation. Two residents reported that the drawers provided for storage under their beds were no longer working properly and a requirement has been included for this equipment to be repaired / replaced. One resident reported that they were able to make use of the private telephone facility provided at the home but they were unable to make calls to certain numbers such as mobile phones. They stated that this made communication with certain contacts very difficult. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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) 33 and 35. An organisational training programme is in place that ensures that residents benefit from a competent and qualified staff team. Numbers of staff are sufficient to meet individual needs. These levels must however be kept under review as residents needs change. EVIDENCE: An organisational training programme was observed to be in place at the time of inspection. This included courses such as medication, Health and Safety, customer services and supervisory skills. Staff at the home were seen to have been booked to attend corporate induction training and a specialist course regarding autism. One member of staff reported that they were currently in the process of completing Learning Disability Award Framework (LDAF) training. The staff rotas examined evidenced that two members of staff were on duty for the majority of daytime shifts - the inspector did however note that only one member of care staff was on duty during the morning shift on the first day of inspection. Staffing levels have been highlighted in previous inspection reports due to high levels of incidents involving one resident. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 20 Staff members spoken to reported that incidents involving physical aggression had decreased at the home since the previous inspection had taken place in January 2005. The inspector was informed that there were still incidents involving verbal aggression but staff ‘cope’. The records in place confirmed the reduction in reported incidents and three residents additionally stated that there had been less incidents occurring. As stated previously, the individual resident was receiving input from the Community Assessment and Intervention Team. Staffing levels must be kept under review at all times. It is recommended that two staff be on duty during both morning and afternoon shifts at the home. This will serve to further ensure the welfare of both staff and residents at the home. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 and 42. Residents currently benefit from a well run home. The organisation must ensure that a permanent manager is appointed for the service to try to ensure long-term stability / consistency for the resident group. Systems in place to ensure the health and safety of residents were found to require further review. EVIDENCE: An acting manager has been in post at the home since January 2005. Feedback from residents and staff was positive on the day of inspection with comments including ‘she works well’, ‘she’s nice’ and ‘good with one resident in particular’. The inspector was however informed that the acting manager was leaving and the recruitment process was underway to appoint to the position permanently. The Requirement from the previous inspection for a manager to be registered for the service has been re-stated. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 22 Health and Safety records were observed to require further review to ensure that residents and staff are fully protected by the checking procedures in place. Records pertaining to Gas Safety, hot water temperatures, electrical installation testing and fire alarm drills were seen to be satisfactorily maintained. Shortfalls were observed on the day of inspection with regard to ensuring that full and accurate records are maintained for weekly fire point testing and the monthly checks of First Aid boxes. Up to date records were not in evidence with regard to annual portable electrical appliance testing or that a risk assessment was in place for Legionella. The inspector identified that a full six monthly Health and Safety premises inspection had recently been undertaken but records for the in-house monthly audit were not up to date. Rame Close G54-G04 S10219 Rame CLose V227261 140505 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 2 3 x x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x 2 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rame Close Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 x x x x 2 x G54-G04 S10219 Rame CLose V227261 140505 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. Standard YA1 Regulation 6 Requirement The Registered Persons must ensure that the Statement of Purpose and Service Users Guide are kept under review and revised as necessary. This is with particular reference to the details of the manager in post and the CSCI. The Registered Persons must ensure that medication records are maintained fully and accurately at all times. (Previous timescale of 01.04.05 not fully met). The Registered Persons must ensure that all items of medication no longer in use are disposed of promptly and appropriately. Timescale for action: 01.07.05 The Registered Persons must ensure that: The drawers provided within the bases of individual beds are in good working order. The bed provided within the staff sleep-in room is adequate and fit Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 25 Timescale for action 01.08.05 2. YA20 13 (2) 01.07.05 3. YA20 13 (2) 4. YA25 YA28 23 (2) 01.09.05 for the purpose. 5. YA37 8 (1) The Registered Persons must ensure that an application is submitted to the CSCI for registration of a manager for the home. (Previous timescale of 01.05.05 not met). The Registered Persons must ensure that a risk assessment is put in place for the home regarding Legionella. (Previous timescale of 01.04.05 not met). The Registered Persons must ensure that First Aid Boxes are checked on a monthly basis with full records kept. (Previous timescale of 01.04.05 not met). The Registered Persons must ensure that fire points are tested on a weekly basis with full records kept. The Registered Persons must ensure that portable electrical appliances are tested annually with full records maintained. 01.09.05 6. YA42 13 (4) 01.09.05 7. YA42 13 (4) 01.07.05 8. YA42 13 (4) 01.07.05 9. YA42 13 (4) 01.08.05 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 YA9 Good Practice Recommendations It is recommended that detailed individual assessments be put in place with regard to identified higher risk activities such as self administration of medication. Assessments should be detailed and fully address potential risks to the individual. It is recommended that the use of the ground floor lounge G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 26 2. YA28 Rame Close 3. 4. 5. YA28 YA33 YA42 as a sleep-in room be reviewed. It is recommended that the telephone facilities provided for residents be reviewed to ensure that they are suitable to meet individual needs. It is recommended that two staff are on duty for each daytime shift. It is recommended that monthly in-house Health and Safety audits are completed. Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG 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 Rame Close G54-G04 S10219 Rame CLose V227261 140505 Stage 4.doc Version 1.30 Page 28 - 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. 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