Inspection on 28/11/05 for Rame Close

This inspection was carried out on 28th November 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 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 11/10/06

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 28th November 2005 01:00 Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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.V269427.R01.S.doc Version 5.0 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.V269427.R01.S.doc Version 5.0 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 Ms Rose Dundas Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th June 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.V269427.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by a regulation inspector on the 28 November 2005. The inspection took place over four hours. The inspector spoke with six residents, the manager and three members of staff. A number of records were examined, as well as a tour of the communal areas of the home. What the service does well: What has improved since the last inspection? What they could do better: There are real opportunities for a number of residents to develop their skills and to become more independent. The new manager in post spoke about helping residents to do this and to support individuals to look at options for moving on from the home. Two Requirements have been made. The new manager must make application for registration with the CSCI and a risk assessment of the home for Legionella must be completed. Please contact the provider for advice of actions taken in response to this Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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.V269427.R01.S.doc Version 5.0 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. Good information is available to prospective residents about the home. EVIDENCE: The Statement of Purpose and Residents (Service Users) Guide for the home has been reviewed since the last inspection took place in June 2005. Both documents now give good information to both existing and prospective residents about the home. A new manager started work at the service in September 2005. The above documentation should be updated to reflect this change once he has been registered with the CSCI. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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, 7 and 9. Further improvements have been made to residents support (care) plans to make sure they are up to date and reflect individual strengths and needs. Staff carry out individual risk assessments to promote the safety and independence of residents, however the system used to do this could be further improved. EVIDENCE: The manager has further improved the system used for support planning at the home. The support plan for one resident was looked at during this inspection. This document was well organised and clearly showed a ‘live’ process of support planning for the individual resident. Plans for areas such as financial management gave short and long term goals with a review date stated. Support plans for two residents are discussed at each monthly staff meeting. This action makes sure that all staff are fully aware of the support required by each resident to successfully meet their needs and goals. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 10 A review meeting was being held for one resident at the time of this inspection. General assessments are drawn up to look at the different areas of risk for residents. It is recommended that individual assessments be completed for the higher risk activities to ensure that sufficient detail is recorded concerning the resident and activity undertaken. The manager reported that this was already being looked at as part of the continuing improvements being made. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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): 11, 14 and 15. Residents are supported to take part in activities and to be part of the local community as required. Residents receive appropriate support to maintain contact with their family and friends. EVIDENCE: The new manager spoke of plans to help individual residents gain further independence and to perhaps move on from the home in the future. This is already reflected in the developments being made around support planning at the home. The minutes of the monthly residents meetings showed that residents were fully involved in the planning of activities. A meal out had been arranged for the following day and two Christmas trips organised to have a meal and to go to the theatre. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 12 A new television has been bought for the main lounge and residents now have access to digital television through a set top box. One resident said that the new manager was “getting things sorted”. Residents continue to participate in a variety of day and work activities. One resident reported that they were still working in a supermarket and another resident said that they attended a local day centre. Two residents said that they had regular contact with their family. Arrangements were being made for staff to take one resident to see a family member at the time of inspection. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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): 19 and 20. The health needs of residents are satisfactorily met. Good medication systems are in place for the protection of clients. EVIDENCE: Residents are offered regular health care checks. The support plans examined documented where visits had been made to GPs, dentists and opticians. One resident spoke about being on the waiting list to see someone from the local specialist community team. Another resident was seeing a dietician on the day of inspection. Three members of staff stated that the behaviour of one resident was being better managed and this was no longer having such an impact on the other residents and staff. Individuals spoken to confirmed this with one resident reporting that things had now “calmed down”. All items of medication are securely stored and an organisational procedure for medication is available for reference by staff. Medicines training was provided for staff in June 2005. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 14 The manager has introduced an improved system of checks for residents who are self-medicating. It is recommended that risk assessments for the selfadministration of medication by residents be more detailed and look at all potential risks to the individual. Medication administration records were generally well maintained. This is an improvement in record keeping since the June 2005 inspection visit. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 15 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 and 23. An appropriate complaints procedure is in place at the home. Satisfactory procedures are additionally in place for the protection of vulnerable adults. EVIDENCE: An organisational complaints procedure is in place that has been produced using pictures and photographs. No complaints have been received by the home or by the CSCI since the previous inspection in June 2005. The home works to safeguard residents from abuse by ensuring all staff have training on the Protection of Vulnerable Adults (POVA) as part of their induction. Further courses are made available to staff to develop and update their awareness. Clear procedures are available to make sure that staff have an understanding of their role and responsibility in reporting any concerns to the appropriate persons. An adequate system is in place which safeguard residents’ money. Copies of receipts are kept and individual residents money is checked and signed as correct at the daily handover meeting. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The standard of accommodation is good providing residents with a comfortable and homely place to live. The home is kept clean and hygienic. EVIDENCE: The communal areas of the home are homely and comfortable. The new manager in post reported that new flooring had been ordered for the hallways, kitchen and communal lounge. Residents had been fully involved in choosing colours and types of floor for these areas. Staff members spoke of future plans to adapt the office to also include a sleepin area. This was recommended at the June 2005 inspection and will stop staff having to sleep on a sofa bed in the ground floor communal lounge as they do currently. One resident said that the fire door at the bottom of the stairs was “a pain” as it prevented easy access. The manager reported that he was going to support the resident in raising this with the Fire Officer. All areas of the home seen on this visit were clean and tidy. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 17 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): 33, 34 and 35. An effective staff team meets the individual needs of residents. Good opportunities are provided for staff to take part in training. The recruitment records for staff require review. EVIDENCE: The staff rotas examined evidenced that two members of staff were on duty for the majority of daytime shifts. Staff and residents spoken to reported that these levels were satisfactory. The manager reported that he was reviewing the staffing rotas to make sure that staff are available at times when residents require their support. A well organised training file is kept at the home. Courses attended by staff have included medicines, an introduction to autism, infection control and challenging behaviour. The manager reported that he was reviewing the staff records at the time of this inspection. It is recommended that a summary of the required information for each member of staff be kept at the home. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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, 39 and 42. Residents benefit from a well run home. The manager must apply for registration with the CSCI. Staff carry out regular checks to ensure the heath and safety of residents. EVIDENCE: The manager has been in post since September 2005 and previously worked as a deputy at another home run by the organisation. Feedback from clients and staff was very positive regarding the manager. One individual said “I like him a lot” and another person said that it was “good” having a permanent manager in post. The manager reported that he is starting to study for the NVQ Level Four managers award. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 19 Monthly residents meetings are held at the home and any issues from these are discussed at the staff meeting. The project plan for 2005 includes targets such as increasing the involvement of residents and making more use of activities budgets. An organisational quality assurance system is in place. As stated within the previous inspection report, it is recommended that the views of the residents, their representatives and other stakeholders be formally obtained as part of this process. Records of regular checks for fire safety, First Aid boxes and hot water temperatures are kept satisfactorily. Residents are encouraged to take responsibility for doing these with support from the staff team. Records to confirm that a Legionella risk assessment has been carried out were not available to the inspector. The manager stated that he planned to address this in the short-term. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rame Close Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 2 X X 3 X DS0000010219.V269427.R01.S.doc Version 5.0 Page 21 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 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 01.09.05 not met). The Registered Persons must ensure that a risk assessment is put in place for the home regarding Legionella. (Previous timescale of 01.09.05 not met). Timescale for action 01/02/06 2 YA42 13 (4) 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA9 Good Practice Recommendations It is recommended that individual assessments be put in place with regard to identified higher risk activities such as the self administration of medication. Rame Close DS0000010219.V269427.R01.S.doc Version 5.0 Page 22 2 3 4 5 YA24 YA24 YA34 YA39 Assessments should be detailed and fully address potential risks to the individual. It is recommended that plans to provide a sleep-in area within the current office be actioned as soon as possible. The need for a fire door at the bottom of the stairs should be raised with the Fire Officer for the home. It is recommended that a summary of required recruitment information for individual staff members be kept at the home. Further consideration should be given to ensuring that the quality assurance system makes formal provision for consultation with residents, their representatives and other stakeholders in the service. 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