Inspection on 22/05/07 for Raola House

This inspection was carried out on 22nd May 2007.

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

Raola House 15/05/06

Raola House 14/02/06

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 Raola House 205 Woodcote Road Wallington Surrey SM6 0QQ Lead Inspector Mohammad Peerbux Key Unannounced Inspection 22nd May 2007 9:45am Raola House DS0000065735.V341364.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 Raola House DS0000065735.V341364.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. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Raola House Address 205 Woodcote Road Wallington Surrey SM6 0QQ 020 8835 2258 020 8669 3533 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) Tordarrach Mrs Ayodele Obaro Care Home 6 Category(ies) of Learning disability (6), Sensory impairment (6) registration, with number of places Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th May 2006 Brief Description of the Service: Raola House is registered with the Commission for Social Care Inspection (CSCI) to provide residential care for up to six adults with learning disabilities and or sensory impairment. The property is situated on a busy residential road close to the centre of Wallington and is well placed for local shops and public transport links. There is ample space in the front garden for parking and the back garden, which has a patio area and large lawn, is extremely well maintained. The philosophy of care and principle objectives of Raola House are based upon the development of community-based initiatives, recognising that people with learning disabilities have the right to a normal pattern of life. The range of weekly fees is between £1000 and £1200 and the registered provider provided this information on the day of the inspection. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2007/2008. In writing the report consideration has also been given to information received throughout the year such as comments from people who use the service, reports of incidents and complaints. This was the home’s first inspection for the year 2007/08. It took place over six hours. Some times were spent looking at the policies and procedures, talking to staff and registered manager. Some of the service users were spoken to however due to their cognitive ability it was difficult to seek their views. A tour of the building was also carried out. They are all thanked for their time and all of those who provided feedback for their support in the inspection process. There has been concern raised as far as Adult Safeguarding is concerned and the Local Authority is carrying out an investigation presently. What the service does well: What has improved since the last inspection? Legionella testing has been carried out in line with a requirement made at the last inspection. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Raola House DS0000065735.V341364.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 Raola House DS0000065735.V341364.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 and 2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who may use the service and their representatives have the information needed to choose a home, which will meet their needs. EVIDENCE: The home has developed a Statement of Purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides basic information about the service and the specialist care the home offers. The guide is made available to individuals in a standard format. However both documents must be reviewed to include all details as per regulation 4 and 5 respectively. The home consults the assessment information to see if they can meet the prospective individual’s needs before they make the decision to accept the application for admission and offer a placement. Evidence suggests that prospective people who use services have a needs assessment carried out before they are admitted to the home. The home has also received copies of Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 9 the summary, and care plans, from those assessments carried out through care management arrangements for most of the residents. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally residents’ care plans include detailed information about their needs and personal goals. This helps staff to know the residents’ needs and how to meet them. EVIDENCE: The care plans are person centred and are drawn up with the involvement of the resident together with their family, friends and/or advocate as appropriate, and relevant agencies. The plans are written in plain language and are easy to understand. However it was noted that not all identified needs of the residents are included in their care plans and this might affect their lifestyle and quality of life. The home must ensure that care plans cover all aspects of personal and social support and healthcare needs of the residents. The plan must also Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 11 establishes individualised procedures for residents who are likely to be aggressive and cause harm or self-harm, focusing on positive behaviour, ability and willingness. There is a key worker system that allows staff to work on a one to one basis and contribute to the care plan for the individual. Care plans are reviewed and updated as required. The manager stated that staff provide residents with the information, assistance and communication support they need to make decisions about their own lives. Each care plan includes a risk assessment, which is reviewed regularly. Management of risk is positive addressing safety issues whilst aiming for better quality of life. Where limitations are in place, the decisions have been made with the person where possible and are recorded. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to explore opportunities to enhance their quality of life as well as maintain and participate with friends and the local community, with the aim of maximum integration. EVIDENCE: People using the service are given the opportunity to take part in a variety of activities both within the home and in the community. The registered manager stated that where possible staff gather information on community based events and try to make individual arrangements for people to attend. There have been concerns raised to the Commission that the residents are having limited activities. This was discussed in depth with the registered provider and it was agreed that the recording of activities could be further improved; as it Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 13 was difficult at times to identify what activities the residents have been involved in. The registered manager also stated that some residents are involved in household chores. Service users are able to access a wide range of community activities. None of the service users are registered to vote due to their level of learning disability. People who use the service are actively encouraged to maintain links with their families and friends. The registered manager stated that the home has an ‘open’ visitor’s policy and simply recommends that visitors telephone to say they are coming to ensure there loved ones will be available. Residents, who were at home at the time of this inspection, appeared to enjoy some level of independence. Routines can be flexible and are well observed to take into account all the residents’ individual needs. Some of the residents were spoken to however due to their cognitive ability it was difficult to seek their views regarding the care and support they receive. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 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. 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. Overall the arrangement for health care needs of the residents is good and they receive personal support in the way they prefer. EVIDENCE: The delivery of personal care is individual, flexible and person centred. Staff respect the privacy and dignity of the residents and are sensitive to their changing needs. Where needed, guidance and support regarding personal hygiene (e.g. to wash, shave) is provided. Times for getting up/going to bed, baths, meals and other activities are flexible. People who use services have access to health care services both within the home and in the local community. Generally health needs are monitored and appropriate action and intervention taken. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 15 The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Regular management checks are recorded to monitor compliance. The allergies of the residents are recorded in their care plans. However it is recommended this information be also recorded on their medication administration records. An assessment has been carried out to ensure each member of staff is competent to handle, record and administer medication properly. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Complaints are generally managed well, which should ensure that residents’ and relatives’ concerns are listened to. However there is a lack of understanding of safeguarding procedures and how they work. EVIDENCE: The home has a complaints procedure that is clearly written and easy to understand. The procedure is also available in symbol format. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the home always responds within the agreed timescale. Policies and procedures for safeguarding people who use the service are in place however there is a lack of staff understanding of safeguarding procedures and how they work. Links within external agencies are weak and there is little evidence of the home being open or proactive when dealing with them. There has been an incident recently where a resident was inappropriately restraint and this was not reported to the Local Authority. Staff working at the home have a limited understanding on issues around restraint. Presently there is an investigation being carried out regarding the incident. The home must ensure that physical and verbal aggression by a resident is understood and dealt with appropriately, and physical intervention is used only Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 17 as a last resort by trained staff in accordance with Department of Health guidance. Training of staff in the area of protection must be arranged by the Home. Other training around dealing with physical and verbal aggression must also be made available to all staff as needed. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally hygienic and clean, homely and comfortable; this environment therefore facilitates the residents’ health and emotional wellbeing. EVIDENCE: The home is suitable for its stated purpose. It is accessible, meet residents’ individual and collective needs in a comfortable and homely way. Residents’ bedrooms are personalised to reflect their individual needs, and personalities. Overall the home was decorated to a good standard throughout and appeared to be very comfortable, bright and warm. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 19 The home is kept very clean and hygienic and free from offensive odours throughout. Systems are in place to control infection in accordance with relevant legislation and published professional guidance. However there was chemical left unlocked in the toilet downstairs (see standard 42). Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 20 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 adequate This judgement has been made using available evidence including a visit to this service. One concern was identified in regard to recruitment checks not being completed satisfactorily, which impinge on the safety and protection of residents being ensured. EVIDENCE: The registered manager informed that 10 staff are employed at the home. Six staff have NVQ level 2 in care and two staff are undertaking the course at present. The home has a staff team with sufficient numbers to support residents’ assessed needs. There has been concern that staff are working 24 hours shift. The staff rota was checked and it indicated regular shift patterns. However it was noted that one staff member who is a student was working over 20 hours during a week. The registered provider must ensure that staff who are students are working no more than 20 hours a week during term time. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 21 As part of the inspection process staff records were sampled for references, criminal record checks, application forms and copies of identification. It was noted that out of eight staff files, five had only one reference. Some of the same personnel files were checked at the last key inspection and they did contained two references. The registered provider stated that she is in the process of reorganising all the staff personnel files and was unable to comment on the missing references. The registered provider must ensure that staff files contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001. The home recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. The registered manager is aware that there are some gaps in the training programme. The home must ensure that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. There is inconsistent or inadequate supervision of staff with infrequent individual sessions. The registered manager is required to ensure that care staff receive at least six supervisions a year covering good care practices and career development. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 22 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): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally managed well however the health, safety and welfare of service users and staff are not being promoted/protected and this potentially places them at risk. EVIDENCE: Since the last inspection, the deputy manager has been dismissed and the home has recruited a new deputy manager. The registered manager is presently in day-to-day control of the home. The home does what it has to do to satisfy the regulator, and has the right policies and procedures in place Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 23 although there is evidence that practice is not always consistent or well applied. The home has an effective quality assurance and quality monitoring systems, based on seeking the views of service users, to measure success in achieving the aims, objectives and statement of purpose of the home. A tour of the premises was also carried out and it was noted that the hot water temperature in the shower room upstairs was above the recommended level of 43 degrees centigrade. The registered provider must ensure that the hot water in the shower room is within the recommended level. It was also noted that there was cleaning material left in the ground floor toilet. All cleaning materials and chemicals are kept locked in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1999. Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 24 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 2 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 1 X Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 4 and 5 Requirement The Statement of Purpose and Service User Guide must to include all details as per regulation 4 and 5 respectively to ensure that prospective people and their representatives have the information to choose a home that will meet their needs and preferences. Residents’ care plans must cover all aspects of personal and social support and healthcare needs of the residents. This will help in meeting their current and changing needs, aspirations and achieve goals. Training of staff in the area of protection of residents must be arranged by the Home. Timescale for action 22/08/07 2. YA6 15(1) 22/05/07 3. YA23 13(6) 22/06/07 4. YA23 13(6) 22/06/07 Training around dealing with physical and verbal aggression of residents must also be made available to all staff as needed. Staff who are students must not worked more than 20 hours a week during term time. 22/05/07 5. YA33 19 Raola House DS0000065735.V341364.R01.S.doc Version 5.2 Page 26 6. YA34 19 Staff personnel files must contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001 for the protection of residents. The home must ensure that all staff receive relevant training that is focussed on delivering improved outcomes for people using the service. Care staff must receive at least six supervisions a year covering good care practices and career development. 22/05/07 7. YA35 18(1) 22/08/07 8. YA36 18(2) 22/05/07 9. YA42 13(4) The hot water in the shower 22/06/07 room upstairs must be within the recommended level of 43 degrees centigrade to prevent staff and residents from scalding. All cleaning materials and chemicals must be kept locked in accordance to Control of Substances Hazardous to Health Regulations (COSHH) 1999. 22/05/07 10. YA42 13(4) 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. 2. Refer to Standard YA20 YA12 Good Practice Recommendations It is recommended that the allergies of the residents are recorded on their medication administration records. It is recommended that residents’ activities are recorded in more details. 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