Inspection on 14/02/06 for Rathbone Centre, The

This inspection was carried out on 14th February 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 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

Rathbone Centre, The 08/07/09

Rathbone Centre, The 26/01/07

Rathbone Centre, The 19/09/05

Rathbone Centre, The 13/01/05

Rathbone Centre, The 29/07/04

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 Rathbone Centre, The 8 Chatsworth Way West Norwood London SE27 9HR Lead Inspector Mary Magee Unannounced Inspection 14th February 2006 10:00 Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Rathbone Centre, The Address 8 Chatsworth Way West Norwood London SE27 9HR 0208-670-4039 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) apreston@rathbonesociety.org.uk Lambeth Elfrida Rathbone Society Shaun Mathew Jones Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th September 2005 Brief Description of the Service: Rathbone is a small registered care home owned and managed by the Lambeth Elfrida Rathbone Society, a registered charity. The property is a large detached Edwardian house with lots of character and set in a leafy area of South East London. It is conveniently situated and close to public transport and the local shopping area of West Norwood. A mature well maintained garden is located at the rear. Rathbone also operates an outreach service that provides support to people with learning disabilities in the community. This service is managed from an open plan office in the premises. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken during daytime hours. The service manager, the registered manager and two members of staff were present and contributed to the inspection process. Two service users invited the inspector to view their bedrooms. All the communal areas were viewed. Comments received from service users and members of staff are included in the report. The inspector examined a selection of records. These included staff and service users’ personnel files as well as records relating to the maintenance of the premises. What the service does well: What has improved since the last inspection? Service users continue to make good progress with some talking of achieving their goal and nearing a move to independent living accommodation. Great improvements were seen in the internal presentation of the premises. All the communal areas have been repainted in soft pastel colours. New carpets have been fitted to the lounge and the stairs. Service users were Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 6 involved in choosing the new colour scheme. A new set of comfortable sofas have also been supplied in the lounge. All support staff at the home receive an excellent training package. Every staff member has completed an NVQ Level 2 qualification and is proceeding with the next stage. Support plans are good and are kept up to date. 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. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 124 Service users are supported to have the same opportunities as people without disabilities. EVIDENCE: The home sets out aims and objectives for the centre in the Statement of purpose and the users’ guide. Evidence was presented that the Aim of the home “to support adults with learning disabilities in order that they might develop and grow as individuals and fulfil their lives as they choose” was being achieved. Service users are valued and are supported to make choices from a range of available options both in the home and in the community. service users are offered impartial advice, information and support to enable them make informed decisions about themselves and their lives. Staff individually and collectively have the skills and competencies to deliver the care necessary to meet the assessed needs of current service users. Evidence of good practice by individual staff members was observed directly. An example of this was the competent and reassuring manner in which a staff member dealt with a sensitive situation between two service users. While there have been no new admissions for some time the home is successful in supporting service users achieve their goal of moving to independent/supported living. For one lady in order to prepare and plan for the future a referral has been made to housing to support her planned discharge to supported housing. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 10 Service users are enabled to take control of their lives and receive the necessary support to make decisions. Arrangements for the delivery of care are good and ensure that service users receive the appropriate support to help achieve their goals. EVIDENCE: The needs abilities and aspirations of service users are assessed through various means. These range from care management assessments to direct observation and from communicating with individuals and getting a clear picture of what they like and need. Service users are fully involved and contribute to the care and support arrangements in place. The written plans reflect agreements between service users and the home and what support mechanisms are needed to help them achieve their aspirations and goals. Service users are encouraged and supported to take risks as part of leading an independent lifestyle. Methods used such as ongoing travel assessments to determine service users readiness and ability to travel unescorted were seen. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 10 Other methods were also seen. For some service users verifiable methods are used to establish levels of trust and confidence were present. Plans are tailored to individual needs to give service users the chance to create a lifestyle of their choice and at a pace that suits them. Two service users have had local authority reviews completed in recent months following referrals by the home. Examples were seen of the positive outcome for service users as a result of the empathy shown by staff in dealing with setbacks and varying capacities. Staff are skilled and experienced and display competencies at supporting service users with decision making. One area where the home excels is the effort made by staff in supporting service users make challenging decisions that present difficulties rather than take an easier option. Service users participate in all aspects of life at the home. They choose food that they like and are supported to shop for it. There are regular service user meetings. User consultation is ongoing at all services used by service users. Continuous feedback is actively from service users via user satisfaction questionnaires. Comments received are taken on board and used to shape services. A selection of documentation is available in formats that are understood by service users, recently a new complaints format in picture form was introduced. Discussions with service users provided evidence that information held by staff was handled appropriately and that their confidences were kept. Records of a confidential nature were found stored securely. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11 14 15 17 Service users receive the support to enable them to lead fulfilling lifestyles. They are very much part of the community using leisure and recreational facilities. EVIDENCE: Service users have numerous opportunities to maintain and develop social emotional and independent living skills. Staff at the home place a focus on valuing people. This has enabled individuals grow as individuals and develop confidence and self-esteem. The organisation has a strong presence in the local community and is recognised as a lead in promoting cultural and leisure activities for people with learning disabilities. The organisation recently organised an exhibition of artwork by people with learning disabilities in a local gallery. The exhibition contained excellent works by service users. Service users are kept informed of what recreation and leisure facilities are available in the locality. They receive support to lead a full social life as they desire. The manager demonstrated evidence of how service users are supported in relationships. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 12 In accordance with care plans and supporting choice and decision making the involvement of friends and families is guided by what service users want. Policies for the home respects the rights of service users to invite people to the home to visit. Support and advice is given to support those in relationships even though on occasions these relationships present challenges to the service. Full consideration on all occasions is given to any risk presented to service users staff. Service users prepare meals with the support from staff. They choose food that they like and that is healthy. For service users that have some weight issues guidance and support is given on low fat/low calorie food. Direct observation was made of how this succeeds. A service user was busy writing a shopping list for food. She later went to the supermarket with a member of staff to get her shopping. On return that she labelled the food she had purchased and placed it in drawer allocated in the fridge and freezer. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 20 Service users receive a good quality of physical and mental health care. Their health care conditions and monitored. Areas of concern are identified and receive prompt attention. EVIDENCE: At the previous inspection it was found that service users received the support in a way they preferred. The home has procedures in place to successfully address the assessed healthcare needs of service users. Their physical and emotional health of individuals is monitored closely and recorded. If there are any issues of concern or potential complications highlighted prompt action is taken and appropriate referrals made to healthcare professionals. Staff are successful at encouraging and supporting service users manage their healthcare. Some service users require support with attending appointments and receive the support of staff. An enhanced service provision for people with learning disabilities has been agreed between the local GP practice and the health trust. Staff at the home are currently working closely with this GP surgery to complete health action plans introduced by the local authority. Records were Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 14 present of appointments with dentists, doctors and hospital consultants, as well as with occupational therapists. One service user self medicates. Procedures including risk management strategies are in place to manage this effectively. The procedures for the administration of medication were viewed. Daily recording sheets demonstrate that medication is administered and that records are completed accurately. Medicine received at the home is checked and signed for to confirm accuracy. Unwanted medication is retuned to the pharmacy and records are maintained to acknowledge this. One area of practice that has slipped is the practice of regularly auditing the medication held at the home. The registered person should ensure that regular audits are completed for medication held at the home. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 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 Service users are valued as people and have their views listened to carefully. Any issue raised is responded to. Service users find that nothing is trivialised. EVIDENCE: This home listens to the views of service users. Observations made were of a relaxed environment and that service users interacted appropriately with members of staff. Various requests by service users were responded to. Where a service user had difficulty with another user and felt bullied a support worker dealt the issue sensitively that resolved the situation. The office has an open door policy with service users feeling at ease entering to talk to support staff. User group meetings are held twice a year. This involves consultation with those using the services of the organisation and also service users from the home. Service users are involved on a regular basis in the reviewing process for policies and procedures for the home. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 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 25 28 30 The home has a planned maintenance programme that ensures the maintenance and refurbishment is kept up to date. Six service users are accommodated in single occupancy rooms, with some rooms having less floor space available due to the layout. EVIDENCE: The premises has a wealth of character but requires continuous financial investment to keep them to acceptable standards. It is bright and appealing following complete refurbishment internally to the communal areas. New carpets have been fitted to the stairs and in the lounge. Service users were involved in selecting the new colour scheme, the new furniture and carpets. Communal areas offer service users comfort and space to entertain guests and relax away from their bedrooms. The lounge on the first floor is particularly attractive with clever uses of coordinating furnishing chosen by service users. Service users were looking forward to placing pictures on the walls. Some pictures painted by service users are due to be displayed throughout the home. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 17 The majority of bedrooms are spacious and easily accommodate service users belongings. Of the two bedrooms visited one was under the space requirements. Although the room has floor space below minimum standards the service user was happy with the bedroom and living at the home. The service manager spoke of plans for the future that might be considered. These are to include consideration to be given to converting some loft space into a bedroom or moving to a another premises with lower maintenance costs. The home is clean and homely. Service users feel able to relax in their environment. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 Service users benefit from the presence of an effective staff team that have the right qualities and attributes. Support staff are skilled and experienced and show a real commitment to their role. EVIDENCE: Members of staff are clear about their roles and responsibilities. Observations were made of how well they demonstrated these skills and experiences. Members of staff sat patiently with a service user when they returned from shopping. He took time to explain at a level that was understood by the service users on how to store and label the shopping. The home has made significant investment in the staff team. All support workers have completed NVQ programmes in Level 2 and plan to start the next NVQ programme. There is a learning and development programme to address the training needs for the staff team. There are few changes to staffing team. The majority have worked there for more than two years. Recruitment files viewed were viewed for staff. Good practice in recruitment was seen, references and records of face to face selection interviews were present. Enhanced disclosures completed by the CRB were stored separately from staff files. These had been sought for all staff employed. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 19 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): Service users benefit from living in a home that is well run. The rights and best interests of service users are promoted and safeguarded by the homes policies and procedures. The health and safety of staff and service users are promoted but more attention is required in maintaining these safe working practices in a consistent manner. EVIDENCE: At the previous inspection it was found that the management of the home was effective and that the home was run in the best interests of service users. The management approach fosters an atmosphere of openness and respect. The opinions of service users are welcomed and affect how services are planned. Regular service user meetings are held. The views of service users are listened to and influence planning for the home. Consultations take place with service users twice a year to review home and organisational policies and procedures. Record keeping is good with staff keeping information regularly updated. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 20 Service users benefits from living in a home where the service is run in their best interests and where those using the service are the key players. A service user spoken to has found that the home has helped her develop as an individual. The quality assurance system is still in the development stage. It involves the input of service users and trustees of the organisation Numerous methods are used to measure the effectiveness of the service. The Picasso system currently is used to develop the quality assurance system for the organisation. More time is needed to expand this and in order to complete the project for the services delivered by the Elfrida Rathbone Society. The requirement made at the last inspection regarding the quality assurance system is restated. A selection of records were viewed relating to the upkeep and maintenance of essential equipment and the premises. Current electrical and gas certificates were present. Records were seen of regular fire drills and testing of fire alarm equipment. A member of staff is allocated the responsibilities of ensuring that essential fire prevention work is undertaken. However for a short period in the previous autumn this essential work had lapsed and essential testing of equipment was not done as frequently as recommended by LFEPA. This is the subject of a requirement. A visit was made by the fire prevention officer. Recommendations made regarding these and the servicing of emergency lighting have been responded to satisfactorily. On touring the premises it was observed that the premises were well maintained. Staff present showed a commitment to maintaining a safe environment and spoke of the importance of vigilance in the workplace. However to ensure that safe working practices are maintained it is recommended that regular health and safety audits are conducted of the premises and that any identified risks are identified and responded to swiftly. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 21 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 4 3 x 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 x ENVIRONMENT Standard No Score 24 3 25 3 26 x 27 x 28 3 29 x 30 3 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 x 3 LIFESTYLES Standard No Score 11 4 12 x 13 x 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 3 x x 3 3 x x 2 x Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 22 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 YA39 Regulation 24 (2) Requirement The registered person must ensure that a system is established for reviewing at appropriate intervals the quality of care provided at the home. A copy of a report on this review to be made available to the inspector. Not achieved within the original timescale of 31/01/06. The registered person must ensure that adequate precautions are taken against the risk of fire, including the (a) reviewing fire precautions and testing fire equipment at regular suitable intervals. (b) the maintenance of emergency lighting. (c) ensuring by regular fire drills and practices that staff and service users are aware of procedures to be followed in the case of fire. Timescale for action 30/04/06 2 YA42 23(4) 30/04/06 Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 23 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 3 3 Refer to Standard YA19 YA20 YA25 YA42 Good Practice Recommendations The registered person should ensure that health action plans issued by local authority are completed for all service users. The registered person should ensure that regular audits are completed for medication held at the home. The registered person should consider how the home will address the shortfalls in bedroom not meeting minimum space requirements. The registered person should ensure the health and safety arrangements are in place for the promotion of safe working practices, regular health and safety audits should be completed for the premises. Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 Rathbone Centre, The DS0000022765.V280830.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!