Inspection on 19/09/05 for Rathbone Centre, The

This inspection was carried out on 19th September 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rathbone Centre, The 08/07/09

Rathbone Centre, The 26/01/07

Rathbone Centre, The 14/02/06

Rathbone Centre, The 13/01/05

Rathbone Centre, The 29/07/04

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Edenvale

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Chatsworth Care - Dawson House

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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 19/09/05 DS0000022765.V252318.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 DS0000022765.V252318.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. DS0000022765.V252318.R01.S.doc Version 5.0 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 DS0000022765.V252318.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 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 old 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. The properties surrounding it are of similar style. The premises are unsuitable to accommodate people with restricted mobility, as there is no lift. A mature well maintained garden is located at the rear. An outreach service providing support to people in the community with learning disabilities is also managed from another office in the premises. DS0000022765.V252318.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 undertaken over three hours. Present for the inspection was the service manager, the registered manager and two support workers. Two service users were spoken to individually. All the communal areas of the premises were viewed. A service user showed the inspector around her bedroom. A number of records relating to service users and staff were viewed. What the service does well: What has improved since the last inspection? Care plans were up to date and reflect individuals’ current needs. The premises have been refurbished. All the communal areas have been redecorated with new carpet fitted to the stairs and lounge. This refurbishment has contributed to the overall ambience of the home. Staff have received further training and development enabling them to become more skilled and competent in their role. DS0000022765.V252318.R01.S.doc Version 5.0 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. DS0000022765.V252318.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 DS0000022765.V252318.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): 125 An environment is provided that is inclusive and fosters independence and selfexpression for adults with learning disabilities. EVIDENCE: The aims and objectives of the home as stated in the Statement of Purpose are to offer support to adults with learning disabilities in order that they might develop and grow as individuals and fulfil their lives as they choose. The service users’ guide includes comprehensive information on the services offered at the home. Two care files examined included personal histories, needs assessments and written care plans developed with service users agreeing how their assessed needs would be met. Records also contained progress notes indicating that care plans were followed. Staff have developed the “knack” of knowing and timing appropriate activities for service users. An example such as the progress of a service user from previous inspection was evident. A major turnabout had taken place of which he was very proud. He experienced frequent spells of non-engagement and disinterest. Recognising recent changes in the way he responded and with appropriate timing staff had encouraged and supported him to enrol and attend a college course. DS0000022765.V252318.R01.S.doc Version 5.0 Page 9 Interaction between staff and service users indicated that service users had developed good relationships with staff, also that staff understood their ways, likes and dislikes and communicated effectively with individuals. DS0000022765.V252318.R01.S.doc Version 5.0 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 the following standard(s): 679 Service users are fully consulted on and involved in developing person centred care plans. EVIDENCE: Two care plans were examined. These reflected all aspects of personal and social care needs and the support needed by both service users to help them achieve their goals. Records were maintained of the progress achieved and of the developments made. Details were recorded of the changes necessary as and when circumstances changed for both service users. The written plans contained details of needs assessments including that of risks identified such as anger management. Information was recorded on the management of challenging behaviour that included encouraging the service user to vent frustrations appropriately. Care files showed that care plans were reviewed regularly and that areas identified for development were incorporated into new care plans and agreed changes were recorded. DS0000022765.V252318.R01.S.doc Version 5.0 Page 11 Service users have developed the skills to access the community independently following training and advice on personal safety. Service users are encouraged to carry identification and details of the phone number of the home in case of emergency. A number of service users have bought mobile telephones to keep in touch with the home. Appropriate action is taken by staff that address immediate concerns, these include periods when service users fail to return to the home when expected and when communication was not received. Records that include appropriate notifications are made as appropriate. Service users are supported with making decisions and taking control over their lives that include receiving the advice and support required to take responsible risks and to learn from making poor choices. Service users receive advice and training on personal safety to avoid limiting their choice of activity. DS0000022765.V252318.R01.S.doc Version 5.0 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 the following standard(s): 12 13 16 17 Service users have opportunities for personal development with individuals participating in fulfilling activities outside as well as within the home. EVIDENCE: Service user receive support and encouragement to lead meaningful lives. Timetables/programmes of activities are tailored to individual preferences, needs and abilities. A service user spoke of the goals she had set for herself and of the ongoing support given by staff to help her achieve this. She spoke of the review completed recently with staff and how much forward she had progressed. Service users are given the opportunity to participate in and contribute to the communities that they live in. A Youth Club has been established by the organisation in the locality which a large number of service users regularly attend. The home has established links with many leisure, entertainment and recreation providers and has established special discounted rates for service users. There is a resource library at the home with up to date information on resources available for service users and staff. Opportunities are given to service users to develop more independent living skills. Many attend college and continuing programme of studies. DS0000022765.V252318.R01.S.doc Version 5.0 Page 13 Service users have developed the skills to travel independently and have freedom bus passes. One service user has regular part time employment at a restaurant. One service user sits on the learning disability Forum and speaks out on disability issues. Service users use a weekly menu planner. Using this planner they buy the necessary ingredients for the meals and receive the support from staff as necessary. One service user has difficulty with maintaining a steady body weight. Staff provide guidance on planning healthy meals. This includes portion management and avoiding snacking in between meals. Service users have individual sections in the fridge/freezer for the storage of food. The interaction between staff and service users was positive with a clear indication that individuals’ needs were understood. Several indicators were observed of how independence and choice was respected in the daily lives of service users. Service users lock their bedrooms, members of staff were observed knocking on bedroom doors. Consultation with service users took place privately. Service users have a variety of activities to choose from in the community that they attend. These are appropriate to the needs and preferences of the group. DS0000022765.V252318.R01.S.doc Version 5.0 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 the following standard(s): 18 19 Procedures are in place to ensure that the healthcare needs of service users are monitored and that any areas of concern are addressed. EVIDENCE: None of the service users require direct help with personal care. However, a number require varying degrees of prompting which support workers do discreetly. Indications of how well staff know service users were evident. For example one service user that experiences frequent periods of non engagement staff have managed to successfully motivate him to respond positively by timing this to the most appropriate time. Daily handovers at change of shift are thorough and help maintain continuity of care and support. Staff members reflect the cultural and ethnic composition of service users. An enhanced service provision for people with learning disabilities has been agreed between the local GP practice and the health trust. The majority of service users are registered with this practice. Service users are supported to maintain appointments with healthcare professionals, including tracking and reminding individuals of the importance of these. Records of regular appointments with dieticians, opticians and dentist were viewed on service user files. DS0000022765.V252318.R01.S.doc Version 5.0 Page 15 The local authority has introduced health action plans for service users. These have not been completed, as these require the input of the GP as well as service users to ensure all needs relating to health are met. Subject of a recommendation. The registered person should ensure that health action plans issued by local authority are completed for all service users. DS0000022765.V252318.R01.S.doc Version 5.0 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 the following standard(s): 22 23 Staff at the home are competent and knowledgeable on the appropriate action to take to safeguard service users from neglect or abuse. EVIDENCE: The organisation has developed a new complaints procedure. It is available in picture/sign format and understood by all service users. As well as each service user receiving this information a copy is also displayed on the notice board in the home. From talking to service users and from the feedback received it was evidenced that service users’ views are listened to carefully and considered. Discussions took place with two support workers. Evidence was provided in staff feedback that staff at the home are knowledgeable on safeguarding service users from abuse or neglect. There have been no staffing changes since the last inspection. Adult Protection procedures are included as part of the training programme for staff. DS0000022765.V252318.R01.S.doc Version 5.0 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 the following standard(s): 24 25 27 28 30 Six service users are accommodated in single occupancy rooms. The premises are old and need significant investment to maintain the standard. There is a planned maintenance programme in place. EVIDENCE: The premises, a large Edwardian house with a wealth of character, requires a substantial budget to maintain it to a reasonable standard. It is bright and homely. A large number of the bedrooms are located on the first and second floor and there is no passenger lift. The kitchen/dining area is on the second floor. There is a large well maintained secluded garden to the rear of the property. The bedrooms are not ensuite. There are sufficient numbers of bathrooms/showers conveniently located on the first and second floor (two in total). A large comfortable lounge with large sofas is provided on the first floor. The registered person has a dedicated budget for maintenance and repairs. A requirement was made at the previous inspection regarding the redecoration of the communal areas and new floor covering for the stairs and the lounge. All of the work has been undertaken except for the carpet. Confirmation was received that this had been completed before the issue of the inspection report. DS0000022765.V252318.R01.S.doc Version 5.0 Page 18 One service user showed her bedroom to the inspector. It was spacious bright and homely and met the needs of the service user comfortably. All of the home was clean and hygienic. Records are maintained in the kitchen of daily fridge and freezer temperatures. DS0000022765.V252318.R01.S.doc Version 5.0 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 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): 32 35 36 Service users benefit from a stable staff team that are competent and skilled. The organisation has made a significant investment in staff training. EVIDENCE: The organisation has a staff training and development programme. All support staff will have completed NVQ Level 2 in care by end of December 2005. Staff are motivated and interested and demonstrate an empathy to service users in their approach. The environment is relaxed and inclusive with staff demonstrating a commitment as well an enjoyment of their role. There is very little staff turnover. Two support workers spoke of how much they enjoyed their role. The organisation they said “promotes the ethos of valuing people and that includes service users and staff”. Staff also found that the emphasis placed on training made them feel well equipped for their role. There is ongoing supervision and support for staff. Records were in place of one to one supervision. At handovers it was evident that communication was clear between staff and that all areas relating to service users were included in the process. DS0000022765.V252318.R01.S.doc Version 5.0 Page 20 One of the NVQ assessors was present at the home. She reported positively on the input by students/support workers completing the NVQ programme. DS0000022765.V252318.R01.S.doc Version 5.0 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 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 42 Service users benefit from living in a home that is well run and where every individual matters. EVIDENCE: The home is run in the best interests of service users. The registered manager has completed the Registered Managers Award and registered with CSCI. The manager fosters an atmosphere of openness and respect. The opinions of service users are welcomed and affect how services are planned. A service user spoken to said he was, “kind and helpful and liked by service users”. Services are tailored to individual needs and constant efforts are made to develop and involve individuals in further developing a service that is responsive and flexible. The service manager has worked with using the Picassos System (a quality assurance system) to measure how successful the home is in meeting its aims and objectives. This has also taken into account other services used. The outcome of the review and the results of these were not available. These will DS0000022765.V252318.R01.S.doc Version 5.0 Page 22 be evaluated at the next inspection visit and are therefore the subject of a requirement. There were no hazards or risks identified while touring the premises. Records relating to the upkeep of the premises were not viewed. DS0000022765.V252318.R01.S.doc Version 5.0 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 3 3 X X 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X 4 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 3 X 3 LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 4 17 Standard No 31 32 33 34 35 36 Score X 4 X X 4 4 CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 4 X 2 X X 3 X DS0000022765.V252318.R01.S.doc Version 5.0 Page 24 No 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 YA39YA39 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. Timescale for action 30/01/06 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 YA19 Good Practice Recommendations The registered person should ensure that health action plans issued by local authority are completed for all service users. 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