Inspection on 26/01/07 for Rathbone Centre, The

This inspection was carried out on 26th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Rathbone Centre, The 08/07/09

Rathbone Centre, The 14/02/06

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 26th January 2007 10:00 Rathbone Centre, The DS0000022765.V317853.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 Rathbone Centre, The DS0000022765.V317853.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. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rathbone Centre, The Address 8 Chatsworth Way West Norwood London SE27 9HR 0208-670-4039 0208 655 9568 a.preston@rathbonesociety.org.uk 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) 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.V317853.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Rathbone is a care home registered to provide care and support for six young adults with learning disabilities. It is owned and managed by the Lambeth Elfrida Rathbone Society, a registered charity. The home is accommodated in 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. Parking is restrictive in the immediate vicinity. 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. Charges for services are £ 852.29 per week. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over a whole day. Both the service director and the registered manager were present during the inspection. Four service users were present and spoke with the inspector. Two of them were interviewed privately and were happy to tell of their experiences. Three senior practitioners that have involvement with the service were spoken to. Their views are incorporated into the report. Two relatives also gave their views on how the service is performing. The inspector examined a selection of personnel records. These included those relating staff and service users’ personnel files as well as pre inspection questionnaires with records relating to the maintenance of the premises. Individual personnel records relating to how two service users were assessed and are supported from the time of admission were examined. What the service does well: The service is well managed and staffed by a skilled staff team. A person centre approach is in place with service users given the opportunity to develop their own person centred plan at the pace that suits each individual. “This is an excellent service in terms of the quality and support provided to service users. Individuals lead the lives they choose,” was the comment received from a senior practitioner. The service demonstrates that it enables adults with learning disabilities to develop and grow as individuals and to lead the lifestyle as they choose. Major obstacles are overcome by providing service users with good information and advice so that they are well informed. As a result of the effective management and supervision in place support staff are enabled to support service users make challenging decisions that help them develop their potential. The service is particularly good at considering service users’ choices and balancing these appropriately with the assessed risks that would otherwise restrict service users. The service networks well with other useful links in the community resulting in service users availing of a wide range of services ranging from education to leisure activities. The service director is constantly striving to seek more opportunity in the community for service users to have access to and develop new interests. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Rathbone Centre, The DS0000022765.V317853.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 Rathbone Centre, The DS0000022765.V317853.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): 1234 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is very competent at meeting the needs of individuals with learning disabilities and offers them the same opportunities as those without disability. Prospective service users have the opportunity to test drive the home before they make the decision to move there permanently. EVIDENCE: Information is supplied to current and prospective service users in the form of a service user’s guide. This has been simplified by the use of pictures in order that it is accessible to service users. The home has recently reviewed the Statement of purpose and the service users’ guide. The aims and objectives for the centre are set out in the Statement of Purpose, “ the aim is 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. Evidence was found that the home achieves these aims. Four service users spoke to the inspector. The feedback received was that service users feel valued as individuals and that support received enables them to make informed decisions and avail of choices from a range of available option. Service users are placed at the heart of the service and participate fully in the running of the home. The ethos of valuing people and giving service users the same opportunity as any other members of the community is an objective that the home successfully achieves. Service users have a strong presence in the Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 9 community and are enabled to access the facilities. Systems are in place that includes person centre approaches plus the support of a very good team of dedicated and skilled staff. This gives service users the opportunity to learn develop and deal positively with issues that may otherwise hinder their progress. “Since I came her I have become more self sufficient,” was a comment received from a service user as she prepared an evening meal. Service users are assessed before they are offered a place at the home. The home demonstrates a sensitivity in responding to a service user should their needs change and it is found that the home is no longer a suitable placement. An example was seen in the last two months. A service user of many years experienced more extremes of challenging behaviour and was no longer in the appropriate setting. Referrals were made to professionals from the mental health and learning disability team. Until a suitable placement was found the home successfully managed the service as the challenging condition intensified, (over three weeks). To manage the risks safely management and staff undertook additional duties both during the day and at nighttimes to promote and safeguard the health and welfare of the individual and the remaining service users and staff at the home. One care manager spoke of the exceptional manner in which that staff had responded to this difficult situation, he said that it was good indication of how much service users are valued. The inspector met with a service user that had moved to the home for a trial period two days earlier. Support staff ensured that he felt included. A male support worker supported him to the local recreation centre to observe a swimming session. Although care plans were in the development stage written needs assessments completed by care management had been supplied to the home. The service user had lived with family prior to moving to the home. His previous outreach support worker involved in supporting him in the family home was involved in supporting his transfer to the home. This was planned to make the transition as smooth as possible. The support worker had also supplied additional and useful information to staff so that this could be combined with the needs analysis and help develop a person centred plan with the service user. The plan was for a trail period to last over three weeks. All the indications were that the trial period was successful, the service user had made the decision that he liked the home and wanted to live there permanently. The inspector observed that the home communicates with family relatives. The manager was observed to speak to the family by telephone to keep them informed of progress and of his decision. Rathbone Centre, The DS0000022765.V317853.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): 679 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users find that the home makes good provision to meet their assessed needs. The home provides support, advice and guidance so that service users make informed decisions on how they lead their lives. EVIDENCE: The inspector looked at the care arrangements for two service users. One service user had come two days earlier for a trial period. The care plan was still in the development stages. Following admission care plans are developed with service users. The needs, abilities and aspirations of the service user are collated and assessed by various means. These range from care management assessment information to direct observations made as well learning from a personal perspective what the individual likes and needs. The evidence available from viewing the current arrangement was that this is completed at a pace that suits the individual. It was clear from talking with support staff that they had read the information supplied in the needs assessments and the personal history for the newly admitted service user. They were sensitive to his needs and explained to the inspector his preference for a quiet environment. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 11 The care and support arrangements for another service user were examined. Observations were made of written care plans agreed with the service user. From the records seen it demonstrated that the service user was fully involved in agreeing this plan and that it had been tailored and adapted to her changing needs over a period of time. Details are available to service users about independent advocacy services, these are included in the service user’s guide and on the notice board. Two service users attend a self-help group/advocacy for people with learning disabilities and avail of regular get togethers with other young adults in the community. Service users receive advice and guidance on managing risks. They are encouraged and supported to take risks as part of leading an independent lifestyle. This is agreed and written in care plans. The outcome for service users is that more independence and an awareness of the obstacles encountered in the community are experienced. For travelling safely the use of mobile phones for service users is encouraged so that they can keep in touch with the home. A service user spoke to the inspector about her aspirations and objectives and her ongoing ambition of becoming more independent. These corresponded with those written in the plans. The care plans had been reviewed recently and showed the new objectives to be achieved. The names of those involved in helping the service user achieve the goals were also included in the care plan. For example, a weight reducing club. The service user is pleased with the level of independence she has established since moving to the home. She spoke of a previous placement and found that the support provided there to be over cautious and hindered her independence. One of the strengths of this service is the effort made by staff in supporting service users make decisions that may often present more difficulties. Service users receive support and encouragement that help build confidence and self esteem and enable them to overcome many obstacles that they encounter. The inspector observed the interaction between service users and staff as individuals returned from the day’s activities. A service user was unhappy about differences she had experienced earlier with another student at the college she attends. A support worker was on hand and guided her on the best course of action to resolve the issues so that she pursued the interest that she enjoys. The inspector observed another service user that continues to make steady progress as a result of the support she receives to help her achieve her objectives. For example, a support worker was available in the kitchen to offer guidance and support the service user as she prepared her weight reducing Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 12 supper. She explained how much she looks forward to the day when she will have her own flat. 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 on going, as service users feel able to express their views openly and without any fear of recrimination. Continuous feedback is actively sought from service users via user satisfaction questionnaires. The service manager spoke of the plans to review the policies and procedures for the home in 2007. Service users have been consulted and will be involved in the reviewing of all policies and procedures. Service users are involved in the recruitment of support staff. One of the strengths of this service is the consideration given to supporting service users develop their potential while managing the risk appropriately. Examples were seen of a service user receiving the necessary information and advice to make a decision about her life and then developing more confidence in accessing the community. Initially vulnerability and safety were highlighted as areas of particular concern. The risk assessment showed that following a period of escort support the service user progressed to the stage of travelling independently in the community. Staff at the home are good at recognising and responding well to changes in service users’ conditions. A service user recently had developed greater needs than could be met at the home. Appropriate referrals were made to care management. To manage the situation management home put into place procedures to temporarily minimise or reduce the risks to service users and staff until a new placement was found. This entailed greater staff coverage and overnight management. The inspector received positive comments from a social worker on the exceptional work done by staff during this crisis. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 13 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): 11 12 13 14 15 16 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users find that choice of opportunity is promoted in the home, also by linking with other services and resources available in the community. Service users have responsibilities for routines such as cooking and household chores and part time employment, these help to inspire independence. EVIDENCE: The home promotes equality and fairness, admissions and referrals are monitored to ensure that equality of opportunity is given to all individuals in the community. The composition of service users reflects this. From discussions with four service users it was evident that from the time of admission service users feel comfortable with how satisfactory they find the person centred support adopted. Service users find that the environment gives service users opportunities to grow and develop as individuals and achieve goals and aspirations. Service users live ordinary and meaningful lives at a Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 14 pace they are comfortable with. The majority of service users have full programmes of activities throughout the week. These range from doing household chores to part time employment. One service user was attending to her laundry. She told the inspector that she had done some part time work earlier in the day. All these responsibilities she found had contributed to her progress, she is due to move to independent living when suitable accommodation becomes available. Another service user was pleased to tell the inspector how much progress she has achieved, she invited the inspector to view her bedroom. She takes great care of her bedroom and likes to have it looking comfortable and clean always. 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 has become involved with art galleries. Service users have discovered to appreciate art and feel proud of newly discovered talent. A recent exhibition took place displaying the artwork provided by a number of service users. A booklet has also been produced to include these pictures. Service users are informed of recreation and leisure facilities available in the locality and enjoy participation in these activities. Consistent support is available to enable them lead as a full social life as they desire. A service user displayed numerous trophies that she had won in competitive sports. A number of service users attend college, two of them showed the inspector certificates of recent achievements in IT. According to written care plans and to support choice and decision making the involvement of friends and families is guided by what service users want. A relative of one service user met the inspector. His rapport with staff was excellent as he collected his sister to take her out for the weekend. Another relative spoke to the inspector by telephone and gave her views, “ my sister is so happy at the home, she has never feel as secure in any other place that she lived prior to coming there”. She also said that she finds the service is an excellent service that makes a big difference to service users’ lives. The rights of service users to invite people to the home to visit are respected. Support and advice is given to support those in relationships even though on occasions these relationships present challenges to the service. On all occasions full consideration is given to any risk presented to service users and staff. The inspector observed service users prepare meals, support staff were on hand to offer and guide as necessary. Meals are totally individualised and arranged by service users at a time that they like and find convenient. A kitchen dining room is used for meals. Service users choose and purchase food that they like in conjunction with the support worker, staff try to promote healthy eating by providing guidance in booklets and by explaining the reasons as to why healthier options are best. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 15 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 is progressing. Service users have the option of being supported to choose and cook meals that are appropriate to their cultural and ethnic needs and personal preferences. Service users are encouraged to try meals from cultures different from their own. Support staff respect the rights and choices of service users. Service users receive the necessary support required to devise menus for their evening meals on a weekly basis. Staff take responsibility for providing service users with education and training on healthy eating while meeting any specialist needs and preferences. From talking to service users as they prepared evening meals the inspector found that service users enjoyed their new found competence as they prepared the meals of their choice. Meals are individualised, with service users choosing shopping and preparing evening meals of their choice. Sundays a communal lunch that considers individual preferences is available. As part of the their development service users are educated on safe food practices such as the importance of “use by dates” on products. They also label and date perishable foods when they first open them. Support staff educate service users, also monitor and keep an unobtrusive eye on progress to ensure that good food hygiene procedures are adhered to Service users take responsibility for locking their bedrooms. Staff according to service users do not enter without seeking permission first. This was also an observation made. Service users feel at ease and access all communal areas. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 16 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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides quality support in a style that service users like and need. Staff at the home make excellent provision for monitoring and responding to the physical and emotional healthcare needs of service users. Medication procedures are good with an emphasis on developing service users capacity to self medicate. EVIDENCE: Service users have a say in the choice of support worker, such preference for staff from the same cultural background or of the same gender. The cultural composition of staff reflects closely that of the service user group. Personal support is delivered in a way that is flexible, reliable and consistent. Just one service user requires direct help with personal care. A recent review acknowledged changes in the individual’s needs and risk assessments and care plans have been updated to reflect how to manage these appropriately. The inspector saw how support workers prompt and encourage service users when necessary. An example was seen of a service user that had chosen not to attend to his personal care early in the day. Support staff aware of the Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 17 importance of promoting self worth were observed to encourage him to use the shower and dress in fresh clothes. The policies and procedures in place successfully address the assessed healthcare needs of service users. The 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. A good example was seen of this recently. The inspector had been kept fully informed on the progress of a service user who had become very challenging. While awaiting response in relation to a more suitable placement for respite the service manager and the registered manager escorted the service user to consult with mental health professional. Throughout the crisis period appropriate action was taken by agreeing new guidelines to minimise the risk to all service users and support staff. Three service user require assistance with administration of medication. The records of administration were seen. Regular audits are completed of medication. Two service users following assessments self medicate. Two service users are competent at attending GP and health checks independently. A service user spoke of enjoying the fact that she now collects her own prescriptions and takes it to the pharmacy. From viewing records it was evident that service users’ progress is recognised and that support plans are tailored to reflect these changes. Evidence was present of appointments with a range of healthcare professionals to enable service users remain healthy. Health action plans are in place for service users. These record health checks and future appointments planned. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 18 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): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service makes very good provision to safeguard service users from any form of neglect or self harm. Service users have confidence in the service and feel free to express their views EVIDENCE: Three service users spoken with told the inspector of their experiences. They find that their views matter. They feel that any concerns or suggestions they have are listened to and acted upon as necessary. They find that the service is user focused in all respects. These were views of three local authority practitioners that have been directly involved with service users and the home. The complaints procedure is supplied to service users in a simplified picture version. Copies of other important contacts such as the learning disability team, the advocacy and befriending service are also included in the useful information section provided to service users, these are displayed on the notice board too. The records viewed of complaints received suggested that the procedure for dealing with complaints was satisfactory at the home. Two complaints were acknowledged on the records, the information seen included the outcome and response period. Neither of the complaints logged were made against the home or the service provided, these were in relation to a service user’s visitor. The home has robust procedures to safeguard service users from neglect or abuse. Management and staff are competent at following the appropriate procedures if there are any concerns or issues of concern. The reports received from two practitioners familiar with the home are that staff can be relied upon Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 19 to always take the appropriate action to respond to any concerns about a service user’s welfare. Evidence was seen of the competency of staff at managing situations and giving due consideration to the vulnerability of service users and staff. While one service user went through a recent crisis staff demonstrated this ability to safeguard all service users. Additional support was provided during the out of hours period by both the service manager and the registered manager. A very sensitive and difficult situation was managed very well until temporary respite could be found for the affected service user. The allocated social worker was spoken to. He was complimentary about the home and the manner in which service users’ needs are met, on this occasion the crisis was handled was handled very well while a delay was encountered in finding a temporary respite placement. He had worked alongside management and finds them to skilled and committed to safeguarding vulnerable adults. The registered manager and staff make all the appropriate notifications to families and social workers and CSCI within permitted timescales. The inspector observed how a newly admitted service user was supported in his early days at the home. The manager spoke of his vulnerability, this especially with the locality until is familiar with his new surroundings. A support worker allocated to support him was fully briefed on taking the appropriate action to support him in the community while considering his risk of absconding. The inspector observed that close contact was kept with the immediate family on his welfare and how he responded to the support offered. There have been no allegations of abuse or neglect at the home. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 20 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 25 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The atmosphere experienced at the home is relaxed and homely. Service users feel comfortable and free to access all communal areas in this pleasantly maintained home. They are consulted on and help to choose the furnishings and décor that they like. As part of their development in achieving their goals they have responsibilities for household chores that includes the importance of maintaining good hygiene practices both in the kitchen and in their bedrooms. EVIDENCE: The home is in a detached spacious property with lots of traditional features. It is well sited and closely located to public transport and shops so that service users can freely access community facilities and services. The emphasis is on service users developing independence, therefore service users take advantage of developing travelling skills and using public transport to attend community facilities and services. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 21 Service users find that the home provides an environment that is appropriate for the particular lifestyle they choose and that it meets their needs. Three service users spoken with have lived at the home for a number of years. They like the style of the house and are pleased with the refurbishment that has taken place in the last twelve months. Service users choose the new colour scheme for the lounge. The lounge on the first floor is bright and very pleasant area that service users use to relax and congregate. Colour schemes are well coordinated. Comfortable leather sofas are available for service users and guests to relax. The dining room/kitchen on the second floor are homely and have adequate storage space for service users to retain individual food supplies. The home is not wheelchair accessible. Although one service user requires specialist footwear for walking she finds the exercise of using the stairs to be beneficial in helping her keep fit. All of the premises are clean and hygienic. Service users spoke to the inspector as they completed laundry chores. “I find that taking responsibility for my own room and cleaning the kitchen after I have prepared food has helped me develop” was the quote from a service user. The majority of bedrooms are spacious and easily accommodate service users belongings comfortably. 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 enjoys life at the home. She said, “My room suits me and I have what I need around me”. The inspector spoke with the service user’s sister by telephone. She finds that the great quality of life experienced by the service user by far outweighs any shortcomings in room size. However, it is recommended that further consideration be given to how this may be overcome in future plans. The home is not fully wheelchair accessible. It is recommended that consideration is given to how the home plans to address this in the future. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 22 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): 31 32 33 34 35 36 Quality in this outcome area is excellent, This judgement has been made using available evidence including a visit to this service. Service users feel assured that that there are always appropriate levels of suitably trained staff available on duty. The home benefits from the rigorous recruitment procedures, as only staff that have the appropriate experience, attitude and skills are recruited. The home makes good provision for training and developing the staff team. EVIDENCE: Five full time support workers are employed. Four of the support staff have completed NVQ Level 2. Four regular bank support workers compliment the staff team and cover absences. Two of these had student placements at the home while they studied for social work qualification. The remaining two bank staff are currently studying social work full time. A range of training is delivered. This includes all mandatory training. Nonviolent crisis intervention training has recently been introduced for support staff. Three members of staff were spoken to. They commented on the opportunities given for self development and the support and encouragement from management. The inspector found that some support staff have worked within the setting for a long period and display real commitment to the service. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 23 Equality and diversity is promoted throughout the service. This is especially evident in opportunities given to staff that have disabilities. Currently three members of staff are employed, two of these roles are in administration. An ex service user carries out gardening duties. The home is very thorough in the recruitment process and strives to employ staff that have the right qualities, skills and experience. The service director told the inspector that a minimum of two years experience with this service user group is expected from all suitable applicants. Roles and responsibilities are clearly defined in job descriptions. The inspector saw evidence of how staff are supported and managed. Supervision and team meetings are held regularly. There was a busy period recently when one to one supervision slipped slightly. A recommendation is made regarding this. Support workers are employed for night cover as part of their working week, this facilitates good communication enables continuity in the service. The inspector examined the records relating to the employment of the only new support worker recruited since the last inspection. The application form was completed in detail. One the first interview records were made of the observations made during the interview by the panel, also of how the candidate demonstrated the capacity and ability to respond to questions. A second interview was then held in which service users participated. The support worker was appointed when two suitable references and a CRB with POVA check were received. The support worker had completed the basic induction at the home working alongside experienced support workers for a period of time until competencies are demonstrated. During this probationary period management identified that the support worker was relating well to service users and was good in her new role. The support worker was enrolled on the local authority LDAF induction programme due to begin in early February. When the six months probationary period is completed successfully she will be enrolled for NVQ Level 2 in care. Adequate numbers of appropriate trained staff are always available to support service users. The home is reliable and very good at responding swiftly to any changes that necessitate an increase in staffing levels. Evidence of this was verified in recent months. The service manager and the registered manager both covered additional hours including night cover when a service user was going through a crisis. The allocated social worker when speaking to the inspector was complimentary about the management response to periods of crisis. It signifies the supportive setting provided for service users and staff. Mandatory training is provided to staff. The training matrix was not up to date and therefore it was not possible to evaluate if all staff had completed the refresher training. A recommendation is therefore made. The registered manager is trained to deliver training on non-violent crisis intervention; this had begun with the staff team. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 24 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 38 39 40 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. This home is well managed; service users views come first and really help shape the service. The health, safety and welfare of service users is promoted and safeguarded by the emphasis placed on following safe working practices. EVIDENCE: The inspector found that the service at Rathbone is delivered within the key principles of valuing and supporting people. Support staff have the right approach and the key skills necessary that make this a valuable and innovative service. Evidence was seen of imaginative ways used to encourage service users participate in external activities. Service users and their relatives find that the home is the ideal choice of place to live for young adults with learning disabilities. They find that it offers service users the support needed in order Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 25 to grow as individuals and fulfil their lives as they choose. Both groups find that the home is well run and that service users come first. All three practitioners consulted with spoke of the quality service delivered at the home and complimented the excellent manner in which the support is delivered. Service users and staff benefit from the ethos and leadership of a strong management team. The service director oversees all the services provided by Rathbone Elfrida Society. He has a strong presence and oversees all the management of the care and oureach service to the community. He constantly strives to identify new areas of creativity and interests that people with disabilities may benefit from. He is present at the home on most Weekdays. The registered manager is experienced and qualified; he keeps his skills and knowledge updated. The inspector observed the positive interaction displayed between management and service users, service users felt confident in talking with ease to the managers. Service users (three) expressed their views on how the home is run and feel that the ethos of caring is tangible in the service“. The manager will always listen to what I have to say, he is great and that is why this is such a good home” was a comment received from a service user. The service director is keen on improving and developing further services for young adults with learning disabilities. He plays a major part in organising social activities that include youth clubs in the community for younger adults with learning disabilities. Members of the youth project include service users from the home. A partnership has been developed between the youth project and artists through a series of workshops. A recent exhibition took place in which works completed by service users was displayed. The inspector viewed the results of a recent quality assurance and monitoring evaluation completed for the home. It involved service users and also reflected aims and outcomes for service users and for the home. An annual development plan is being devised to respond to the outcome of the evaluation. The home has written policies and procedures in place to comply with current legislation and to safeguard service users and staff. Two support workers demonstrated their knowledge of procedures to be adopted in accordance with the home’s guidance. The service director spoke of proposed changes for the future. Plans are in place for service users and staff to engage in joint discussion about the policies and procedures in the next three months, and to be part of the team that will review and amend them as required. Risk assessments are carried out for safe working practices. Guidelines are in place for support workers to follow following written risk assessments. The guidelines are kept up to date and range from procedures to prevent service users self-harming or prevent harm to other service users or staff. Guidelines are in place for supporting service users in the community. Staff are informed Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 26 on all aspects of support including guidance on safety, two support workers spoken to spoke of the importance of staff always following the agreed guidelines to achieve the best outcome for service users in relation to safety and welfare. A completed pre inspection questionnaire included information that confirmed that all essential equipment was kept regularly serviced and in good order. Regular testing of fire fighting equipment that includes fire alarms and emergency lighting takes place. Records how that a recent fire drill had taken place. A support worker allocated this responsibility informed the inspector that he completes regular fire drills. A fire prevention officer made recommendations on a visit to the home, this was followed up in 2006. According to written correspondence these recommendations were responded to satisfactorily. Individual members of staff are designated responsibilities, examples of these include a support worker allocated the responsibility of fire officer, and another member of staff takes responsibilities for the health and safety of the environment. In light of recent changes to legislation regarding fire evacuation it is recommended that the fire prevention officer view the most recent fire risk assessment in place. Records of recent health and safety audits were viewed. This has been responded satisfactorily following a recommendation set the previous inspection. This role of health and safety officer demands skills and competencies. It is recommended that the support worker be given additional training in relation to her development for this role. Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 27 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 3 3 4 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 2 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 4 32 4 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 4 4 4 X X 3 X Rathbone Centre, The DS0000022765.V317853.R01.S.doc Version 5.2 Page 28 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. Standard Regulation Requirement Timescale for action 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 4 5 6 Refer to Standard YA25 YA29 YA35 YA36 YA42 YA42 Good Practice Recommendations The registered person should consider how the home would address the shortfalls in a bedroom not meeting minimum space requirements. The registered person should give consideration in future planning for the home to improve disability access. The registered person should ensure that training needs are kept under review and that the training matrix is kept updated to reflect the skills composition of the staff team. The registered person should ensure that one to one supervision is regularly provided. The registered person should ensure that the fire prevention officer is consulted on the fire risk assessment in place. The registered person should ensure that the support worker designated the role of health and safety officer is given additional training in relation to her development in this role so that the area of health and safety is further developed. DS0000022765.V317853.R01.S.doc Version 5.2 Page 29 Rathbone Centre, The Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V317853.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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