Inspection on 28/09/07 for Rethink Recovery House

This inspection was carried out on 28th September 2007.

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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Rethink Recovery House 13-17 Roxborough Road Harrow Middlesex HA1 1NS Lead Inspector Clive Heidrich Key Unannounced Inspection 28th September 2007 2:50 Rethink Recovery House DS0000069589.V345572.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 Rethink Recovery House DS0000069589.V345572.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. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rethink Recovery House Address 13-17 Roxborough Road Harrow Middlesex HA1 1NS 020 8816 3717 020 8816 3717 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) Rethink Mr Joao Carlos Caixeirinho Botas Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 7 5/2/07 Date of last inspection Brief Description of the Service: 13-17 Roxborough Road is a registered care home providing personal care and accommodation for a maximum of seven adults who have mental health needs. The home is run and staffed by Rethink. The home is located in a quiet residential road in central Harrow, close to shops, pubs and other community leisure and transport amenities. The building offers purpose-built accommodation to people using the service, and was first registered as a care home in 1997. It is a two-storey building. It offers short-term placements to people using the service, either on a crisis (one place) or assessment (six places) basis. All the homes bedrooms are single. One downstairs room has en-suite facilities. There is a walk-in shower downstairs, and a bathroom upstairs. The home has a garden to the rear that is well-maintained and accessible through the communal areas of the house. There were six people living in the home at the time of the unannounced inspection. Fees charged to residents who are not on Section 117 were £72.85 per week at the time of the inspection. The Service User Guide is available on request. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There has been a change of registered provider since the last inspection. However, the new provider, Rethink, was very much involved in providing the service beforehand, and have simply taken over the registered responsibility from the landlords, Housing 21. Staff and the manager confirmed that there was no change in the practices at the home. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. Surveys were then sent to the manager to distribute. These were distributed to residents, relatives/advocates and community professionals. There was one reply from a resident, and two from relatives/advocates. The CSCI’s new staff surveys were given to the home for distribution at the start of the visit, from which two detailed replies were also received. Feedback was overall positive. It has been used throughout this report. The inspection itself took place across two half-days, in late September and early October. The first day included discussions with residents and staff, a tour of the premises, and observations of care practices. The manager was not present that day due to leave, but was fully available on the second day. That day involved consideration of records and discussions with the manager. The inspector thanks all involved in the home for their patience and helpfulness before, during, and after the inspection. What the service does well: Feedback from residents and relatives/advocates was generally positive about the service. As one resident noted in a brief chat with the inspector, “it’s a good service.” Another commented that, “staff have helped me learn to cook.” One relative stated that, “The home encourages residents to have a positive attitude toward their progress towards independence, providing them with advice and practice in life skills.” Staff were also enthusiastic about the service, stating for instance that, “Feedback from residents, ex-residents and carers shows a high level of appreciation for the work that is being done at the home.” The home has a very capable staff team, most of whom have relevant NVQ qualifications or degrees. One relative/advocate stated that, “The two staff members we have regular contact with, clearly have the skills and experience needed. We are most impressed by them.” There is an excellent standard of supporting people to move into the home. The prospective resident is very much involved in this process, including through assessment meetings, self-assessment processes, and visits to the home. The service has a good record of meeting residents’ needs, as Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 6 evidenced through service-exit questionnaires. The service works with residents to set up individual plans that reflect the resident’s goals and which have meaning to the resident. Plans are reviewed very frequently with the resident. The service provides residents with very good standards of individual and collective opportunities for personal development. This includes through daily one-to-one meetings, group meetings, and support with occupational pursuits. An experienced and competent person capably manages the unit. Residents and staff fedback positively about the manager’s involvement. What has improved since the last inspection? What they could do better: The provision of service-specific training to staff, in such areas as medication management and protection of residents from abuse, is insufficient overall. This could lead to mistakes in care practices by staff, which therefore fails to protect residents appropriately. Service-specific training for the staff team must be completed. The service did not have the local borough’s updated Safeguarding Adults protocol. This could lead to abuse scenarios being incorrectly addressed, or scenarios not being recognised. The protocol must be acquired and made available. Risk assessments, in the areas of fire safety and for some individual residents, were not up-to-date. This could compromise the safety of residents. The assessments must be brought up-to-date. There is one requirement that was not addressed in full from the previous inspection. It was required for senior management visits to take place monthly Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 7 at the home, to help ensure that care practices are suitable. Three had taken place since the last inspection, which is not sufficiently frequent. Monthly visits must be made and reported on. A full list of requirements and recommendations is available at the end of this report. 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. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 8 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 Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 9 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): All of them. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. All new residents receive a comprehensive needs-assessment before admission this is carried out by staff with skill and sensitivity. The prospective resident is very much involved in this process. Before agreeing admission, the service carefully considers the needs assessment for each individual prospective person and the capacity of the home to meet their needs. The service has a good record of meeting residents’ needs. The assessment process includes coming to the home and having a meal with current residents. Trial stays can be arranged. Contracts and Service User Guides are provided, to inform new residents of how the home operates. EVIDENCE: Feedback from residents about the process of deciding whether to move into the home or not was overall positive. One resident noted that staff from the home met them with before moving in, to find out such issues as food preferences. Another noted that people were helpful when they moved in. A third stated that they received enough information to make a decision about moving in. Relative/advocate surveys made similar comments about information provision. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 10 The two care files checked through found there to be very good standards of acquiring relevant information on the prospective resident. This included community professional assessments, management assessments that included clear discussions with the prospective resident, and a self-assessment by the prospective resident. The assessment process includes two standard visits to the prospective resident, and then a visit of that person to the home for a meal with everyone. Life history documents were also in place. For the crisis bed, effectively an emergency placement, there was less but still sufficient pre-admission information. There were also notes of discussions amongst staff and the manager about whether the home could meet the needs of individuals or not. Meetings in this respect happen most weeks. An admission checklist is followed for when a new person moves into the home. The list was very detailed, for instance including about introducing current residents, providing keys, explaining routines, and providing a Service User Guide about the home. The checklists were not always fully signed, however there was evidence that unsigned items had nonetheless been addressed. Residents are provided with a suitable contract of occupancy. It is renewed as needed, as the contract is typically valid for four weeks. It was encouraging to receive feedback, from residents and staff, that residents may stay in the home longer than planned, to enable planned moves to work out as well as possible. One resident provided positive feedback about being provided with support with household tasks. This had enabled them to gain confidence with the tasks. Their pre-admission information identified that this was clearly an area where they would benefit from support, to address dependency issues. Feedback from the Service Evaluation Questionnaire 2006-07, based on surveys from ten people who progressed from the service during that period, was also encouragingly positive about the service provided and the outcomes for these people. This information, along with such judgements as staff being suitably committed to meeting residents’ individual needs, and relative/advocate feedback about the home always meeting needs, shows that prospective residents can expect to have their needs met if they move into the home. The manager noted that all new residents are provided with an information pack about the home that includes the Service User Guide and the complaints procedure. Updates of the Service User Guide and Statement of Purpose were seen to be suitable. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service works with residents to set up individual plans that reflect the resident’s goals and which have meaning to residents. Plans are reviewed very frequently with the resident. The service generally enables residents to have choice and control over their lives, although there are a few areas of risk that appropriately limit residents’ complete freedom within the home. The service upholds residents’ independence as much as possible. EVIDENCE: One resident noted that they make their own decisions in the home, and that staff respect this, but that they are expected to attend both resident meetings and supper unless they verbally decline to be there. Another resident said that the service is not restrictive, and so they choose their lifestyle in the home. Feedback from residents about staff was positive, noting that they do listen to and act on what the resident says. Relative/advocate feedback agreed that the service supports people to live the life they choose. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 12 There was recognition amongst staff that certain hazard controls are needed in the service, such as a locked knife-drawer, and a locked kitchen at night. Efforts are made to neutralise limitations arising from this, one resident noting for instance that, “drinks and snacks are left overnight in the dining area including a small fridge for milk.” Discussions with residents about these controls found residents only to dislike some aspects of the house chores (see standard 16), but they accepted that this was part of the process of living in the home. Staff clarified that they have overall responsibility for house cleanliness, including undertaking chores assigned to residents if necessary to uphold hygiene matters. Staff explained how they respond should a resident not return to the home at the anticipated time. It is based on their knowledge of the individual. The home also has a robust missing-resident policy. One resident spoken with stated that they are very much involved in their care plan, and that they can influence it. Checks of two people’s files found that each have a care plan in place that is individual to them, is target-based, and which is reviewed weekly. The resident tends to write the plan with staff support, to own the objective. Each aspect of the plan is regularly reviewed by the resident and the keyworker, to rate progress and refine the objective. Objectives included about self-medication, attending support meetings, and learning domestic skills. The plans were consequently seen as very meaningful. There are also detailed risk assessments in place for some residents. However, for the two files checked on, one had a risk assessment from an external professional that preceded the resident moving into the home, and the other lacked any clear assessment. This puts those residents at risk of receiving a service that does not suitably respond to their individual safety needs in the home. The need to review assessments to reflect the person’s current placement and situation, and for the service to be responsible for this, was discussed with the manager, who agreed to address the shortfalls. There was evidence of keyworker reviews of resident’s progression in the home in some cases. This provides a useful summary, and references key information. There was also a high standard of making daily records about staff experiences of each resident’s progression. It is recommended that some form of index be kept within these records, to refer to key events for a resident such as contact with community health professionals, so that key information about this can be more easily found within the records. Rethink Recovery House DS0000069589.V345572.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): All of them. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service provides residents with very good standards of individual and collective opportunities for personal development. This includes through daily one-to-one meetings, group meetings, and support with occupational pursuits. Relationships with family and friends are appropriately supported. Rights and responsibilities are clearly recognised, and hence residents’ independence is appropriately supported. Nutritious, home-cooked meat and vegetarian meals are cooked by one resident each night. EVIDENCE: Care files goals for individual residents tended to focus on personal development. The files also included regular self-assessment reviews by the resident about their overall mental health. It was encouraging to see gradual progression within this process. Staff and residents fedback about the service enabling people to recover and to gain skills. One staff member stated that, Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 14 “One of the things the service does well is provide an encouraging environment where residents can grow & gain self-confidence.” The manager and staff noted that the service also provides outreach work, for residents that have left the service to be provided with some degree of support if they want it. There are also monthly coffee-mornings for current and ex-residents to meet and discuss issues. Residents provided feedback that they are supported by staff to pursue occupational choices such as work and college placements. Staff discussed some residents’ occupational pursuits during the handover that the inspector sat in on. Residents are free to come and go in the community as they wish, but the service does organize some collective trips such as to the local cinema, for which there was some appreciative feedback during the inspection. One resident noted that staff provide suggestions for activities, such as for going for a walk, and experienced them as supportive in this respect. They also noted that activities are discussed during resident meetings. There was also feedback about specialist group sessions being provided in the home, on cultural identity, healthy living, and recovery approaches. Residents spoken with confirmed that they can have visitors at the home. One noted that overnight stays are not permitted, but had no issue with this. They also noted that they would anticipate staff supporting them if they refused to see a visitor. Residents also stated that there is a useable payphone, which was seen available in the upstairs hallway. The manager explained that resident are asked about how they want their relatives and friends to be involved in the service. The service provides a Family and Friends Development Programme should the resident wish to be involved in this with their family and friends. Relative/advocate feedback noted that the service supports their involvement. Residents noted no concerns about having their rights respected. One person explained that the kitchen is locked at night but that drinks and fruit are placed in the dining room, including milk in a small fridge. The manager noted that the fridge was acquired following a resident stating that the milk being left out was going off. One person stated that they have keys to the home and their room, and that they can lock their room from the inside. They can come and go from the home as they wish, but are requested to let staff know an expected time of return. Staff and residents explained about residents’ responsibilities in the home. A task-list is drawn up weekly, to identify who will undertake which cooking or cleaning job each day. Residents confirmed that staff provide sufficient support with these tasks, for instance in enabling one person who had little cooking skills to become more capable. Staff confirmed that they retain overall Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 15 responsibility with ensuring that the tasks are done, ultimately doing it themselves if needed. Residents’ rights and responsibilities are recorded about in detail within the Service User Guide that is provided to each resident. There was positive feedback from residents about the food provided, noting that menus are agreed at meetings in advance, and that one resident each night undertakes the cooking. Dietary requirements are respected, for instance with providing vegetarian options and ensuring that individual’s dietaryintolerance issues are respected within ingredients. The kitchen was seen to have sufficient food available. Residents explained that occasionally some foods run out, at which point they can add requests to a list that is addressed. Rethink Recovery House DS0000069589.V345572.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 and 20. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support that is individual to their needs and which is documented about. They receive support with physical and emotional health needs, including through community health professionals. The home has procedures for assessing and enabling residents to selfmedicate, or to gain these skills. The home has reasonable procedures to look after medication where needed. However, there is a lack of documented training and assessment of staff to evidence their capability. EVIDENCE: One resident stated that they are well supported by staff to have private chats about how they are coping. They were pleased that they had progressed to coping with having these meetings less frequently. The AQAA noted that these individual meetings in particular are used to provide person-centred support with respect to the individual’s mental health. The staff handover meeting that the inspector was present for, included much discussion about individual residents, how staff were responding, consideration Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 17 of the emotions involved, and planning on further personal support for the individual resident. There was evidence of members of multi-disciplinary teams being liaised with in supporting residents’ emotional well-being. This included from feedback at the staff handover, where it was evident that staff can attend residents’ individual review meetings with psychiatrists. Conversely, it was also apparent that residents can make and attend health appointments privately. One resident noted that the service provides sufficient support with looking after their health. They kept their GP when moving into the home. The manager clarified that the service does include for support with personal care based on the needs of the individual, which would be included within the care plan if needed. It was noted that there is a healthy living group for residents that considers exercise and diet. There was a degree of positive feedback about it from residents spoken with. Staff explained that the aim is for each resident to self-medicate. The home has a self-medication progression plan, whereby the resident is assessed for capability at each stage of progressive responsibility for their own medications. This starts from prompting staff to administer medication at correct times, through to self-medicating but with occasional staff checks of the process. Residents have lockable facilities in their rooms for medication storage. Records were seen of staff monitoring the occasions when a resident managed to prompt them to provide their medication as part of the self-medicating process. This included records of why the resident did not manage the task. This was then reviewed weekly as part of the resident’s care planning process. The home has a designated and secure clinical room, for residents’ prescribed medications that the home looks after. Medications were seen to be stored in a tidy manner, and the area was suitably clean. Medicines are dispensed weekly into individual mediform dosette packs by staff, with relevant resident involvement depending on ability. The medications of two residents that need degrees of staff support were checked through. These overall raised no concerns. It was clear that administration records are kept up-to-date by staff. There are also checks at the staff handover, to ensure that medication has been given where applicable, based on an up-to-date guidance grid within the office. A record is kept of all medicines entering and leaving the home. It includes weekly checks of the stock. A sample check of tablets against these records found discrepancies. These were explained as being due to those in the dosette Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 18 box not being included in the stock count. To enable stock-taking to be accurate, and hence to better protect residents’ medications, tablets in the dosette box must be included. The as-needed (PRN) medication of one resident was seen to include guidance on dosage, and times of administration. It lacked a written statement on why the medication might be given, albeit that staff could suitably explain this. To ensure that the medication is provided appropriately, the reasons do need to be recorded. Checks of training files found that most staff, including bank staff, have not had formal training in medication management. The manager and staff explained that in-house training is provided through a shadowing process. Whilst this may ensure that staff are suitably competent, there are no records of this beyond staff signing that they have read the medication policy. As there are procedures such as filling of dosette boxes, that have a significant risk of mistakes occurring, it is necessary for all staff to receive formal training in medication management, and for there to be a documented in-house process of assessing and approving of staff to be able to safely provide medication. This latter process should include occasional review of abilities. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 19 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): Both of them. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are confident that concerns and complaints are listened to and acted on by staff and management. The service’s procedures and training are not fully appropriate to protect people who use the service from abuse. EVIDENCE: Residents reported that staff very much listen to their concerns and act on what is said. One person gave as example for this, about if they are being annoyed by another resident. Residents also reported feeling safe in the home. Relative/advocate surveys were reasonably positive about knowing the complaints process and having complaints addressed. Staff also responded positively about knowing what to do if a concern or complaint is raised. One noted that, “We have an open-door policy. Management and staff are all approachable and issues are dealt with quickly.” There have been no complaints recorded about since the last inspection, neither in the home nor through the CSCI. The manager noted that there is now an updated complaints leaflet available in the entrance hall. It contained suitable timescales. It did not mention about making complaints through the CSCI, however the manager noted that this is stated in the Service User Guide. This was found to be the case, along with the details of how to make a complaint to the service. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 20 The organizations complaints procedure was viewed. It was very detailed and had both clear timescales and clear expectations on employees on how to respond. The home’s policy on abuse-prevention was available from the office computer. This is available to staff who have computer access, however some staff including bank and agency do not have this. The policy should be available for all staff and anyone else to refer to. The manager agreed to address this. The policy was appropriate. available to residents about considered for the home, in manager agreed to address It referred to there being information leaflets how to be protected from abuse. These should be line with user-empowerment strategies. The this. The manager noted that the home does not have Harrow Council’s current Safeguarding Adults procedures, which explains actions to follow if an allegation of abuse occurs in Harrow. He agreed to ensure that this is acquired. He was able to state appropriate reporting procedures, should an allegation of abuse occur. The last formal training provided to staff about abuse-prevention was in 2004. Most staff therefore have only had in-house induction training in this area, and hence could be out-of-date with respect to current safeguarding practices. The manager agreed to ensure that update training is provided. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 21 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, 27, 28 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is kept suitably clean and homely. There is enough communal space, and enough toilets and bathrooms, across the two floors. EVIDENCE: Residents noted that the home is kept sufficiently clean, and that they have a role in this. The home also employs a cleaner for a few hours each week. Residents had no concerns about the environment. A tour of communal areas of the home was undertaken on the first day of the visit. The home was clean and tidy from the start of the inspection. There were no significant health & safety risks, and the building and furnishings were generally well-maintained. The home was also pleasantly decorated. The lounge carpet near the garden exit was the main area that could be improved on, as it was significantly worn away just in that area. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 22 The AQAA noted that the use of the new quiet room downstairs continues to be discussed amongst staff and residents. It is used mainly for meetings at the moment. The home has an accessible walk-in shower and toilet area downstairs, and two toilets plus bathroom upstairs. There is an open but roofed brick-structure in the garden, for people to use for smoking in adverse weather conditions. The house itself is a non-smoking environment. The laundry area was seen to meet standards. Staff stated that it includes a new washing machine following the previous machine breaking down. The machines are domestic in nature. Staff have protective clothing for assisting any applicable residents with personal care. The empty bedroom was seen to be appropriately furnished, including a washbasin. The external cable issue raised in the last inspection report has been addressed. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service provides very competent and qualified staff in sufficient numbers to meet residents’ individual and collective needs. Service-specific training is provided, although for the staff team as a whole this training is insufficient. Staff receive appropriate support and supervision. The recruitment procedures appropriately protect and support residents. EVIDENCE: The inspection started during the staff handover from morning to evening shift. Observations from this found staff to be suitably respectful and knowledgeable about residents, and to communicate relevantly about key issues. Residents spoke positively about staff, stating that they are always available, and always willing to listen and support. This includes at night. As one resident stated, “Staff are never bad.” Relative/advocate feedback found that staff always have the right skills and experience to look after residents. Feedback from staff found that they all have relevant qualifications for the work. Discussions with the manager confirmed that most staff working in the Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 24 home have qualifications at NVQ level 2 in social care or above. Some have degrees in relevant subjects, and others are pursuing NVQs at higher levels. This clearly exceeds standards. A sample of the duty roster found that two people always work during the day. Staff and the manager explained that, during recent months when there were vacancies in the permanent staff team, bank and agency staff were used and the manager covered a few shifts. The manager explained that the home was never left with two inexperienced staff working together. He noted that if specific issues arose that needed additional staff, such as a waking night, then this could be arranged temporarily. No concerns were expressed by anyone about the level of staffing in the home. The manager noted that the home is became fully-staffed in-between the two inspection visits. The recruitment records of one staff member were checked through. These were seen to be suitable overall. They included two pertinent written references, and an appropriate Criminal Record Bureau check, that were all acquired before the person started employment. There was also an application form, a detailed employment history including reasons for leaving and gaps in employment, health checks, and a contract of employment. Staff surveys confirmed that appropriate recruitment checks take place. Checks of the training records of a sample of three staff found that a variety of training has been provided to individuals, but improvements are needed collectively. New staff are provided with compulsory training from the organization as part of the their contract, which includes about health & safety, mental health awareness, and equality & diversity. They also work through a detailed induction checklist within the home. Other staff have attended courses such as on professional boundaries, food hygiene, and management for senior staff. However, as a team, too many people have not had formal training in key areas such as food hygiene, abuse-prevention, and medication. The manager recognised this, and stated that he expected to buy team training in these areas. The organization also provides training in some areas. To ensure that residents receive a service from staff who have had suitable training in all key areas, team training gaps must be promptly attended to. It is additionally recommended that the organization adjust its procedures to ensure that bank staff receive the formal training courses that permanent staff receive, so that these bank employees can provide a service that better meets residents’ needs. It was clear from staff files checked that six-weekly supervision sessions are regularly held for individual staff. The records were detailed, including about work performance and training needs, and are signed by both parties. Staff fedback positively about supervisions and support. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 25 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 and 42. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are strong standards of management in the home, which helps staff to provide residents with appropriate support. There are very good standards of communication amongst the staff and management teams. Residents benefit from weekly resident meetings, and the service has processes to self-monitor and evaluate its effectiveness. Health & safety procedures in the home generally protect people using the service. EVIDENCE: The registered manager has been in charge of the home for a number of years. He has degree-level qualifications in relevant social science subjects, and has a diploma in Management Studies. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 26 Residents fedback positively about the manager, noting that he makes himself available for them if requested. Staff noted that he usually takes part in the daily handover. One stated that, “The manager gives good advice on how to provide best practice in the house to our residents.” There were records of staff meetings happening monthly across the last three months. The records showed suitable information being discussed, and that staff can raise issues. There were also records of psychology meetings taking place monthly until June 2007. The residents’ meeting minutes book was briefly checked. It showed that weekly meetings usually take place, using an agenda that anyone can add to. Previous minutes are discussed at the start of meetings, which helps to ensure that issues are addressed. Minutes also showed that residents can clearly raise issues and that these are considered. The AQAA noted that residents are requested to fill in a service evaluation questionnaire upon discharge. This helps to inform the service of what they are doing well and what can be improved. A report on this process was received by the CSCI in August 2007. Ten people provided feedback, which was found to be very positive overall. Where dissatisfaction was identified, plans were made to address the issues. The provider is also responsible for ensuring that senior management undertake monthly checks that the home is operating appropriately, including through resident feedback. Since the last inspection, there were reports of this process available for two months in the home, with a third report not yet received. This fails to meet the expected monthly frequency, which must be addressed to help ensure that any significant concerns are identified promptly. It was noted by staff and residents that, earlier in the week, there had been a power cut at the home. Reasonable actions were taken to ensure everyone’s safety in the home at the time. Requests had now been made to fix the emergency lighting that was no longer working. During the second day of visiting, it became apparent that the home has not had its electrical wiring checked by a professional in many years, as no certificate to this effect was able to be recalled. The manager agreed to attend to this, in case there are any fundamental flaws with the wiring. The manager noted that portable electrical appliances were recently tested. Certification was seen to be in place in respect of professional checks of the gas and against legionella. There are comprehensive risk-assessments about the environment that are updated monthly. There are also monthly checks of the temperature of hot water outlets in the home. The last fire risk assessment was conducted in February 2006. There is an expectation of these being updated annually, for instance because smoking Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 27 arrangements have changed to outside only, since that last assessment. It was noted that weekly fire checks are undertaken in the home, that a professional check of systems took place in August 2007, and that the last fire drill was from that month, all of which is appropriate. The last visit of the fire authority was from 2004, when practices were stated to comply with fire regulations at that time. The last environmental health department visit was in 2005, when standards were rated as good throughout. Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 28 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X X 2 X Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA9 Regulation 13(4) Timescale for action There must be a risk-assessment 15/12/07 in place for each resident, to reflect the person’s current placement and situation, and for the service to be responsible for this. This was not always the case. There must be a documented in- 15/02/08 house process of assessing and approving of staff to be able to safely provide medication. This should include occasional review of abilities. Staff must also receive formal training in medication management from a suitably competent person, unless they already have up-to-date training in this respect. This is all to minimise the risks of medication errors occurring. To enable stock-taking to be accurate, and hence to better protect residents’ medications, tablets in dosette boxes must be included when making stocktaking records. Requirement 2 YA20 13(2) 3 YA20 13(2) 01/12/07 Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 30 4 YA23 13(6) 5 YA35 18(1)(c) 6 YA39 26 There must be a copy of Harrow 01/12/07 Council’s current Safeguarding Adults procedures available for use in the home. Team training gaps in key areas 01/03/08 such as food hygiene, abuseprevention, and medication, must be promptly attended to. This is to ensure that residents receive a service from staff who have had service-specific training in all key areas. Regulation 26 visits must take 01/03/08 place on a monthly basis. Previous timescale of 1/4/07 not met. This is to help ensure that any significant concerns are identified promptly. Copies of the visit reports must be provided to the local CSCI office in a timely manner. There must be an appropriate electrical-wiring certificate in place at the home, to show that a professional is confident that there are no fundamental flaws with the wiring. The fire risk assessment must be reviewed annually, to help ensure that fire hazards are being minimised. 7 YA42 23(2)(b) 15/01/08 8 YA42 23(4) 15/12/07 Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 31 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 YA6 Good Practice Recommendations It is recommended that some form of index be kept within residents daily records, to refer to key events for a resident such as contact with community health professionals, so that key information about this can be more easily found within the records. To help ensure that as-needed (PRN) medications that the home looks after on behalf of any resident are provided appropriately, the reasons for the resident having each such medication should be recorded within the MAR sheet. The home’s policy on abuse-prevention should be available for all staff and anyone else to refer to, not just those who have computer access. Information leaflets on how to be protected from abuse, as referred to within the home’s abuse-prevention policy, should be provided to all residents. The lounge carpet near the garden exit should be considered, as it was significantly worn away just in that area. It is recommended that the organization adjust its procedures to ensure that bank staff receive the formal training courses that permanent staff receive, so that these bank employees can provide a service that better meets residents’ needs. 2 YA20 3 4 5 6 YA23 YA23 YA24 YA35 Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Rethink Recovery House DS0000069589.V345572.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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