Inspection on 20/02/06 for Royal Hill

This inspection was carried out on 20th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Royal Hill 31/07/08

Royal Hill 26/03/07

Royal Hill 07/07/05

Royal Hill 07/02/05

Royal Hill 28/06/04

Royal Hill 11/03/04

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 Royal Hill 101 Royal Hill Greenwich London SE10 8SS Lead Inspector Sue Grindlay Unannounced Inspection 20th February 2006 12:00 Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Royal Hill Address 101 Royal Hill Greenwich London SE10 8SS 020 8694 3652 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) Greenwich Council Vacant Care Home 7 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (7) of places Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Royal Hill is a Home for seven adults with a severe learning disability and complex needs, who are also residents of the London Borough of Greenwich. The Home is owned by Hyde Housing Association and managed by the London Borough of Greenwich. The Home is purpose built and is situated on a corner site in a residential area of West Greenwich. There is limited parking in the drive to the front of the building. The Home is within walking distance of the heart of Greenwich with its shops, markets, park, river walks and Maritime Museum. Greenwich station is close by and buses routes run to Lewisham, Blackheath and Woolwich. Tenants have spacious single-occupancy rooms with ensuite toilet and shower facilities. A kitchen and laundry are on the ground floor. Two communal lounge-diners open out onto the enclosed garden, which is mainly laid to lawn. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection over three and a half hours. It covered key standards not covered in the last inspection, and looked at issues that have arisen in the interim, particularly the administration of medication. The manager and assistant manager were on site, and all seven residents were seen. A tour of the building was made, two bedrooms and all the communal areas were viewed. One relative was spoken with. Documents looked at included Person in control reports, care plans, staff and residents’ meeting minutes, fire drill record and staff records. What the service does well: 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. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 6 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 Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards have been met and all the current tenants have been in placement since the Home opened in May 2003. EVIDENCE: No standards were assessed under this section on this occasion. All the tenants have been in the Home since it opened, and the standards were met on the first two inspections. Tenants received a personal letter before admission from the manager stating that their needs could be met within the Home, and this is good practice. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8 and 9 Tenants’ individual and changing needs are well monitored at Royal Hill and service user consultation is good. EVIDENCE: Care plans were up to date, and risk assessments had been reviewed appropriately. One service user has a new walking frame and a risk assessment had been drawn up for its use in December 05 with a review date of June 06. A tenants’ survey is sent out each year and the results collated. Questionnaires are currently being returned. Tenants meetings were minuted. At the meeting in November two tenants said that they liked the food at Royal Hill, and expressed a wish to see the Christmas lights in London. Risk assessments are made and reviewed according to changing needs. One tenant has been reassessed by the occupational therapist as his walking has decreased. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 15, 16 and 17 Tenants at Royal Hill are enabled to lead active lives and maintain relationships with significant people. EVIDENCE: Tenants at Royal Hill enjoy a range of activities. The assistant manager has set up a new activity programme for one tenant, who had been quite agitated over the Christmas period. The issue of her compatibility with other residents is still an issue for the service. Three residents went on holiday to a cottage in Suffolk in October, and several went to the pantomime at Dartford at Christmas. Another tenant enjoys going to the cinema. One staff member said that the Home’s vehicle is not large enough to take all the residents out, and sometimes staffing ratios do not enable them to give sufficient one to one time with residents. Several of the tenants have regular home visits with their families. One tenant was brought back from her weekend at home during the inspection. Her father said that he was content with the care that she was receiving at the home, which he described as, “all in all excellent”. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 10 The Tenants’ Guide for Royal Hill states that ‘You will be offered your own key to the house and your bedroom’. In fact none of the service users holds a key, but rooms can be locked at the tenant’s request, if they go away for the weekend for example. Post is given to tenants to open themselves. Tenants are encouraged to help around the house within their own capacity. They do not cook, but will help with washing and preparing vegetables. One young woman is proud of her baking, and enjoys responsibility for emptying the dishwasher. Meals are decided in the morning for that day and tenants are able to make their choices. The meal for that evening was sausages, and there were good quality Lincolnshire sausages in the fridge for that meal. Fresh fruit and vegetables were available. One tenant has to have a soft diet, and an explanation of his needs written by the Speech and Language therapist was on the wall in the kitchen. The Home has decided against having a cook as that perpetuates an institutional model. The Home sets out to create a normal domestic setting. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Tenants’ physical and emotional health needs are met. Medication errors are putting service users’ health and well being at risk. EVIDENCE: Women in the Home have only female support workers. There are two male support workers, and, if they are on the shift, they will take care of the men. Tenants have access to professional services outside of the Home, for example one tenant has input from the psychological service. Another has input from occupational therapy and speech and language therapy. Since the last inspection, the Home has reported six incidents of medication errors; three of these were in one month alone. The manager said that each incident had been followed up with the person concerned and staff are taken through the medication procedures and guidelines. It has also been discussed in team meetings. A senior manager discussed a recent medication error on her visit on 16/01/06. She noted that the Assistant manager had followed the correct procedure. There are photographs of the residents in the front of the medication folder, and copies of signatures and initials. MAR charts are initialled and countersigned if medicine details are hand-transcribed. All the PRN guidelines have been revised, with guidance from the psychologist on the appropriate time to administer this. The manager said that she was considering a training update for all staff, and that would ensure correct Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 12 methods were understood and correct procedures followed. This is subject to a requirement (Requirement 1). Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Tenants know that they are listened to and their views matter. EVIDENCE: There have been no complaints at the Home since the last inspection. It was recommended at the last but one inspection that copies of the complaints procedure should be sent out to relatives, and this was being done at the last inspection. The Home was also sending the Commission’s new leaflet, “Is the care you get the care you need?” which invites feedback from service users and their families. It was also recommended that compliments received are also logged and this recommendation is renewed (Recommendation 1). Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 and 29 Tenants’ bedrooms enable them to make choices and to pursue their own interests. There are some aids and adaptations to promote independence. EVIDENCE: Two bedrooms were looked at on this visit. One is about to be decorated, and the tenant chose her own bedding and the colour of the paintwork. The other room belonged to a young man, and there was a new television and DVD player installed. The bed base in this room looked a little frayed, and it was recommended that a valance be used to improve the look of this room (Recommendation 2). A glass sided lift is in the Home to assist one wheelchair user in going up and downstairs. One tenant has an up and down bed that helps staff to lift him, and one tenant has a wheelchair. The plans to set up an alcove in the downstairs corridor as a sensory area have not progressed, and the manager said that they were looking to the new financial year to purchase sensory equipment. It is recommended that a sum of money be set aside for this project to be completed for the benefit of the tenants (Recommendation 3). Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35 and 36 Staff are competent, effective and well supported. EVIDENCE: The Home has a balance of new and established staff, but they all demonstrate the capacity to be responsive to the tenants, and this is shown by the calm and contented demeanour of the residents. In one questionnaire a relative states, “We have full confidence in the staff at Royal Hill and we consider ourselves very fortunate that [the client] has secured a place in a kind, caring and secure establishment”. Night visits are continuing to ensure that staff are appropriately vigilant. There is one vacant night staff post and this is filled by agency staff who know the tenants well or by overtime cover. One staff member said that staff at Royal Hill form a “really good team”. The manager has compiled a training needs assessment of the team, and training records are now kept with staff profiles. This is enabling the manager to have an overview of what training staff have done, and where there might be a shortfall. At the last inspection staff supervision had not got off the ground. The new manager and assistant manager have both done training in supervision, and are being proactive in setting up a supervision schedule for all staff. The Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 16 manager and assistant manager are to have joint supervision with the development manager and this will help to ensure close working relationships. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Royal Hill is well managed, and tenants are safe and well cared for. EVIDENCE: The new manager is now formally appointed to her post, but is not yet registered with the Commission. However both she, and the assistant manager are doing their NVQ4 in management. The manager is aware that she was coming in to a situation where staff and tenants were missing the manager who had been instrumental in helping clients to move into the Home. However she has worked alongside staff, and has discussed any changes in staff meetings, and the appointment of an assistant is strengthening the management role. Person in control reports were available in the Home, but have not been sent to the Commission. This is a restated requirement (Requirement 2). It was noted that several visits had been made at night as part of the monitoring of night time cover. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 18 The manager has initiated a ‘Read and sign’ folder so that staff are aware of any new policies and procedures introduced in the Home. At the last inspection a number of small health and safety matters were noted. These appear to have received attention. Door stops have been replaced with magnetic door closures, paper towels were available for hand washing in the kitchen, regulation 37 reports have been sent to the Commission to notify any events affecting the well being of tenants and fifteen placements have been booked for fire training. Water temperatures are checked regularly. The temperature of the water in the bathroom recorded 41 degrees. The fire drill record shows the evacuation time and the names of all staff and tenants who participated. One member of staff returning to work after a period of ill health was subject to a lone working risk assessment. All the staff are asked to carry walkie talkies around the building, so that they can summon assistance if required. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 19 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 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 3 27 X 28 X 29 2 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 3 X 3 X Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The Registered Person must ensure the safe administration of all medicines received into the Home. Responsible Person reports should be made monthly and be unannounced, and copies of the reports of these visits should be sent to the Commission (Restated requirement, previous timescale not met). Timescale for action 05/05/06 2. YA39 26(5)(a) 05/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA22 YA26 YA29 Good Practice Recommendations It is recommended that all complaints, compliments and suggestions are logged with the date and any response made. It is recommended that a valance be purchased to cover a frayed bed base in one of the bedrooms. It is recommended that the sensory area be set up with equipment as had been proposed, to provide a stimulating and attractive place for tenants to sit, and as a communal DS0000043007.V277687.R01.S.doc Version 5.1 Page 21 Royal Hill resource. Royal Hill DS0000043007.V277687.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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