Inspection on 31/07/08 for Royal Hill

This inspection was carried out on 31st July 2008.

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 no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Royal Hill 26/03/07

Royal Hill 20/02/06

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 08/11/2008.

CARE HOME ADULTS 18-65 Royal Hill 101 Royal Hill Greenwich London SE10 8SS Lead Inspector Wendy Owen Key Unannounced Inspection 31st July 2008 10:00 Royal Hill DS0000043007.V364692.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 Royal Hill DS0000043007.V364692.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. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Royal Hill Address 101 Royal Hill Greenwich London SE10 8SS 020 8694 3652 020 8692 8211 key.gordon@btconnect.com 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 Angela Margaret Gibbons Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Royal Hill DS0000043007.V364692.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 26th March 2007 Date of last inspection 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 en-suite 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. All people are funded by the Local Authority and the charges are fixed for each person. We have been made aware that the charging system is likely to change in the near future. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 1 star. This means the people who use this service experience adequate outcomes. This inspection took place over two separate visits lasting one and a half days. The inspection included viewing of the Annual Quality Assurance Assessment (AQAA) completed by the manager or Provider giving information about hw they were meeting the standards, what improvements had been made and what improvements they are expecting to make. We also spoke to staff and management, observed practices, toured the home and looked at records. We also used the information provided in the Annual Service Review in February 2008 where we obtained feedback from people using the service and four of their relatives. During the visit we spoke to staff, manager and deputy manager and also contacted relatives to obtain feedback from them about the service provided. We also toured the home, viewed records and observed routines. At this inspection there were six residents living in the home with one vacancy. What the service does well: People at Royal Hill enjoy a good quality of life, and staff spend time with the them in order to meet their needs. One relative wrote “X is treated always with care and his privacy is respected.” Another wrote “I must say that X is given a very good standard of care at Royal Hill.” Other comments included “My friend has ..…an incredibly supportive key worker who is proactive in keeping contact and updating” and “ Royal Hill does feel like a home rather than just somewhere to live. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 6 There is some stability within the staff group, some of whom have know people living there for a long time, and individual needs and lifestyles are catered for as fully as possible. Royal Hill offers a pleasant and comfortable environment with plenty of room to move around, and a range of private and communal spaces which is very important to young people. Concerns are managed effectively and where complaints are raised these are listened to and responded to appropriately. In general staff receive training to ensure they can meet individuals’ needs and ensure their safety. What has improved since the last inspection? What they could do better: The home has suffered with a number of changes of management over the last few years and these changes impact upon the quality of the service and how it is organised and run. There also need to be more monitoring of the quality of care to ensure improvements are made where necessary. Medication practices and training need to be improved so that staff understand the importance of individuals’ prescribed medication and that people receive their medication when they should with records that verify this. Whilst the environment provided is generally of a good standard there must be improvements in some areas including the fitting of a new laundry fan and making sure trailing flexes are made safe to ensure hazards are reduced. There is personalisation in individual rooms but corridors are lacking in any touches that would make them feel more homely. Garden furniture should also be replaced giving people furniture of a good standard that is not in a state of disrepair. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 7 There us a need to ensure all staff are regularly updated in moving and handling to ensure they are updated in good practice and remain competent to provide personal support to people. Staff would also benefit from training in how best to communicate with individuals and this should also be included in the care plans along with information about people’s cultural needs. This would ensure people receive the care they want in the way they would like it delivered and therefore be more person-centred. Following on from this the manager should look at how information could be better presented for those unable to read and how they can involve people more in the development of their care plans and subsequent reviews. Some of the documents contain conflicting information and so this should be looked at to ensure individuals and their family members are not misinformed. People are generally care for well by staff. However, we felt the opportunities for staff to engage and interact to improve overall well-being were often missed. 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. Royal Hill DS0000043007.V364692.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 Royal Hill DS0000043007.V364692.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): 1,2,4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place that enable people to make a decision on whether the home is suitable for them. The assessment processes ensure that staff have the information to enable them to provide care and support to meet individuals’ needs. EVIDENCE: Information is available in the form of a Statement of Purpose and Service Users Guide. Both have been developed in the written format. Copies of these documents are kept on individual files. This format is not suitable for those living in the home as they have little understanding of the written word and therefore the information must be provided in way that they would be able to understand, whether this be a DVD, pictorial format or audio. All the residents have lived in the home since it opened five years ago. Currently there is one vacancy in the home with the manager looking to assess and admit a new person into the home. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 10 Greenwich Local Authority places and funds people to live in the home and therefore the home’s admissions process revolves around their criteria. We discussed the pre-admission process with the manager and deputy manager who told us that they have a system in place that includes being provided with the social worker’ assessment and assessment by a senior member of staff from the home. As part of the process and to help the person decide if they like the home and if they “fit in” with other people living there they are able to stay for a short while building up to longer periods. This also helps the decision and settling in process. Contracts and tenants guides are also in place for each person, although there is conflicting information on these that may give rise to misunderstanding and possible complaints. We were told that the Local Authority are currently planning changes to the fees which may present the organisation with families raising concerns with this. The charging policy at present needs to be made clearer to ensure people have written information about what they need to pay for. Royal Hill DS0000043007.V364692.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have good information about the assessed needs of people and the way they wish to be cared for to ensure they can meet their needs and enable them to live safely in the community. There are adequate systems in place to involve people in the how they wish to live their lives. EVIDENCE: All of the people living in the home have care plans developed according to their assessed needs. We viewed two of these and found them to be recent and comprehensive in the information provided to staff on how people like to cared for and supported. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 12 They also contained a range of photographs of the individual enjoying various activities and showing them in relaxed moods. The information includes a profile and summary of identified needs long with a care plan and associated risk assessments. The care plan covers a variety of health, social, financial and personal care as well as night-time routines. Whilst routines are developed for each person we found that there could be more information on cultural needs of each person. For example: some individuals enjoy a particular skincare routine and whilst this is detailed and is good practice other areas are missed out such as the way one person like to wear bright colours and jewellery as is their culture. Although, we understand that staff are generally aware of these and carry out care to their specific needs there are opportunities for information to be missed because it is passed by word of mouth. We felt the care plans becoming more person centred, although use of the first person whilst writing them would show “ownership” by the individual and signing their agreement either by the person or their family would show evidence of their involvement. One relative said “Life plans…….. are always thorough and comprehensive.” They also told us that they were involved in this aspect of their family member’s care. The service also uses a key worker system with one person telling us that their friend has “…an incredibly supportive key-worker who is proactive in keeping contact and updating us.” We noted in one case that there had been a review for one person in November 2007 and evidence of changes. However, it not clear about the involvement of the individual or people that are important to them in their development. Risk assessments had been developed to ensure independence is promoted, whilst balancing risks. These include going out into the community, using the stairs, accessing the kitchen and the community. In the case of one person a “best interest” meeting had taken place regarding some health issues. This is good practice. Many of the people living there are not able to fully communicate verbally. In one care plan they use a “communication passport” to support people. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 13 There is, however, a lack of training such as “makaton” to assist staff and as one member of staff agreed they felt they would benefit from this. Residents meetings also take place with some evidence of records of these. These are quite basic in the way they are recorded and where issues are discussed it is not clear if they are addressing or taking action about decisions made. All three minutes viewed were handwritten with two of the three having no date on them. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 14 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): 12,13,14,15,16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are generally enabled to lead active lives and maintain relationships with those that matter to them. People are provided with adequate food and refreshments. EVIDENCE: The home offers a variety of opportunities to be active and stimulated, although not in the form of educational activist due to individuals’ abilities and dependency. Some of them attend a day centre ranging from one or two visits to virtually daily visits and others are funded for 1:1 staffing to enable them to enjoy leisure activities such as going out or baking. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 15 There is evidence of people going out and visiting the local area enjoying everyday social activities such as going to restaurants, pubs and shopping. Some people enjoy physical activities such as swimming, going for walks in the park which is in very close proximity to the home or going to guides. A number of people have sustained relationships with family members and the home encourages them to do this. Some family members are more involved than others, as is their choosing or, as dictated by their situation. One family member told us that their family member is offered a number of activities and that they often involved in these because they choose to be. It is sometimes difficult for staff to engage individuals in activities as they present with behaviours that challenge often refusing to participate and being determined in their refusals. People were free to choose where they sit and relax, and whether they were on their own or with company. We noted that whilst residents were enjoying their time in the home there was little activity and stimulation provided by staff. We felt that they missed opportunities for interaction and engagement during the time they spent together often seated watching TV. Whilst some enjoy this there are opportunities to interact and discuss the programmes etc. One relative wrote “There are a few members of staff who are worth their weight in gold giving great care and support. However, there are always those who appear to show little or no interaction or support. The minutes from residents meetings showed that some wanted to do more things such as musicals or going out in the car. They also expressed a desire for a new TV with sky. The manager has told me that this has been ordered. It is positive that there is an agreement that they arrange a holiday for each person each year. Staff escort costs are split between the individual and organisation. Holiday activities are discussed during meetings between staff and individuals at meetings with one of the minutes stating tow of the residents wished to holiday in Lanzarote, which they did. 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 individuals’ request, if they go away for the weekend for example. The reasons for this should be clearly documented along with decisions about capacity. Contracts also state that individuals can choose how they wish their room to be redecorated and their own bedroom furniture. However, this conflicts with the tenants’ guide that states that basic furniture will be provided. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 16 We were aware that some residents now benefit from a double bed paid for by themselves. Meals are provided and from the feedback people enjoy an adequate standard of food provided at various times to suit their lifestyle. The involvement of people in the purchasing and preparation of meals is very much dependent on the ability of individuals. We noted that one person enjoys baking cakes and does this regularly with their key-worker. Staff take meals with people living there with a separate budget for this. This is good practice as it give staff time to interact with individuals at a relaxed time. From the care plans it is not clear about peoples likes or dislikes in these areas or the special diets. This would be beneficial to ensure staff have the information to ensure these needs are met. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Individuals’ receive good support and have healthcare access to professionals to ensure their healthcare needs are met. Medication practices must be more robust to ensure people are safe. EVIDENCE: Each person has information on how people wish to have their personal care provided and mobility issues. This is quite detailed as it needs to be where people are not able communicate their specific needs. The manager should look at how they could make the care plans more user friendly and accessible individuals and how they can evidence others’ involvement in their development. “I have never needed to raise concerns about care but have asked about health issues and these have always been addressed.” Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 18 Care plans, risk assessments and other documentation provides details of physical health needs and any particular behavioural problems. There are also a number of risk assessments completed including risk of choking, epilepsy seizures and verbal or physical aggression. In the case of one person a “best interest” meeting had taken place regarding some health issues to ensure they received the support and care they required to remain fit and well.. A separate book is maintained detailing how a person’s healthcare needs are being met with the Community Learning Disability team having a role in monitoring their healthcare needs. It is also up to staff to monitor these and take appropriate action by referring to the appropriate healthcare professional or asking for advice. On viewing the two records we found evidence of various health care support from GPs, hospital appointment, dentist, optician, podiatry and specialist support from psychology. We did however notice that where care plans had recorded that weights are to be monitored and recorded monthly this is not happening. The manager states that this is undertaken by the hospital or GP which explains the lack of regular monitoring. If the person’s health care needs’ require weights to be monitored regularly then there should be a system for doing so to ensure they do not suffer any detriment to their health. We also audited the medication systems and practices. People who have prescribed medication have their medication stored safely and records of medication prescribed are in place. No individual is able to take responsibility for their medication at present. All the medication is dispensed by Boots pharmacy and arrives at the home in blister packs where appropriate. All records are generally pre-printed by the pharmacist, except where medications need to be added later, for whatever reason. We noted that the records were not completed in the allergy section, although it was good practice to note each page had been numbered to ensure staff are aware that there are a number of medications to be administered for that person. Where the records required prescribed medication to be handwritten onto the medication records there were a number of occasions where there was only Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 19 one signature in place. This raises an element of risk where medication could be wrongly transcribed. For one person the records had gaps for all their medication in the morning and at lunch-time, although the medication had gone from the blister pack. There were also a number of occasions where medication had not been recorded in or carried forward. The lack of accurate records mean that there is potential for medication to have been left no administered, especially where the medication is prescribed in box or bottled form. It was difficult from viewing the training records to determine how many staff had received medication training or whether the training is accredited to so that have full and accurate information and guidance to ensure their competency. We had been advised of an error in medication. They took appropriate action and through discussions with the Commission and referring them to our guidance the risks of errors occurring have been reduced. They have also sought our advice over other medication issues. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 20 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. People are given opportunities to express their views with staff listening and responding to ensure their concerns are addressed. There are adult protection procedures in place which staff are aware of and they understand their roles to ensure people living there are protected. EVIDENCE: There is a complaints procedure in place copies of which are held on individuals’ files. They are produced in symbols, pictorial and word format. There is a hard-backed book for the purpose of recording complaints or concerns. The feedback collated for the Annual Service Review completed by ourselves show that people are aware of how to make a complaint and that they generally feel concerns are dealt with. We had discussions with two people who have raised concerns. One was not about the actual service but about the Local Authority role in the care of their family member and one was a discussion about the “complaint” raised. This individual felt that their concerns were listened to and action taken to improve this area. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 21 Both people felt that their family members were safe in the home and had no major concerns to raise. “I find I can talk to the management and staff about anything concerning XXXXX well-being” wrote one relative. It is difficult to determine if some individuals are unhappy because they cannot communicate verbally. Therefore staff need to look for other signs of where things are not right and staff who have been working with people there for a long time they are able to do this. However, it would be beneficial, especially here new staff work in the home or there any individuals who are admitted, to have some guidance for staff in this area. There have been no adult protection concerns since the last inspection, although we have commented in later standards about informing us about events or incidents between people living there required under Regulation 37 that possibly required referral under the safeguarding adults procedures. We also mention the need for staff to be made aware of these regulations and the communication required. We were told that social services were aware of these issues and were actively trying to find an appropriate outcome. We spoke to three staff who were aware of their role in ensuring people are protected from abuse and ensuring appropriate action taken. The evidence we could obtain showed that many staff have been provided with adult protection training. We have made comments in the later standards for staff to be aware of the requirements of Regulation 37 particularly where there are incidents between people living there that may require investigation under the adult protection procedures. The home has a no restraint policy and staff are provided with training in how to manage those with more “difficult” behaviours. One person spoken to told us about the “restraint” policy. However, we are concerned that in light of some more extreme aggression there may be times when staff have no other option than to use reasonable force to protect other people or themselves. The council are appointee to all people living there with a member of the council staff, the bursar, visiting the home regularly, ensuring monies are provided and monitoring that individuals’ monies are safeguarded. We audited some of these and saw that records and receipts are kept of expenditures and monies brought into the home by the bursar. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 22 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): 24,25,26,27,28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Royal Hill provides a clean and comfortable environment for people to live in which is generally safe and well-maintained. EVIDENCE: On touring the home we found it be a spacious environment for service users. Bedrooms are a good size, and there is a range of communal space including a large level garden, laid mainly to lawn. We noted that, despite some new garden furniture being purchased last year, these were looking worn and damaged. These should be replaced. Several bedrooms were looked at on this visit. Most were bright, well decorated, and personalised with individuals’ own pictures and items. Some residents had chosen to have their room decorated and some have purchased Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 23 bigger beds at their own cost. We have commented on this aspect in the appropriate standards. We did note that due to the mount of equipment people have in their rooms the wires were left in a mixed up and trailing the floor and potentially hazardous to people. There are ways in which numbers of flexes and wires could be tided and made safe for individuals. There is a range of comfortable, safe and accessible shared spaces provided with individuals being able to choose whether to sit in one of the two communal lounges or stay in their rooms. There are also sitting areas in the corridor which is the preferred place for one of the people living there. We noted that the communal areas are quite bare and lack a homely feel. We suggested that, taking into account the individuals living there and their behaviour, that they could personalise the walls much more. The stair carpet was also found to be marked, dirty and worn in places. A glass sided lift is in the home to assist those with mobility problems to go up and down the stairs. An alcove area in the downstairs corridor has been set up as a sensory area and is a pleasant area to sit with sensory equipment, bright mobiles, wall ornaments and soothing music. The home was clean and tidy throughout and hand-washing facilities were available in the laundry and kitchen. There were no odours in any part of the building. We noted that the fan in the kitchen was not working and that the door was often left open to cool the room down. This presents a risk to people living there. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 24 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 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The staff are generally experienced, skilled and competent to provide good care to people. The recruitment procedures need to be more robust to ensure people living in the home are protected from the employment of people who could potentially harm them. EVIDENCE: The home is currently suffering with a fairly high level of staff long-term sickness and this together with the management changes continue to impact on the stability of the home. However, a number of staff have worked in the home and in the previous care environment for a number of years and therefore know the people living there very well. This is one of the strengths of the service and could be at risk if the current staffing problems continue. Feedback from the survey undertaken by us in preparation for the Annual Service Review suggests that some relatives believe not all staff provide a consistent quality of care. “There are a few members of staff who are worth Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 25 their weight in gold giving great care and support. However, there are always those who appear to show little or no interaction or support.” Whilst another wrote that staff spend a good deal of time undertaking chores rather than spending time with the residents. For others “There is a “…feeling of stability” (staff have known him for a number of years). One relative said of Royal Hill that it feels like a home rather than just somewhere to live. “…I believe the staff do their utmost to give X a secure and guided life structure. We consider ourselves to be very fortunate for X to be housed at Royal Hill…….” The staff in the home are provided with various training to ensure they are able to meet individual needs those living there. This ranges from induction to core and specific training and is provided through Greenwich training consortium. We found that core training had been provided except for regular moving and handling training. This needs to be undertaken as determined by a risk assessment completed regarding this aspect of training. There was evidence of training in autism, challenging behaviour, medication and epilepsy. There was however, little evidence of equality and diversity training for staff or some guidance in communication. Some staff thought makaton training which would be beneficial. This would help in ensure more person centred care and the care planning. The records viewed did not give us good evidence of staff training undertaken with the lack of organisation and no training matrix in place to determine when training updates are required and ensure all staff receive training they require in a timely manner. Of fifteen staff in the home, seven have NVQ 2 or above and five are currently studying for the qualification to ensure staff are skilled and competent to provide care to this client group. When we looked at the practice of recruitment of staff we found that the home maintains a profile in relation to each staff member detailing the checks made by the personnel department. We noted that not all the information required was evidenced on the pro-forma and therefore this does not assure us that the checks as required by the regulations and Schedule, had in fact been, undertaken. This includes Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 26 verification of previous employment in care or that the application form has been scrutinised for any gaps in employment. The manager must assure himself that the employer confirms in writing that the checks have been completed. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 27 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, 39,41 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The lack of stable management over the last few years in the home means that people cannot be assured of a consistent quality of care or that all areas of health and safety are addressed. This means people are placed at risk of harm. There is the capacity for this to improve with the recent recruitment of a new manager. EVIDENCE: We have commented on the lack of stable management in the home over the last few years. This has also been highlighted by the relatives and staff as a concern and one of the areas requiring most improvement. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 28 Over the last year the manager was appointed to manage to homes which are located in fairly close proximity. Since the last inspection in March 2007 and the Annual Service Review in February 2008 the manager has decided to concentrate on just one home leaving Royal Hill yet again with a change of manager. These regular changes impact on the staff because they have to work to meet each change of manager’s way of working. The current manager, not yet registered has worked for Greenwich Social Services in a number of areas over a number of years. We were also informed that the deputy manager has been appointed to another home although internal promotion has meant that there is some stability in this area. It is hoped that there will be some continuity and stability for the people living there and the staff team to ensure a good standard of care is provided. There has been a review of the whole service by independent consultants over the last year and a review by the Borough regarding Greenwich Living Options(GLO) on the whole service in June 2007. This report identifies where improvements could be made over the whole of the service and not just Royal Hill. The report used information from recent surveys, records from individual units and those held by GLO. It is positive that the Borough held Beacon status for Valuing People in 2006 showing a good standard of service for those with Learning Disabilities who lived in the borough. A survey completed (possibly completed by the parents of those living in the home although it is not clear) was undertaken in August 2007. Five of these stated the service was excellent and one good. However, there needs to be a report on the outcome to determine any areas for improvement along with an action plan to ensure improvements are made. There is some evidence that the service is being monitored by senior staff within the organisation, with reports completed on the monitoring visits. We noted that the last report held by the home was dated April 2008. These must be completed monthly and reports maintained in the home. We also noted that the way in which records and systems were organised could be much improved to aid efficiency and effectiveness and running of the home. For example: training and recruitment records and location of key records and reports. We also looked at the records of the servicing of the services and equipment used in the home to ensure they are safe to use. The information provided in the AQAA showed that there were some areas that needed checking. This included the servicing of the gas equipment and the Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 29 servicing of the lift. The gas equipment required it’s twelve month servicing in June 2008 and had not been undertaken. The lift had been serviced November 2007 and requires its six monthly servicing as required of lifting equipment that carried people. These areas had been addressed by the time the report had been completed. Other records had been viewed and found to be satisfactory, including testing the hot water system and viewing the records of regular temperature checks. A health and safety audit had been completed during the current year with few areas requiring action supported by monthly health and safety checks. This has not highlighted the risks with trailing flexes in peoples’ rooms and also does not detail the need for staff to be trained regularly in moving and handling. We looked at the fire records and found a fire risk assessment in place, records of weekly checks, records of servicing of the system and equipment and records of fire drills taking place. It is positive to note that all staff had undertaken fire training, although the manager is reminded of the need to provide this training annually. We also noted that the fire risk assessment completed in March 2007 had some areas of risk that needed some interventions to minimise the risks in those particular areas. These had not been completed. It is also good practice to review the risk assessment at least yearly or when there are any changes to the environment etc. When we looked at the trainings we found that it was difficult to determine the up to date training because of the system in place with information held in different places. From the records viewed we noted that some of the core training such as moving and handling were undertaken a few years ago for some people and they had not been updated in this area. This means staff are not fully aware of current good practice and also presents a risk to those living there due to competency. We did see evidence that staff have received training in first aid, food hygiene and infection control Recent guidance from the Department of Health requires services to undertake a risk assessment to determine their first aid training needs ie should staff have the one day appointed person or the four day “first aider” training. We wrote in the Annual Service review that we were not being notified of events as required under Regulation 37. There had been incidents between people living in the home which we should have been notified of and could possibly have been subject to adult protection referral. Since that time we have received more regular notifications in the areas Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 30 required. However, we strongly advise that all staff be made aware of the requirements of Regulation 37 to ensure there is consistency on communication about incidents. We also looked at the way individuals’ monies are managed and these were found to be adequate with individuals monies generally safeguarded. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 31 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 2 2 3 3 x 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 x 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 2 x 2 x 2 2 x Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 32 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 14 Requirement Care plans must be developed and reviews held with the involvement of individuals or their relatives to ensure their person’s individual needs are to be met. Medication practices and training of staff must be more robust to ensure any risks to individuals are reduced. Where care plans or risk assessments require individuals to be weighed regularly this must be done to ensure health risks are reduced. Trailing wires must be made safe to ensure potential hazards to safety are minimised. The fan in the laundry must be repaired or replaced to keep the area to a temperature where risks are reduced and enable staff to work without leaving the door open. A risk assessment must be produced to determine the frequency of moving and handling training to ensure people in the home are supported by competent staff. DS0000043007.V364692.R01.S.doc Timescale for action 01/11/08 2 YA20 13 15/09/08 3 YA19 12 15/09/08 4 5 YA42 YA24 13 23 15/09/08 01/10/08 6 YA42 13 01/11/08 Royal Hill Version 5.2 Page 33 7 YA34 17 8 YA42 23 9 YA42 13 10 YA39 26 Recruitment practices must be more robust so that the manager can assure himself that people working in the home have had the required checks and therefore individuals are safe. The fire risk assessment must be reviewed and updated to ensure there is a record of any possible risks and actions taken to reduce these risks to people living in the home. A risk assessment relating to the first aid training needs of the home must be completed to enable the manager to determine the home’s needs in relation to ensure people receive appropriate treatment. The Provider must complete regular monitoring visits and ensure the reports of these are maintained in the home to ensure the quality of care is being monitored. 01/10/08 01/11/08 01/12/08 01/10/08 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 YA1 YA5 YA35 Good Practice Recommendations Information for people living in the home should be provided in formats that suit their needs. Contracts and tenancy agreements should be reviewed to ensure they do not provide contradictory information. Staff should be provided with training on the best ways to communicate with individuals living in the home. This should include makaton or other appropriate communication systems. Care plans should include how staff or others the best ways to communicate to individuals living there and information on the cultural needs of each person to ensure the care provided meets the persons’ needs. DS0000043007.V364692.R01.S.doc Version 5.2 Page 34 4 YA7 Royal Hill 5 6 7 YA8 YA24 YA24 Residents’ meetings minutes should include the action the home is taking to address the issues raised. Corridors should be made more homely for the people living there New garden furniture should be purchased to replace the broken furniture currently used. Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Royal Hill DS0000043007.V364692.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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