Inspection on 18/07/05 for Scott House

This inspection was carried out on 18th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Scott House 16/10/07

Scott House 17/10/06

Scott House 08/12/05

Scott House 10/01/05

Scott House 16/08/04

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

CARE HOME ADULTS 18-65 Scott House 7 Warham Road South Croydon Surrey CR2 6LE Lead Inspector Margaret Lynes Announced 18 July 2005, 09:30 th 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 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 Stationary 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. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Scott House Address 7 Warham Road, South Croydon, Surrey, CR2 6LE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8686 9312 020 8686 3212 Laurel Residential Homes Limited Care Home 21 Category(ies) of Mental disorder registration, with number of places Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/1/05 Brief Description of the Service: Scott House is a large traditional brick built property situated to the south of Croydon, but close to the town’s many community facilities. The house consists of a large lounge with open plan dining area and a conservatory. There are 15 single bedrooms and 3 double – none has en-suite facilities other than wash hand basins. There are 8 toilets, 3 bathrooms and 2 showers. There is a garden to the rear and off-road parking to the front. The stated aim of the home is to provide care for people with long term mental health problems. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced, and was conducted over one day. During that time a number of records were examined, parts of the premises were inspected and time was spent talking with service users, their relatives and staff. Following the last inspection visit it was noted that there remained 16 outstanding requirements from earlier inspections, while nine new requirements were made. Of this total of 25, all but 3 have now been met. Of those 3 remaining, two have actually been partially met. This visit resulted in 7 new requirements being made. The majority of these requirements relate to minor issues and should not be difficult to meet. In meeting them the home will improve the overall quality of the service being provided, and improve the well-being of the service users. What the service does well: What has improved since the last inspection? What they could do better: Only seven new requirements have been made as a result of this visit. Of paramount importance are those relating to staff recruitment, risk assessments and fire safety. Immediate steps need to be taken to ensure improvement in all of these areas. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 6 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. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 2 The home has now met the previously made requirement regarding the Service User Guide, which means that prospective service users now have the information that they need to make an informed decision about where to live. Only one service user has been admitted since the last inspection visit. They had a comprehensive pre-admission assessment, provided by the placing authority, on file. This means that that the service user and their relatives can be reassured that the home has taken into account their individual needs, and feels that it can meet them; and the staff in the home can be as familiar as possible with new service users, and have an understanding of what specific service they will need to provide. EVIDENCE: Prior to this inspection a copy of the revised Service User Guide was sent to the local CSCI office. It now contains all of the information required in the Regulations. As mentioned above, the new service user had undergone a detailed assessment prior to being admitted to Scott House. This was supplemented by a needs assessment, carried out after admission, an introduction to the home, and a care plan. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 9 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 standard(s) 6, 7 and 9 The service user plans seen adequately covered the health, personal and social care needs of the service users. This means that the staff team are aware of the differing needs of their residents, and know what specific care needs to be given. The Inspector was satisfied that the service users were encouraged to make decisions about their lives, with staff assistance where necessary. While staff were able to discuss potential risks to individual service users, little was documented. The Inspector was not satisfied, therefore, that staff had fully risk assessed each service user, or that the service users were being supported to take risks as part of an independent lifestyle. EVIDENCE: The proprietor, acting deputy and the senior carer responsible for monitoring service use plans kindly spent time explaining the revised plans that were now in operation. Staff were now being asked, in conjunction with the service users and their relatives, to identify both ‘needs’ and ‘wants’, and them to draw up a plan to outline achievable goals and the action that needed to be taken. These actions are then transferred to an activities board, which is revised on a weekly Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 10 basis. Each service user has an identified keyworker who takes responsibility for the entirety of that service user’s care. This includes ensuring with colleagues that action plans are followed even when the keyworker is not on duty. Although still in its infancy, this new system had started to produce results. This is in part due to a reduction in the number of identified goals, so that service users are not bombarded with action plans, but can focus on one or two issues at a time. The service users, from their comments both to the Inspector and to staff as they were passing the office, showed that they were actively involved in their plan of care. While staff were able to talk about possible risks to service users, particularly with regard to activities, they had not, with few exceptions, actually recorded any risk assessments. Those that were recorded were concerned only with the risk of fire due to smoking in bedrooms. It is important that each service user has a clear risk assessment, both for their protection and the protection of other residents, staff and the community at large. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 11 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 standard(s) 12, 13, 15, 16 and 17 The home has reviewed its external activities programme and as a result more options have been made available to service users. The Inspector was satisfied, both from looking at the new programme and in talking with service users, that they were able to take part in appropriate activities and be part of the local community. The level of contact with family and friends varies considerably. Some of the service users are fortunate to have relatives who do keep in touch and visit, but others have little or no contact with friends/family or associates outside of the home. Nevertheless, contact with family and friends is supported and encouraged. The Inspector was satisfied that staff respected service users’ rights, and encouraged them to take responsibility for their daily lives. This interaction could be improved, however, by increasing the frequency of residents’ meetings. While the main (evening) meal of the day was not sampled, service users commented that the food was always good, and none raised any issues. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 12 EVIDENCE: Almost all of the residents are able to go out independently, and do so on a regular basis. Most of them enjoy going out with staff and participation in community-based activities is encouraged and supported. Several of the residents attend a local day centre. While at times it can be difficult to engage residents in fulfilling activities; nevertheless, the staff team gives persistent encouragement. It appeared, from the records, that service user meetings were held on an infrequent basis. It will be recommended that these be held more often, so as to offer service users more opportunity to be involved in the day-to-day running of the home. A number of service users kindly took the time to speak with the Inspector, and 12 pre-inspection questionnaires were returned. With one exception, all commented positively about the home. One relative raised a number of concerns, which were investigated as part of the inspection, but were not substantiated. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 13 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 standard(s) 18, 19 and 20 From observing the interaction between the staff and the service users, and having also talked to a number of service users, it was evident that they felt that they were being treated with respect and that they received personal support in the way that they preferred. Staff ensure that each resident is able to access community based health facilities as and when required. The Inspector was satisfied that service users were adequately protected by the home’s policies and procedures re medication, and service users are encouraged to self medicate wherever possible. EVIDENCE: The service users spoken with were full of praise for the staff team. They felt that they were well looked after, but were also given the opportunity to be involved in their care and make decisions, including how they received personal support, for themselves. To the extent that community based services are available for this client group, staff do all they can to enable the residents to access it. The proprietor again raised concerns at the lack of consistent clinical support for the mentally ill. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 14 The medication administration records were examined. In general they were much improved from the last visit, with no errors noted. There were two queries raised by the Inspector regarding terminology used and the appropriateness of some of the codes being entered. The senior member of staff responsible for medication documentation stated that the latter issue had already been raised with the staff concerned, and resolved, while in future more attention would be paid to the phrases staff used to record information. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 15 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 standard(s) 22 and 23 The home has a satisfactory complaints procedure in place, which is accessible to service users. There was also a satisfactory adult protection procedure in place which, if followed by staff, will offer sufficient protection to service users. EVIDENCE: One complaint had been made in the home since the last inspection. Investigation into this was still in progress. Concerns were expressed to the Commission shortly before this inspection visit regarding Scott House. These concerns were looked at in conjunction with the inspection and discussed with the proprietor and acting deputy manager. While none of the concerns could be wholly substantiated, the points raised were, nevertheless, taken on board by the aforementioned staff. The acting deputy manager has attended a POVA training course, and other staff are due to attend one in the near future. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 16 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 standard(s) 24, 26, 27 and 30 A tour was made of the areas of the home which had been previously identified as needing attention. Several minor issues were found however the vast majority of the home was in a good state of repair, and once these issues have been dealt with, the home will fully meet the need to provide a safe and wellmaintained environment. EVIDENCE: The last inspection report contained 16 requirements regarding the premises. It was pleasing to note that action had been taken with regard to all of them and while two remain ongoing, the improvements made to the environment generally were noticeable. As mentioned above, on this visit only the parts of the home where there had been concerns previously were inspected. Just two new requirements have been made. One concerns the need to replace an armchair in one bedroom, while the other relates to the need to replace the carpet, repair a small hole in the wall and take steps to remove a noticeable odour in another bedroom. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34, 35 and 36 Gaps were found in recruitment documentation, which means that new staff are not properly vetted before being appointed. This places the service users at unnecessary risk. Progress had been made with regard to staff training, although the previously made requirement re the need for all staff to have an individual training profile, and the home to have a training and development plan has yet to be met. This means that it is possible that not all staff will receive appropriate training, which in turn will have an impact on service users. Staff were not being supervised to the level recommended in the Standards, albeit improvements have been made. This means that there is more possibility that the quality of care being provided is not always as it should be. EVIDENCE: Checks were made of the files of 5 staff employed since the last inspection. It was evident that not all had had CRB/POVA checks carried out prior to commencing work. Additionally, one had only supplied one reference, while there was no evidence of visas/work permits for three of the five. The need for immediate improvement was made clear to the proprietor. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 18 One member of staff is to be congratulated for recently completing her NVQ II award. Two staff are due to start NVQ III courses shortly, one and NVQ II course while the acting deputy manager will shortly start a level IV course. Staff have been enabled to attend a variety of in-house training courses, however the need for each member of staff have an individual training profile, and the home to have a training and development plan has yet to be met. The proprietor, in the absence of a registered manager, has been spending some considerable time in the home, and has commenced regular supervision and appraisals with the senior staff. In time this will then be expanded to include all staff. One all members of the care staff team are receiving regular supervision the home will meet the good practice outlined in the Standards. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41 and 42 The Inspector was not fully satisfied that the home was being run in the best interests of the service users as the quality assurance system had not yet been implemented, albeit it was now in place. The home’s policies and procedures, and records (with the exception of those relating to fire, mentioned below), were being regularly updated and maintained, thus promoting the welfare of the service users. Gaps in the testing of fire alarms, and no documented evidence of staff fire safety training, indicated that the home was not being maintained to an appropriate level of safety, thus putting service users at risk. EVIDENCE: The home has now put in place a quality assurance system, which, when fully operational, will enable the management to identify any areas where the Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 20 service is sub-standard and then, hopefully, take action to improve it. Ultimately this will mean that the home is run in the best interests of the service users. The proprietors must ensure that they visit to the home on a monthly basis and produce a report of each visit, in accordance with the Regulations. The owners of Scott House also own two other homes, and the manager of one of these had been given the lead responsibility for ensuring that the policies and procedures are regularly reviewed and updated. Of the records that were checked on this visit, only the fire alarm test record was unsatisfactory. It showed that there were a number of occasions when the alarms had not been tested on a weekly basis. Assurances were given that staff received regular training in fire safety however there was no documented evidence of this. At present, Scott House is with out a registered manager. While the day-to-day running of the home is being overseen by one of the proprietors, this situation cannot continue indefinitely. A new manager must be recruited so that the home is operating within the Regulations. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 3 x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x x x 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Scott House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 2 3 3 2 x G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 22 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 9 Regulation 13 Requirement Risk assessments must be carried out for all service users. These should be documented and regularly reviewed. Exposed hot water pipes and earth wiring underneath bedroom vanity units should be boxed in. On a rolling basis, the proprietors must continue with their programme of replacing bedroom furniture. A new armchair is required for bedroom 16. One bedroom (identified to staff) requires a new carpet, the small hole in the wall behind the door requires repair and steps must be taken to remove the odour in this room. New staff must supply all of the documentation listed in the Regulations prior to commencing work at the home. A training and development plan must be put in place, as must individual training profiles for staf. The previously set timescale for this requirement has not been met. All care staff must receive Timescale for action 30/9/05 2. 24 23 30/9/05 3. 26 16 18/7/05 4. 5. 26 26/30 16 16, 23 30/9/05 30/9/05 6. 34 19 18/7/05 7. 35 18 30/9/05 8. 36 19 18/7/05 Page 23 Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 9. 39 24 10. 42 23 supervision on a regular, formal basis and this should be recorded. An appropriate quality assurance system must be implemented in the home. The previously set timescale for this requirement has not been fully met however it has been partially met. Fire alarms must be tested on a weekly basis, and record of staff fire safety training must be maintained. 30/9/05 18/7/05 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 16 Good Practice Recommendations It would be good practice to hold service user meetings on a regular and frequent basis. Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP 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. Extracts may not be used or reproduced without the express permission of CSCI Scott House G53-G53 S25834 scotthouse V198481 180705 stage 4.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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