Inspection on 21/09/05 for St Andrew`s Home

This inspection was carried out on 21st September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Andrew`s Home 25/07/06

St Andrew`s Home 09/02/06

St Andrew`s Home 28/01/05

St Andrew`s Home 10/09/04

St Andrew`s Home 11/03/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 St Andrew`s Home 92 Drewstead Road Streatham London SW2 1AG Lead Inspector Lynne Field Unannounced Inspection 21st September 2005 10:00 DS0000022753.V251557.R01.S.doc Version 5.0 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 DS0000022753.V251557.R01.S.doc Version 5.0 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. DS0000022753.V251557.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Andrew`s Home Address 92 Drewstead Road Streatham London SW2 1AG 0208-769-0668 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) Crown Wise Limited Ms Ruma Devi Luckeenarain Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) DS0000022753.V251557.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. up to three persons only can be aged 65 years and above Date of last inspection 28th January 2005 Brief Description of the Service: St Andrews Home is a private eight bedded home for adults with mental health problems, which was first registered in January 1995. The home is in a residential street near a park, within walking distance of Streatham High Road with all its transport and other facilities. It is decorated and furnished to a high standard. The majority of service users have been at the home since it first registered and it was originally registered for adults with a mental disorder under 65 years. When three service users became over this age, the home applied for a variance to its registration and the registration certificate has been amended to reflect that the home can accommodate up to three service users with mental health problems who are over 65 years of age. The home provides service users with the various degrees of support that they need with daily living. Where appropriate, the home also helps to prepare service users for more independent living, although it is recognised that for some of the service users, this may not be possible due to the extent of their mental health problems. At the time of the inspection there were no vacancies. DS0000022753.V251557.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and was carried out in one day on the 21st September 2005. The acting manager and registered provider were present and took part in the inspection process. The inspector interviewed two staff individually. One of whom had recently started to work at the home. She told the inspector about the induction training she had received. The acting manager spoke about wanting to continue in the position of acting manager till she had completed her NVQ Level 4, which she felt would help give her more confidence to apply to become the registered manager position. Six service users were spoken to individually. One at great length about the complaints she had made to the home, which she said had been treated seriously and the outcome was satisfactory. The inspector was invited to join the service users for lunch. The food was tasty and nutritious and service users said they enjoyed their meals. The inspection included a tour of the home and examination of records on care plans, staff records and building maintenance records. During the inspection staff interaction with service users was observed to be very regular and conducted in a respectful manner. What the service does well: What has improved since the last inspection? What they could do better: DS0000022753.V251557.R01.S.doc Version 5.0 Page 6 Not all the last requirements given at the last inspection had been fully met. For example, the medication policy needs to be reviewed. Recruitment procedures need to be followed when employing new staff. 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. DS0000022753.V251557.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022753.V251557.R01.S.doc Version 5.0 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 the following standard(s): 1-5 Prospective service users’ needs and aspirations are assessed in such a way that a service tailored to their needs is provided. EVIDENCE: The registered provider has forwarded copies of the Statement of Purpose and Service Users’ Guide had been produced in line with requirements from the previous inspection to the CSCI. Both of these documents are comprehensive and meet the requirements of the regulation. The inspector saw copies of these documents, which are given to service users when they come into the home, kept in a file in their bedroom, with other relevant information about the home. The service user and the registered provider had signed the service users agreement. This was shown to the inspector. The registered provider told the Inspector that placements are made on the basis of a full needs led assessment from the placing authority. The Inspector was shown records of the latest service user and noted there was on file a social care and mental health assessment. DS0000022753.V251557.R01.S.doc Version 5.0 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 the following standard(s): 6,7,8,9 Families and professionals are involved when reviews are held. Care plans are thorough and reflect service users’ needs and goals. Service users participation in the running of the home has been encouraged where feasible, though not all service users do this. Risk assessment reviews take place and are recorded. EVIDENCE: Three service user files were inspected. Care plans give a thorough description of service users’ behaviours, reactions and preferences and how the service user was to be treated. Care plans are reviewed six monthly or more regularly if needed and monthly for the service users over the age of 65. Detailed and regular charts are kept of service users’ behaviours, household and community activities and contracts. The inspector viewed individual risk assessments, which had been carried out, monitored and reviewed by the staff with service users every six months or when the need arises. Details of any changes to the risks are recorded in the service users care plans. DS0000022753.V251557.R01.S.doc Version 5.0 Page 10 The inspector saw evidence in the form of a placement meeting report, that placement review meeting are being held with care managers and include the service users family. The inspector spoke to a community psychiatric nurse during the inspection, who said he came into the home on a regular basis to monitor the mental health of the service users and would put a “crisis plan” in place if this were necessary. One service user has one-to-one sessions, which are recorded, on their file, for therapeutic interaction and information collected and recorded for the behavioural status of the service user, both of which is overseen by the mental health team. DS0000022753.V251557.R01.S.doc Version 5.0 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 the following standard(s): 11,12,13,14,15,16,17 Service users are able to take part in age, peer and culturally appropriate activities, leisure activities and are part of their local community. They are actively encouraged to develop daily living and social skills by the registered provider and staff of the home. They are able to maintain relationships with friends and family. Meals are varied and enjoyed by service users. A healthy diet is provided and mealtimes are relaxed and flexibly timed to fit in with individual activity plans. EVIDENCE: The registered provider told the inspector that service users are encouraged to make decisions concerning their daily activities. DS0000022753.V251557.R01.S.doc Version 5.0 Page 12 Service users have an individual activities programme, which is discussed and agreed with their key worker. One service user said that she was able to choose activities she enjoyed doing and told the inspector she sometimes goes out alone or at other times, goes out with another service user for walks. At other times she will go to the local café for a cup of coffee or tea although she could always make a drink or have a snack in the home she said it was nice to go out. Another service user described how her brother and sister keep in touch by taking her out and at times she goes to stay with her sister for a holiday. The inspector joined the service users for their lunchtime meal. Service users said they enjoyed the food served at the home. They said they decided what was on the menu with the staff. They could choose from the menu or if there was not anything they wanted on the menu that day, the staff would make them something of their choice. Service users said there was plenty of food to eat. The inspector was shown the book where the meals are recorded along with a record of the temperature taken of the food before it is served. DS0000022753.V251557.R01.S.doc Version 5.0 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 the following standard(s): 18,19,20,21 Service users receive personal support, in the way they prefer. Medication is being handled safely. Ageing, illness and ascertaining service users wishes in the event of the death is being handled with sensitivity and respect by the registered manager at a time appropriate to the service user. EVIDENCE: Care files contain information for staff on service users who need personal support with their preferred personal care routines and details of how much help an individual requires with different personal care tasks. A key worker system is in operation, with each service user having a member of staff from within the team to co-ordinate their support and care planning. The record of health appointments attended indicated that each service user is supported by staff if this is what the service user requires, to attend an appropriate range of healthcare appointments in line with their individual healthcare needs. Service user medication is stored securely in a locked medication cabinet in the staff office. DS0000022753.V251557.R01.S.doc Version 5.0 Page 14 Staff induction includes medication training and medication administration records. Information about the medications in use and medication stocks checked is in order. Since the last inspection the inspector was shown the medication audit that has been set up and is done weekly. The registered provider told the inspector the medication policy still needed to be reviewed and updated. The registered provider said she has tactfully discussed issues of illness and death with the family members of the majority of service users, but acknowledges some families do not want to discuss this issue and if this is the case will try to find the right time to approach the family. Information recorded on the service users file as to who needs to be informed and what arrangements will be made. DS0000022753.V251557.R01.S.doc Version 5.0 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 the following standard(s): 22,23 Service user’s views are listened to and acted upon and there are safeguards in place to protect them from abuse, neglect and self-harm. EVIDENCE: The home has a complaints policy, a copy of which is in the service users’ guide. The inspector noted that in the minutes of a service users meeting there had been a discussion reminding service users they are entitled to complain about what ever they want and how complaints can help improve the service. The inspector saw the complaints book and there were seven complaints since the last inspection. Six were from one service user. All complaints had been treated seriously and had been dealt with appropriately. The service user concerned told the inspector she was happy with how the complaints had been dealt with. For instance, on one occasion she said she had complained she had not wanted to do her care plan. The staff had explained to her she did not have to help with the care plan but it would help the staff meet her needs if she assisted in her care planning. There is an adult protection policy and procedure in the home as well as a copy of the local authorities POVA policy and procedure. The two staff told the inspector they are aware of abuse and protection policy and how to deal with cases of suspected abuse by reporting any suspicions to the registered provider to deal with. The registered provider would investigate the suspicions following the homes policy and procedures. The home safeguards service user finances with appropriate recording systems. The inspector was told each service user has a finance book in which DS0000022753.V251557.R01.S.doc Version 5.0 Page 16 all financial transactions are recorded and signed by the service user and the member of staff. Four were inspected and were found to be in order. The inspector spoke to service users who confirmed they get their money weekly. DS0000022753.V251557.R01.S.doc Version 5.0 Page 17 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): 24,25,26,27,28,30 The home is bright, clean, comfortable and safe. Service users rooms are comfortable and are decorated to reflect their personalities. The ground floor communal areas and bedroom are accessible to people with mobility needs. EVIDENCE: The home is laid out over three floors and is well decorated and well furnished. The home has a large dining room leading on to a large lounge/conservatory room at the back of the house, which over looks the garden; this acts as the main lounge. There is a small kitchen area where service users are able to make themselves a drink or light snacks. There is a personal computer available for use by the service users. The conservatory leads on to the garden, which has recently been landscaped to provide a patio area with a barbeque, secluded out door seating area and water feature. Both rooms were well used on the day of the inspection. DS0000022753.V251557.R01.S.doc Version 5.0 Page 18 The only access to the upper floors is by the staircase. The home is unsuitable for service users with impaired mobility, except the ground floor. One service user with restricted mobility has been allocated a bedroom on the ground floor with en-suite facilities. All necessary equipment and adaptations were in place to meet the users needs at the present time. Bedrooms are personalised, reflect the taste and interests of the service user and have a wash hand basin. Service users said they are happy with their bedrooms. There is a facility in each bedroom for receiving incoming telephone calls. There is a separate toilet for visitors, service users and staff on the ground floor and two other toilets and a bathroom on the next two floors. There is a laundry, which is next to the kitchen, has a washing machine and a dryer. There is a sink installed for clothes that need to be hand washed. Service users told the inspector they were assisted by the staff to do their washing and one service user said they enjoyed doing the ironing. DS0000022753.V251557.R01.S.doc Version 5.0 Page 19 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): 31,32,33,34,35 The home is supported by an effective staff team in that some long term staff are employed who know the service users well. The policy relating to the recruitment of staff needs to be revised. Recruitment practices need to be more robust as some checks were incomplete. EVIDENCE: The inspector spoke to a new member of staff who recently started working at the home and the inspector was told the induction training programme had included fire training, care planning, key working and listening skills. Her staff file was inspected. All the relevant checks had been completed and were in the file apart from the CRB check, this had been applied for and the member of staff had received their copy but not the home. A copy of the CRB check has since been sent to CSCI. The registered provider must make sure that the disclosure requirements with regard to CRB checks are adhered to. Five staff files were examined. These included two written references as required and a file of checks with the Criminal Records Bureau was kept separately. However, none of the files included records of an interview to evidence that recruitment procedures are in accordance with equal opportunities policies. DS0000022753.V251557.R01.S.doc Version 5.0 Page 20 Throughout the inspection the inspector observed staff interacting with service users and the qualities seen included good listening skills, a calm and confident manner, and a good grasp of the basic areas of need they needed to meet, including communication. Four members of staff are taking an NVQ Level 2 or 3. The registered provider stated that it is planned for all staff to be qualified to at least NVQ level 2. A senior member of staff, who is the acting manager, is taking NVQ qualification at Level 4, with the view to her becoming the registered manager when she completes this. There are two staff on duty each morning and service users have enough staff for them to follow individual planned activities in and out of the home, and for their basic needs to be met. Service users were generally positive about the staff. There is a key worker system though service users said that they could speak to any staff. Service users told the inspector “this is a good place to live” and “the staff are very friendly and helpful”. DS0000022753.V251557.R01.S.doc Version 5.0 Page 21 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): 37,38,40,41,42 Service users know the home is well managed and planned. The health, safety and welfare of service users is promoted and protected. EVIDENCE: Currently the registered provider for the organisation is also the registered manager for this home. This has been the arrangement for some time now and has been identified as inappropriate at previous inspections. The registered provider has continued to attempt to recruit a manager but has been unsuccessful. She has kept the Commission informed of her progress as required from previous inspections and now has a plan to develop one longterm member of staff into the role of registered manager. The deputy member of staff has been acting manager following a successful interview, for nearly eight months. DS0000022753.V251557.R01.S.doc Version 5.0 Page 22 The registered provider is satisfied that they are able to undertake the post but because of personal reservations, the acting manager has asked if she can continue in the role as acting manager to gain further experience before being interviewed again with a view to taking on the role permanently. The acting manager is in the process of taking NVQ level 4. The registered provider and acting manager have overseen an improvement in the quality of care since the last inspection, reflected in improved record keeping. The position of the registered manager must be reviewed. The acting manager must be given support and her training needs assessed to help her make a decision about her capabilities of becoming the registered manager. Staff encouraged service users to speak to the inspector in private to give their views on the home. Service users confirmed that their views are taken into account and one service user said, “It’s a well run home”. The registered provider has been conducting monthly, unannounced visits to review the service and copies of the reports have been sent to CSCI to evidence the provider’s monitoring of the service. Records indicated that all fire and electrical systems and equipment in the home are serviced and inspected appropriately and that all internal checks are conducted at appropriate intervals. DS0000022753.V251557.R01.S.doc Version 5.0 Page 23 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 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 3 3 x DS0000022753.V251557.R01.S.doc Version 5.0 Page 24 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 Timescale for action 31/12/05 2 YA34 13 (6) 19 3 YA38 18(2) The registered person must ensure that the medication policy is comprehensive and includes all necessary procedures for staff. The registered person must 31/12/05 ensure that the recruitment policy is revised to include the specific checks that will be required from prospective staff prior to being employed such as CRB checks, POVA checks and an occupational health check or personal health statement. The registered person must 31/12/05 ensure that the acting manager working at the home receives training appropriate to enable their professional development. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000022753.V251557.R01.S.doc Version 5.0 Page 25 DS0000022753.V251557.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000022753.V251557.R01.S.doc Version 5.0 Page 27 - 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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