Inspection on 04/11/05 for St Helier Avenue (374)

This inspection was carried out on 4th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Helier Avenue (374) 24/09/07

St Helier Avenue (374) 09/02/07

St Helier Avenue (374) 27/01/06

St Helier Avenue (374) 07/02/05

St Helier Avenue (374) 12/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 St Helier Avenue (374) 374 St Helier Avenue Morden Surrey SM4 6JU Lead Inspector David Pennells Unannounced Inspection 12:00 4 November 2005 th St Helier Avenue (374) DS0000007157.V254388.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 St Helier Avenue (374) DS0000007157.V254388.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. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service St Helier Avenue (374) Address 374 St Helier Avenue Morden Surrey SM4 6JU 020 8648 0661 020 8646 4165 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) www.caremanagementgroup.com Care Management Group Limited Mr Craig Anderson Care Home 8 Category(ies) of Learning disability (8) registration, with number of places St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents with challenging behaviour A variation has been granted to allow one specified service user under the age of 18 to be accommodated subject to meeting the following conditions: (1) Amendments to the home`s statement of purpose to describe arrangements to provide for the young person`s needs. (2) The manager must ensure that a copy of the local Area Child Protection Committee procedures is kept in the home and that all staff read, understand and are knowledgeable about these procedures. (3) The manager must ensure all staff, including agency staff, receive appropriate training. This training must be included in staff`s induction and be ongoing for all staff. (4) The home must have a policy on countering bullying. (5) Staff in charge of young people must be at least 21 years of age. 7th February 2005 Date of last inspection Brief Description of the Service: 374, St Helier Avenue is managed, maintained and staffed by the Care Management Group (CMG). The care home is registered with the Commission to provide residential care for up to eight adults with learning disabilities and associated challenging behaviours. The home itself is a large detached brick built house converted to its current use in 1999. Situated close to the ‘Rose Hill’ roundabout on the A297 at its junction with the A217, the home is conveniently situated close to a variety of local shops, eating establishments and bus links. There is a hardstanding at the front of the home for parking a few vehicles and a large garden with a patio at the rear. Extra free ‘on street’ parking is available nearby on the designated dual carriageway verges. Accommodation within the home comprises of six single bedrooms located over two floors in the main building and two self-contained flatlets attached to either side of the property. The communal facilities include a large dining room, a separate comfortable lounge area, a conservatory at the rear of the house overlooking a pleasant back garden, a well-organised kitchen, and a laundry room. There are sufficient numbers of bathroom / shower and toilet facilities located throughout the home to meet most service users needs. Two flatlets are provided with en-suite bathrooms and both have small kitchenettes. In addition, there is a staff sleeping-in room and an office on the first floor. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector spent a lunchtime, afternoon and early evening at the home, firstly just engaging with service users, then with the area manager for the home who was visiting that morning, and then with the manager reviewing requirements and recommendations from the previous inspection report. The inspector then spent a little more time with service users and staff members prior to leaving the home in the early evening, following sharing the weekly ‘takeaway meal’ with them. The inspector is grateful to the service users, staff and management staff for their cooperation and hospitality shown to him. What the service does well: What has improved since the last inspection? Staff retention has been noted to improve; the new manager – who sadly is leaving the post before the end of the year – has developed a more relaxed feel to the establishment; the ambience of the home is clearly warm and appeared happy and content. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 6 A number of developments were noted since the last inspection visit: the dangerously uneven paving slabs on the patio have been levelled, a new sluice–cycle washing machine has been installed and staff lockers have been provided. The office is also safer now, with new shelving installed. Policies and procedures have been updated and all regular servicing and maintenance contracts were in place and up-to-date. What they could do better: The inspector has required a new Selection Criteria to be established for the home – especially for the independent living flatlets – this to address concerns about inappropriate placements more recently experienced at the home. A greater focus on assessment and the introduction of prospective service users is also necessary. The absence of a single risk assessment pertinent to the special needs of a service user was identified, and the need for the home to ensure that documentation relating to service users is securely stored remains an outstanding issue. A need identified to provide a safe for the enhanced security of service user’s personal items held by the home in safekeeping leads to a requirement to obtain such a safe; the area manager sanctioned the action in this regard on the day of the inspection visit. An audit of the medication practices undertaken at the home revealed a need to ‘tighten up’ procedures and to ensure best practice in both recording and providing information to staff involved – especially relating to ‘prn’ (‘when required’) medication. Premises issues cover a requirement to reinstate an inoperative toilet on the first floor, and to ensure that the extractor fan systems provided in the laundry and a toilet are adequate. Under the standard’s health and safety heading a number of concerns – all rectifiable - are raised, including one specific issue – the risk of burns from radiator surfaces – being made the subject of an immediate requirement Notice served on the home that day – on the basis of an assessment of risk bearing in mind the frailty of service users currently using the home. Other health and safety issues included requirements around recording fire checks, fire drills (ensuring all staff are regularly drilled), the provision of more electrical sockets in the flatlets and also in these areas, exploring the possibility of providing emergency lights therein. A final requirement reiterated from the last report is that the home must hold a business and financial plan – clearly showing the development of the service over time and evidencing financial viability. Despite the home receiving sixteen requirements, the service was running generally well and the service users were well and happy. It is to be hoped that the issues raised will be addressed swiftly, enabling the home to ‘ride the storm’ of the time when the home will be without a full-time designated manager. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 7 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. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 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 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, & 3, The home provides service users & other interested parties with full details to enable them to make an informed choice about choosing to live at the home. Service user’s needs and aspirations are assessed, understood and implemented at the home – through the thorough and considered exploration of behaviours, wishes and needs, fully including the service user’s views. EVIDENCE: The home’s Statement of Purpose now has a clear statement as to staff members’ qualifications and experience. The Statement of Purpose / Handbook is a good readable comprehensive document. Service users also have access to copies of the home’s handbook / Service User Guide, which they can keep; the document is presented in formats suitable for the people for whom the service is intended (with appropriate language / pictures / symbols / etc…). Charges (currently ranging from £1100 - £1700 p.w.) are dependent on each specific contract agreed with the placing / funding authority, reflecting a service user’s individual needs; for instance, one service user receives a large number of dedicated hours of 1:1 staff input, which clearly adds a ‘premium’ to the basic charge. Additional charges cover items such as toiletries, magazines and additional activities. Hearing of a couple of the more recent placements in the independent living flatlets, the inspector has misgivings that the home is meeting the standard St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 10 requirements of Standard 3 – where it is explicitly stated that the suitability of a prospective service user should be assessed on a two-way basis – the home being fully involved, and agreeing that the service user’s needs can be fully met - before placement. The registered provider has an ‘Assessment Team’ who undertake assessments – but the inspector is forced to question whether their familiarity with both the house community and current operational status is sufficient when deciding on new placements. The two flatlets could almost be described as being ‘tacked on’ to the house – whilst being geographically associated with the home, the flats operate – to some extent – as independent ‘satellites’, though the ‘effect’ the placements can have on the main community can be significant at times. To address the above issues, a revised set of selection criteria is required to be developed for the home – especially those relating to the independent living units. The inspector is currently concerned about the level of service offered to some who use the ILU flatlets; and is not convinced that such a high level service can be provided in these small, relatively isolated, units. Preparation for such residence at the home clearly needs greater planning and transition work; the near ‘emergency admission’ nature of some recent placements causes the inspector concern. Staff opportunities for training have expanded - including covering mental health awareness - which is invaluable for staff working with this ‘challenging behaviour’ service user group. Such training should not, however give license to the home to ‘overstep’ the mark by introducing people who are more clearly requiring a service based on mental health skills rather than a learning disability focus – which is the primary registration category. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 The home creates and maintains care plans and assessment documents that are designed to ensure that the needs of service users are realistically met in a focused way. Service users can be assured that their rights to individuality and selfexpression are protected, whilst acknowledging the community aspect of living in a shared environment. Consultation and sharing of information will involve, and take into account, the wishes and aspirations of the service user. Service users can generally be assured that risk-taking will be an integral part of the support / protection plans put in place by the home, though ‘special needs’ require recognition and focused documentation. Service users and staff can be assured that the home is taking steps to ensure that information kept personally relating to them will be kept appropriately, in line with legislative requirements. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 12 EVIDENCE: Care plans are based on assessments that cover most aspects of service user’s personal, social and health care needs. Individual plans referred to service users likes / dislikes, strengths, and aspirations. Individual action plans evolved from these identified how service users would be supported to achieve their goals, and how progress would be reviewed. The home encourages service users to participate in their reviews by various means, including the imaginative use of creating video diaries. Care managers are involved in reviews at least on a yearly basis. The culture of the home encourages service users to be involved in all aspects of the daily life of the home; from the weekly encouragement to help cook an evening meal, to the individual requirement to keep their rooms tidy and clean, the focus continues on individual achievement - and communal respect. The general ambience of the home suggested that service users and staff got on well together – ‘understanding each other’ is vital in such a home. Service users do tend to respond to a 1:1 focus far more positively. The annual CMG service user day was held recently – this providing a Forum for service users to hear about good practice innovations and to share ideas for the future development of the homes. Service user’s care plans evidenced that staff members encourage service users to take ‘responsible / positive’ risks wherever possible - being based on risk assessments undertaken by the home. Assessments were generally in place for all service users, and covered various aspects of need, including personal hygiene, community presence, and behaviours likely to challenge. Each risk assessment identified the risk; possible consequences of risk; and action required to minimise it. One audit trail by the inspector showed that a risk assessment was absent in regard of a special need – for a service user’s special circumstances - a diagnosis of epilepsy. The manager was required to put in place an associated risk assessment immediately. The registered provider, CMG, is registered with the Information Commissioner under the Data Protection Act 1998. Staff files were also kept confidentially under lock and key - in the manager’s office. A requirement is made regarding service user files and all associated documentation – which must be kept under lock and key; this will safeguard the privacy and confidentiality of information held on each individual. The manager had previously agreed that a strategy for locking the ‘current’ documentation away in one of the kitchen cupboards (when it was not in direct use) would be devised; the kitchen cupboard, which housed the day-to-day documentation, was still not secure. A new filing cabinet - of a flat-pack construction - was to be built to house documents. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Service users can be assured that the service provides opportunities for them to engage in activities both within and outside the home, and to adopt a lifestyle suited to their individual needs and preferences. Relatives / friends can expect a positive welcome from the home, within the context of respect for a service user’s own choice and decision-making. Service users can expect to be provided with a good standard of nutritious and wholesome food, ensuring that mealtimes are a pleasant and enjoyable time. EVIDENCE: Service users are encouraged and supported to maintain and develop their independent living skills – aimed at enhancing communication and social and emotional contact. Service users take part in the daily life within the home, such as preparing breakfast for themselves, and drinks in the kitchen. ‘House activities’ such as simple domestic tasks - and preparing and serving food is also encouraged. Service users are encouraged to care for and clean their own rooms with the support of their key worker. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 14 Service users do not engage in any ‘formal’ educational input, due to their dependency levels / capability / behavioural presentations – however activities are greatly enjoyed both within and outside the home; these including cooking painting, and gardening at the home, and going to the cinema, bowling, swimming, trampoline-ing, and enjoying trips and meals out. Various social clubs and centres are also attended, including the local youth club, which the home now hires - every Wednesday morning, and whose facilities are enjoyed along with other CMG home service users from the local area. The people carrier is well used, taking people from the home to centres and other leisure opportunities. Some service users ‘just’ enjoy the opportunity for outings - the journey being more enjoyed than the destination - travelling in the house’s car can be very satisfying and non-challenging for some. Service users have opportunities to go on holiday – making a notional / nominal contribution, and also contribute financially to some special activities. The home actively seeks to encourage service users to maintain family links and friendships both inside and outside the home. It is evident – this being backed up by relative’s questionnaires received by the Commission - that visitors are always welcome at the home, and there are no restrictions on visiting times. Visitors may meet service users in the privacy of their bedrooms or in any of the home’s communal spaces, as they so wish. Within the parameters of everyday risk-assessment, there are very few restrictions within the home, apart from those agreed in specific care plans to promote an individual’s best interests (e.g. locked fridge policy). Service users have generally unrestricted access to the home and grounds, excepting the office and staff sleeping-in room. Most service users have been offered keys to their bedrooms, although only those users who occupy the self-contained flats would have their own front door keys. A key pad system is in place for the front door in the main part of the house based on an assessment of the likelihood of risk to service users; the road immediately outside the home is a dual carriageway - and therefore the risks are very high to any who may wander out. Service users help plan the weekly menus through the use of recipe book and visual aids, and are encouraged to help staff prepare the meals. Service users gain great satisfaction from being associated with the food provided; each of the seven helps prepare one meal during the week. Where the agreed communal choice is not desired, alternatives are offered, and a record of this is appropriately maintained. No service user is on a specific diet, but staff members actively encourage service users to make informed choices regarding healthy eating. Service users clearly enjoyed their food – mealtimes are made an ‘event’. The inspector concurs with this opinion, having enjoyed food with the service users on a number of occasions. Service users also particularly enjoy the ‘variety’ of a weekly ‘takeaway’ – which again is agreed corporately on the day. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 15 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. Service users can be assured that their personal, health care and emotional needs will be recognised and met by the home’s service input, through timely medical practitioner interventions, and through the home’s longer-term assessment and care planning programme. The systems adopted by the home regarding medication – once adjustments have been made to staff practice – will ensure the safety and consistent treatment and support for each service user. EVIDENCE: There is a good health care focus generally within the home. One General Practitioner is registered for all the service users at the home; four service users have active input from Dr McCarthy and the Psychiatric Team based at Orchard Hill, Carshalton. Other medical / health professional (opticians / dentists / chiropodists) are contacted as needed - and records of these appointments and outcomes are appropriately maintained. Staff members continued to appropriately maintain records of all accidents and the significant incidents that occurred in the home, these records being faxed to the Commission without delay - in correct accord with Regulation 37. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 16 Service users who present with difficulties are supported to access appropriate care and assessment from the appropriate team; this was the case at the time of the inspection visit when one service user was having great difficulty with living in community in a harmonious way. An incident was reported to the inspector the morning of the visit regarding an unprovoked attack on another service user. A policy and procedure with regard to understanding ‘pressure relief’ issues and addressing the issue of ‘continence’ have both now been provided in the home; this is particularly pertinent to the older service users, and now ensures that care staff members have appropriate guidance in these aspects of care practice. Inspection of the management of medication let the house down somewhat. A bottle of antibiotic liquid was found stored in the medicines cupboard when it should clearly have been kept refrigerated. Two doses of this liquid antibiotic had been missed (apparently) on ‘day three’ of the seven-day course. A ‘prn’ (‘when required’) dosage of medicine appeared to have become a regularised evening input although not written up by the GP / Psychiatrist. A transition from one psychotropic medicine to another prescribed by the psychiatrist had not been properly managed; the new ‘prn’ psychotropic prescription was not properly written up on the ‘prn’ usage / guidance chart, nor was the medication profile updated to clearly pass on the information about this medication change. Some removal of medication from the dispensed monitored dosage packs could also have lead to a possibility of error and mis-accounting / auditing; such actions should not be undertaken by staff, but the dispensing pharmacist. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 17 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 users can be confident that their comments and complaints are responded to, with appropriate action being taken in a timely fashion. The home provides adequate support to service users to ensure that they are protected from harm and any form of abuse. EVIDENCE: One complaint has been recently been received by the home from a service user’s advocate - and the Commission has been ‘kept in the loop’ of communication back from the registered provider showing that the home intends to take swift remedial action to address the variety of issues raised. The inspector’s observation is that the complaints [procedure is therefore available for use and produced appropriate action in response. It has been previously strongly recommended that the provider’s policy with regard to adult abuse be amended to accurately tie in the approach required locally under the jointly agreed London Borough of Sutton Vulnerable Adults Procedure Guidelines. The Council’s Vulnerable Adult Protection procedure was available in the home’s office. Most of the staff team have received training in the Vulnerable Adult policy & procedures. Physical intervention is only used as a ‘last resort’ and then only by staff that have been trained by CMG to manage aggression and conflict incidents appropriately through their ‘Dignified Management of Conflict’ training. Finances at the home are generally well managed. A safe must be provided within the home to ensure the safe storage of monies / cherished or significant valuables held on behalf of service users, and also releasing vital filing space. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 18 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 – 30. Service users can expect to live in a clean, warm and comfortable environment designed to meet their individual needs and providing adequate services and domestic facilities. Service users can be assured that, once the first floor toilet has been reinstated and health & safety aspects identified under Standard 42 are resolved, the home will be a safe environment in which to live, without unnecessary risk to service users. EVIDENCE: The home is suitable for its purpose, accessible, and brightly decorated to reflect the contemporary tastes of the service users. Furnishings and fittings were generally of good quality. The lounge area had more recently been decorated, and the furniture looked good. The dining area has robust furnishings, and an innovative ‘breakfast bar’ concept provides additional useful eating / work space in an under-used space within this room. One of the independent living flats is currently undergoing refurbishment; this due to the deterioration / damage to the fabric following occupation by the previous service user. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 19 There is ample space for all the home’s service users to sit together at meals in the dining room, if they so wish; the ILU service users are expected to selfcater as much as possible. The kitchen continued to appear clean and well equipped, and remains a popular ‘meeting area’. The lounge is also comfortably furnished. The home has a conservatory attached to the rear of the property, which is also popular with the service users. There is a well-maintained, safe garden; outdoor furniture is provided. The paving slabs at the rear leading from the kitchen have now been re-levelled and the intrusive tree root, which was causing the problem, dealt with. The home provides all single bedroom occupancy - which is really essential for this service user group - as well as meeting the NMS. Due to the age of the building the possibility of having ensuite facilities in the main building would be difficult. Information about the size of these rooms is included in the home’s Service User Guide, which assures the reader that each provides the occupant with at least 10 sq metres of useable floor space. The two single occupancy (independent living) flatlets either side of the main house both have their own en-suite bathrooms and cooking facilities. All the bedrooms and bathroom / toilet facilities have been supplied with a call bell alarm, which are tested on a weekly basis. Electromagnetic door holders are provided throughout the home to ensure the safe passage of service users, whilst ensuring the home is protected against fire. Staff lockers have now been provided; these are relatively unobtrusively situated by the front door in the hallway area. New shelving in the office has ensured safer working environment for staff. In the main building, there are sufficient numbers of toilet / bathroom / shower facilities (i.e. two baths, a shower, and four toilets to the six service users). Steps must be taken to urgently reinstate the single toilet facility on the first floor of the home; the current situation leaves only the toilet in the bathroom available upstairs - and someone bathing can often occupy this, leaving NO toilet provision on this floor. Of the current two toilets on the ground floor, one of these is ‘earmarked’ for use by a single service user with special needs. Extraction from the ground floor toilet and the laundry room must be urgently reviewed and stronger – and individual - extractors provided to both locations. Currently the laundry extractor fan appears to draw odours from the toilet through the laundry to the outside air; and when the extractor fan is not on, steam and odour from the laundry travels into the toilet – evidently the cause of the damp on the walls. This situation is unacceptable. Both rooms must be separately mechanically vented. The extractor fan in the upstairs bathroom was also noted to be inoperative. This also requires replacement / repair. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 20 The home was, however, generally clean and free from offensive odours throughout the time of the inspection. The home’s laundry facility is positioned on one of the corridors in the house, away from any areas were food is directly stored, prepared or eaten. Staff members support service users to do their own laundry on designated days. A sluice-cycle washing machine is now provided to ensure the correct and minimal handling of soiled garments and linen. Four service users are incontinent of urine, and one of faeces as well; infection control measures are in place to address these problems. Health & safety issues raised under that heading (Standard 42) relate to this section also, but require urgent attention and are therefore identified as safety issues specifically. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 21 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. Service users can be assured that they will be supported at all times by staff who are experienced and competent in their work, being provided in sufficient numbers to meet their identified needs. Service users can expect to be provided a service that generally ensures their safety and protection from abuse – though management vigilance is needed to ensure that full checks are undertaken using the (usually) thorough recruitment processes, and ongoing staff support arrangements. EVIDENCE: Staff job descriptions seen were comprehensive and linked to achieving each service user’s goals as identified in their care plans. Staff members are familiar with the Codes of Practice as set by the General Social Care Council; they have been issued with a copy of the Codes, which they have signed for. The manager is aware that 50 of care staff working in the home will need to have achieved a NVQ Level 2 in Care [or above] by the end of 2005, in order to meet this standard. There is a concern that this level of achievement will not be met within the timescale, due to certain difficulties within the training input from CMG, the parent company. A clear focus is required on this to aim to achieve the standard within the timescale. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 22 Just one full time worker has left the home’s employ this year; with two other part-time workers also leaving. Agency care input is not used – the home has a bank of reliable and familiar staff members who ‘plug the gaps’ (nine bank workers noted on a month’s rota – with four staff working consistently at the home). In the past eight weeks seventy shifts had been covered by bank workers, averaging out at eight or nine shifts covered each week by between two to five staff. The manager observed that stability within the staff team had, in general, much improved this year. Staffing levels are generally provided at a level of three staff in the house on both early and late shifts, and a 1:1 situation with the single ILU flatlet user maintained throughout the waking day. A member of staff sleeps-in at nights as well as there being an awake staff member on duty. The manager works supernumerary hours to the shift pattern, but may ‘fill in’ / ‘cover’ when necessary. The majority of the staff team have done training in Basic Food Hygiene, most (eleven) have a First Aid qualification, and a significant number have also done training in Health and Safety. Staff training more recently has covered: (showing numbers of staff involved in brackets): ‘Communication Skills’ (3), ‘Fire Safety’ (6), ‘Keyworking’ (4), ‘Dignified Management of Conflict’ (3), Supervision Skills’ (1) and ‘Appraisals’ (1). Six staff members – the seniors – are trained and undertake the administration of medication. It is CMG’s policy that new employees are not permitted to start work until two satisfactory references and all other checks have been confirmed. All new members of staff receive copies of their terms and conditions and a thorough documented induction process follows. The organisation ensures Criminal Records Bureau checks are carried out for all members of staff; documentary evidence confirming that the company had conducted these checks - and held the documentation of file centrally - were available to the inspector, and had been counterchecked by him - at CMG’s Head Office – quite recently. All new members of staff receive a structured induction within six weeks of their appointment and suitable records are kept, with new recruits signing and dating all documentation to confirm they have read them. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 23 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, 39, 40, 42 & 43. The home operates management systems that ensure that service users benefit from a well-run, competently managed environment. Service users can be assured that generally their rights and interests are well served and protected through the home’s approach to record keeping, policies & procedures, and the day-to-day conduct of the home. Service users can be assured that their welfare, health and safety is, in general, safeguarded through the home’s adherence to appropriate guidance and regulations concerning best safety practice, though a number of major issues arise for ‘one-off’ attention from this inspection. EVIDENCE: Mike Jerome, the manager, had previously been registered by this Commission in respect of another CMG care home and came to St Helier Avenue well recommended. Sadly for the home he has decided to move on – and the inspector was able to speak to the Area Manager (‘ROM’) Chris Knight about proposed management cover during the search for a new head of home. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 24 The inspector was pleased, therefore, to have this present opportunity to meet with the manager to assess progress since his arrival at the home, back at the beginning of the year. Mike Jerome’s attitude was still generally positive and determined to ensure a well-run environment for the eight service users resident at the home. The home certainly felt a lot ‘happier’ this year than last; the new management style has brought a greater sense of joint working and personality back into the home. Both the staff and service users are encouraged to participate in the day-today operation of the home and to voice their opinions through meetings, care plan reviews, the homes complaints procedure, and staff supervision. Staff meetings are held on a regular basis and the manager communicates a clear sense of direction and leadership that both staff and service users understand. A clear commitment to equal opportunities is evident at the home; staff and service users are respected for their cultural background / perspective and encouraged to bring their skills to bear on developing quality services / lifestyles at the home. The home contributes to the CMG Quality audits each year - and user representatives and staff members are invited to attend a meeting where the quality of input at the homes is discussed. The registered provider also regularly seeks service users and their relatives’ opinions on paper to elicit feedback about the quality of the service. It can also be confirmed by the inspector that reports compiled by the home’s Regional Operations Manager following monthly, unannounced visits to the home, are regularly being forwarded to the Commission, in accordance with the Care Homes Regulation 26. The home’s policies and procedural guidance are written and developed by CMG - and cover a myriad of topics to meet the NMS for homes for Younger Adults, under general headings of: Mission Statement / Staff Policies / Service Management / Service & Care Delivery / Health & Safety / Residents Welfare, and Emergency Procedures. The examination of Health & Safety areas in the home brought forth a number of areas for attention. Checks of the fire alarm test records suggested that the two ILU flatlets had not been included in the regular break glass checks conducted by the home; so that whilst now being conducted regularly, only four out of the possible six were actually being monitored. A previous requirement that ALL Fire alarm break glasses must be individually identifiable (by numbering) – including the ILU flatlets - and systematic records of tests against these must be kept is reiterated. A second related requirement that sufficient fire drills be held to ensure that all staff members at the home are regularly involved in such an St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 25 event was also reiterated; a matrix recording system is needed to monitor regular annual involvement by each staff member; only eight of the thirteen care staff had experienced a drill over the past four drills – in a space of eleven months. A previous requirement (over two inspection visits) that radiator covers must be installed throughout the house to ensure the safety of service users had not been met. It had been required that priority be given to bathrooms / toilets and bedrooms - and the remainder must be covered thereafter. Other than one cover provided in the ILU flatlet - which was being refurbished (and therefore not in use), no covers had been provided. During this present inspection visit, one bed was found to be aligned alongside a long radiator surface, and another had its foot end close by such a potentially very hot surface. An Immediate Requirement Notice was therefore served on the registered provider: this required that heaters in high risk areas should be turned off until covered, that staff must remain vigilant that such heaters do not get turned back on, that the registered provider provide the Commission with a timescale to show how they will address this issue – to ensure the safety of service users – with priority being given to bathroom / toilet and bedroom areas first (where total skin exposure is possible) - and the reminder to be covered urgently thereafter. Work to address these issues continues at the point of writing this report. Another area of risk already identified by the home leads the inspector to strongly recommended that the marble fireplace surround and mantelpiece (currently clad in foam) be removed - to remove the possibility of harm to service users – especially those with compromised mobility, or a liability to experience a fit. The provision of electrical sockets particularly in the independent living flatlets must be renewed and increased – to avoid the current situation of heavily overloaded extension cables being used. The safety of service users will also be severely compromised if the front garden area is not more securely secured and protected; the provision of a garden gate and reasonable protection from the road - through adequate fencing / walls - is required, to ensure that service users are immediately protected from the risk of this busy dual carriageway at all times. The home is also required to explore the issue of the apparent absence of emergency lighting both within and from the independent living flatlets; in case of an emergency, the need to provide guidance to a safe passage through their flats and out and away from the home is clearly a high priority. The above catalogue of health and safety issues could lead one to believe that no attention is given to such vital areas. This is not the case generally, and the St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 26 inspector is able to report that most regular servicing and maintenance needs concerning services and equipment at the home were in place and up to date; it is reassuring that, despite the above catalogue of health and safety concerns, the home’s general routine operational status is safe. The CMG management of the service clearly ensures the overarching management, the financial viability and accountability of the home. Regular visits to the home by the Company’s area manager (‘Regional Operations Manager’), Chris Knight, ensure that the home is monitored and ‘kept on track’ with regard to the ongoing care processes and regulatory requirements. Lines of accountability within, and beyond the home, were clear. CMG also employs staff in ‘human resources’ and ‘staff training’. There was not a copy of the CMG Company’s Business, Financial & Development Plan available; this should be available at the home to assist the manager, and also for inspection purposes. The manager again confirmed that he is given a budget to run the home; this enabling the service to be responsive to the often very specific identified needs of the service users. St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 27 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 2 X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 2 2 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 1 3 3 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 St Helier Avenue (374) Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X 1 2 DS0000007157.V254388.R01.S.doc Version 5.0 Page 28 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA3 Regulation 4(1) & 6 Requirement A revised set of selection criteria are required to be developed for the home – especially for the independent living units; recent inappropriate admissions have left the staff and (possibly) the selected service user in a ‘failure situation’. Risk assessments relating to specific conditions (such as epilepsy and the possibility of fits) must be recognised and a full risk assessment be put in place to address this issue specifically. Service user files and all associated documentation must be kept under lock and key within the locked offices; this will safeguard the privacy and confidentiality of information held on each individual. (Timescale of 30.09.04 & 30.05.05 not met.) Timescale for action 15/01/06 2 YA9 13(4) 07/11/05 3 YA10 17(1)(b) 30/12/05 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 29 4 YA20 13(2) All medication must be correctly stored according to the pharmacist’s / manufacturer’s instructions; items needing refrigeration must be duly stored safely & correctly. 04/11/05 5 YA20 13(2) Medication provided by the 04/11/05 pharmacist must never be tampered with – this negates the line of responsibility and severely compromises the staff. Medication profiles must be kept updated at all times, to ensure that all staff are clear about the actual current and relevant prescription. A safe must be provided in the home to ensure the safe storage of monies / cherished or other significant valuables held on behalf of service users - and so also releasing vital filing space. Steps must be taken to urgently reinstate the single toilet facility on the first floor of the home. 07/11/05 6 YA20 13(2) 7 YA23 16(2)(l) 30/12/05 8 YA27 13(3) & 23(2)(j) 23(2)(p) 24/12/05 9 YA30 Extraction from the ground floor 24/12/05 toilet and laundry room must be urgently reviewed and stronger – and individual - extractors provided to both locations. The inoperative extractor fan in the upstairs bathroom requires urgent replacement / repair. ALL Fire alarm break glasses must be individually identifiable (numbered) and systematic records of tests against these must be kept. (Timescale of 15.09.04 & 30.05.05 not met.) 24/12/05 10 YA30 23(2)(p) 11 YA42 23(4) 07/11/05 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 30 12 YA42 23(4) Sufficient fire drills must be held to ensure that all staff members at the home are regularly involved in such an event. (Timescale of 30.09.04 not met & 30.05.05.) IMMEDIATE REQUIREMENT NOTICE SERVED: Radiator covers must be installed throughout the house to ensure the safety of service users. Priority must be given to bathrooms / toilets and bedrooms - and the reminder must be covered thereafter. (Timescale of 30.10.04 & 30.05.05 not met.) The provision of electrical sockets particularly in the independent living flatlets must be renewed and increased – to avoid the current situation of extension cables being used and (still) heavily overloaded. The home is required to explore the issue of the absence of emergency lighting both within and from the independent living flatlets; an essential provision in case of an emergency. A business and financial plan must be made available in the home to evidence both the ongoing planning for the home and its financial viability (43). (Timescale of 30.09.04 & 30.05.05 not met.) 31/12/05 13 YA42 13(4) 09/11/05 14 YA42 13(4) 24/12/05 15 YA42 23(4) 30/01/06 16 YA43 25(1) 30/01/06 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 31 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA23 Good Practice Recommendations It is strongly recommended that the provider’s policy with regard to adult abuse is amended to accurately tie in the approach required locally under the jointly-agreed London Borough of Sutton Vulnerable Adults Procedure Guidelines. A minimum of 50 of the care staff team must be qualified nominally to NVQ Level 2 in care by 2005. It is strongly recommended that the marble fireplace surround and mantelpiece (currently clad in foam) be removed to remove the possibility of harm to service users – especially those with compromised mobility or a liability to go into fits. 2 3 YA31 YA42 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 St Helier Avenue (374) DS0000007157.V254388.R01.S.doc Version 5.0 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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