CARE HOME ADULTS 18-65
Talgarth Road Talgarth Road 41-43 Talgarth Road West Kensington London W14 9DD Lead Inspector
Ann Gavin Key Unannounced Inspection 5th November 2007 10:00 Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Talgarth Road Address Talgarth Road 41-43 Talgarth Road West Kensington London W14 9DD 020 7603 8607 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) lyris.ofosu@hestia.org Hestia Housing Ms Lyris Ofosu Care Home 10 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10) of places Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th June 2006 Brief Description of the Service: Talgarth Road is a registered care home providing personal care and accommodation for up to ten people with mental health support needs. At the time of this inspection, 5 men and 5 women were living in the home and there were no vacancies. The home is managed by Hestia Housing and Support and the building is owned by the Shepherds Bush Housing Association. The home is situated in the West Kensington area with access to local amenities and good transport links. Each service user has his/her own bedroom and shared use of lounges, kitchen, bathrooms and toilets. There is a large garden. The weekly fees are £970. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 5th November from 10 am – 16.30 pm. The Inspector spoke with residents, the home’s Manager and staff. They toured the communal areas of the home and one of the residents was happy to show their bedroom. The residents took an active part in the inspection and were willing to spend time with the inspector to give an insight into life in the home. At the time of the inspection the home was full with five men and five women. Talgarth Road offers a good standard of accommodation and high standard of care that focus on outcome for residents. They have equalities and diversity high on their agenda forming part of their weekly house meetings which are chaired by residents. What the service does well: What has improved since the last inspection? What they could do better:
The storage of foods in the kitchen could be improved. Broken storage containers need replacing. Staff need to ensure that residents store their personal food in the fridge appropriately. Please contact the provider for advice of actions taken in response to this
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 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 Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Talgarth Road has good procedures in place to ensure that the aspirations and needs of people wishing to move into the home are well assessed. EVIDENCE: ‘The staff came to see me at the hostel then I came over to see the project’
(Quote from resident) All four of residents that the inspector spoke with said that they had a good introduction to the project. They met the staff and visited the project. The information received via the AQAA (Annual Quality Assurance Assessment) detailed clearly the admission process. The home follows the Hestia referral procedure with the resident completeing the admission form assessing all aspects of daily living, care and medical needs. The care co-ordinator would also provide a Care Programme Approach (CPA) and an updated risk assessment. On visiting the project prospective residents meet the residents and staff. There is the possibility of building up the admission process over time with longer visits and then overnight stays. The resident will have a key worker allocated once they have been accepted into the project. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 9 The four case files looked at all contained good information and clear care plans signed by the residents. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in the home have clear goals and are well supported. They are fully involved in decisions regarding their care and their life within the home. EVIDENCE: The four care plans seen were excellent. All were up to date and gave a clear profile of the resident, their needs and goals. The goals were set around their agreed treatment plan. They were clear in the actions the resident needs to take to achieve the goals and the support the staff will give. There were current care plan reviews and records of key worker sessions. The keyworker sessions notes give a clear indication of the areas to be reviewed. Each item has summary notes with the actions agreed and who will complete. These care worker completes the notes which are signed by the resident. One residents care plan had a clear structure of their daily routine.
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 11 Each resident’s file has copies of referral forms, care needs assessments and health and social care reports. There were up to date risk assessments of people’s financial vulnerability. Each person is assessed for the level of support they may need to manage their own finances. One of the residents spoke of how they are supported to the bank to collect their money. There were assessments of other potential risk factors with the appropriate action. These covered any aspects of potential self harm or aggression with clear action plans to both help minimise risks and manage behaviours. All assessments are reviewed every three months or before if any incident were to occur. There is a good system of keeping a checklist at the front of each care plan. These are completed by the key worker and are checked by the care workers supervisor to ensure continuity of care. The residents spoken with were all clearly involved in making decisions about their everyday life and in the running of the home. The weekly house group is a key part of planning the week and involving residents in all aspects of the house. The residents decided together how best to manage the garden. They decided to forgo their payment to give the money to one or two people to work in the garden as their specific job. Now two residents work together on the upkeep of the garden. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are encouraged and supported to develop their own skills and leisure pursuits. There is a continual focus on enabling residents to maximise their knowledge and achievements. Residents create the menu, help prepare the meals and enjoy their food. EVIDENCE: ‘I enjoy living at Talgarth Road. It gives me a sense of belonging and a family routine’ ‘We write the menu’ ‘The food is super’
(Quotes from residents) Speaking with the residents, manager and staff it was clear that residents are encouraged and supported to develop their own skills and leisure pursuits.
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 13 Some of the residents were out at day centres and others were seen working within the house. The residents are encouraged to undertake tasks within the home to develop their skills and sense of self. Promoting residents own skills supporting them to plan for the future and setting goals to help them achieve them is central to what residents gain from living in the home. The home has a large TV lounge and a separate quiet lounge with a personal computer and music system. Residents were observed using these rooms. One resident spoke of how they help with the health and safety checks each week and explained why these were important. The health and safety group go through why there is a need to do fire drills, safety checks and give residents the information they need to keep themselves and the others safe. These sessions lead onto a test in health and safety and once successful residents are presented with certificates. Two residents spoke to the inspector proudly about the certificates they had obtained. There had been a session about why there is a need to keep menus The house has a weekly programme of activities, which was displayed in the lounge. Each evening from 6.30 pm there was a group. Monday is the regular night for the residents meetings where almost everyone attends. The other evenings had an hour health and safety training, social skills and also an art group, a two hour relaxation group and a bingo and also a movie night. The weekly house sessions has a set agenda covering health and safety equality and diversity and complaints as well as an opportunity for residents to bring whatever issue they wanted to be addressed. All the residents spoken with were confidant that whatever issue they raised they would be treated appropriately One of the residents spoken with said they didn’t feel safe going out but would go with support from staff. Others were happy to go out locally and spoke of how they always collect their medication from the local chemist. The manager and staff said they are working at increasing organised events for residents in the community as well as more ad hoc evenings within the home. One resident spoke of the support they receive in keeping contact with their family. Staff also confirmed that they encourage residents to build relationships with others and friendships have grown within the home. The residents are involved in planning and preparing meals. The menus are planned at the weekly house meeting and residents are encouraged to participate in shopping and cooking lunch and the evening meal. One person was observed helping with the preparation of lunch. Everyone said that they
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 14 enjoyed the food. There was fresh fruit available and spaghetti bolognese was being prepared for lunch. There was a relaxed and unhurried atmosphere during lunch. The menu looked varied and nutritious. The home has a kitchen / dining room which creates a homely environment. The storage cupboard had some broken containers that need to be replaced. The fridge also contained some food which a resident had bought but left in plastic bags. These need to be stored properly for food hygiene. Staff need to ensure that residents store their personal food in the fridge appropriately. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are well supported in meeting their physical and mental health needs. There is a continual assessment of residents overall care needs. Residents are offered medication training programmes to help facilitate insight about their medication EVIDENCE: The manager explained that one of the criteria for people to move into the home is that they need to be compliant with their medication. All the residents are assessed to see if they are suitable for self-medication. One resident is currently self-medicating. This resident explained the procedure and how staff monitors their progress. There was a risk assessment completed for this resident along with a medication consent form. One of the staff went through the system for medication. They explained that the medication is checked at the end of the shift and that there are rarely errors. Medication is kept in a locked cabinet in the main office. The home uses the Boots Monitored Dosage System for all prescribed medication. The records of three residents were looked at all were well maintained. All had the
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 16 residents photograph and clear health profiles. Staff confirmed that they had received medication training. The home works closely with the local pharmacist. The majority of the residents go to collect their medication from the hospital pharmacy. The staff have introduced training sessions on medication and specifically around Clozapine the reason for taking it and the side effects. One of the staff devised a questionnaire with multiple choice questions and also space to expand on the use of medication. This is used as the written part of the exam. Once residents pass they are given a certificate at a ceremony in the home. Residents are encouraged to know about their medication so that they can check if carers give them the correct medication. The local pharmacy reviews the medication every three months. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents spoken with felt that their views were listened to. There is a clear system for resident’s finances. Systems are in place to help safeguard residents. EVIDENCE: ‘We have weekly meetings and at this meeting we can talk about any complaints we have’ ‘You can learn something from everyone.. We get on with each other here..’
(Quotes from residents) The manager spoke of the focus on resident’s involvement of encouraging people to have responsibility for themselves, others and the environment. The weekly house meetings are a place where residents are facilitated to work things out amongst themselves. Residents spoken with confirmed that they had a set time for different aspects as well as a time to bring any thing they wanted to discuss. The complaints book seen highlighted this as the complaints were about a resident not attending the house meetings. Everyone spoken with said how they felt able to say what they wanted and they would be listened to. The financial records of three residents were looked at. Residents have their own individual book and petty cash tin. Residents are supported to the bank each week to collect their monies. The home has a policy whereby residents can not keep more than £100 in the home .All expenditure is written down and
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 18 receipts kept. The shift leader maintains the key and the records are checked after the morning and evening shift. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from good, well maintained clean and bright private and communal accommodation. EVIDENCE: 41-43 Talgarth Road comprises two large, inter-connected houses close to the shops and transport links of West Kensington and Hammersmith Broadway. Each service user has a single room. Lounges, bathrooms, toilets, the kitchen / dining room, laundry room and garden are shared. There is CCTV surveillance for security purposes on all entrances. A tour of all the communal parts of the home plus one bedroom was seen during this visit. All the communal areas have just been decorated in bright colours that the residents chose. The lounge had paintings that the residents chose from a local organisation. The overall appearance is of a well kept clean bright and welcoming home where residents feel comfortable and at home.
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from competent staff. There is a good training system in place for all staff and regular supervision. EVIDENCE: The information received from the manager in the AQAA (Annual Quality Assurance Assessment) states that the home has reached the target for 50 qualified staff as there are currently eight permanent staff and four of these have or are about to complete an NVQ level 3. The manager says that they are working on the skill mix of the team to reflect the needs of the residents. There is always a female of staff. There is a shift plan daily and a designated shift leader. Speaking to the staff they showed that they were clear in their role and responsibilities. All of the staff spoke highly of the training offered by the organisation. They explained how the manager was keen on learning so that the NVQ was not just a piece of paper but a real experience. There was an NVQ assessor visiting at the time of the inspection.
Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 21 The shifts work well according to the staff. There are normally three staff on duty in the morning plus the manager though due a combination of the deputy manager being on leave and one staff just leaving there was the manager plus two staff. The manager felt it was sufficient and everything appeared to be running smoothly. One staff member left for another position within the organisation. Their post is being covered by bank staff. There is a new member of staff starting in January. Residents are involved in staff recruitment there is a designated resident who is carrying this out at the moment. The residents must agree the new member of staff. There is a half day on the homes objectives where residents can also ask questions. The manager says that there is a welcome pack for each new staff member about the home the residents and quality assurance. Each new staff member attends induction training. The induction pack seen was clear and detailed ensuring that all aspects of working with residents, the running of the home and relevant legislation, are covered. Some aspects of the induction were noted as requiring both an explanation and a practical. For the first two weeks new staff work Monday to Friday, 9am -5 p.m. in order to follow the induction programme. Staff spoken with said that they are encouraged to attend training and to develop their skills. They confirmed that they have regular supervision and an annual appraisal. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and standards of record keeping are good. There are good health and safety checks and clear evidence of residents’ involvement in the running of the home. EVIDENCE: The home is managed by an experienced and well qualified manger who has been in post since the initial registration. They are clearly focused on involving residents in all aspects of their car and the running of the hone as demonstrated throughout this report. The deputy manager has been in post for three years but was on annual leave on the day of the unannounced inspection. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 23 One of the residents works with the staff on health and safety checks. The deputy manager has the lead for all aspects of health and safety. The health and safety records seen were up to date and well maintained. The yearly health and safety audit was carried out in April 2007. Monthly audits with an action plan were in place. There was evidence of fire drills every three months and of daily fire panel checks. The weekly checks involve a staff member and the designated resident. They check the fire alarms and lighting. The resident confirmed that they undertake these checks weekly with one of the staff. Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 4 X 3 X X 3 X Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 25 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 16 Requirement The storage of foods in the kitchen should be improved. Broken storage containers need replacing. Staff also need to ensure that residents store their personal food in the fridge appropriately. Timescale for action 30/11/07 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 Talgarth Road DS0000019148.V344978.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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