Inspection on 27/06/06 for Therese Care Home

This inspection was carried out on 27th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Therese Care Home 31/08/07

Therese Care Home 16/03/07

Therese Care Home 28/11/06

Therese Care Home 16/01/06

Therese Care Home 28/06/05

Therese Care Home 09/12/04

Therese Care Home 29/07/04

Therese Care Home 03/12/03

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Townley Road, 2-3

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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 Therese Care Home 144 Gassiot Road London SW17 8LE Lead Inspector Louise Phillips Unannounced Inspection 27th June 2006 10:30a Therese Care Home DS0000010231.V305290.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 Therese Care Home DS0000010231.V305290.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. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Therese Care Home Address 144 Gassiot Road London SW17 8LE 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) 020 8767 5407 Ms Iolenta Castelino Ms Iolenta Castelino Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may provide accommodation and care for one named service user over the age of 65. The category MD(E) must be removed once this service user is no longer accommodated. 16th, 18th and 25th January 2006 Date of last inspection Brief Description of the Service: Therese Care Home provides care and support to three service users with a mental disorder. The home is a two-storey terrace house with a small garden to the front, and larger garden to the rear of the home. It is situated close to the busy shopping centre of Tooting Broadway and so within easy access of the public amenities and transport links served by the area. The home is owned and managed by Ms Iolenta Castelino, the Registered Person. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day with time spent talking to one member of staff, two residents and viewing paperwork. A tour of the premises was carried out and care records were inspected. Information has also been gained from the inspection record for the home. What the service does well: What has improved since the last inspection? What they could do better: 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. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 6 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 Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 7 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): 2 and 5 Quality in this outcome area is good. This judgement has been made as the residents are assessed before moving to the service and have a contract for their stay at the home. EVIDENCE: Since the last inspection no new residents have moved into the home and the standard has been met previously. The home also has a ‘referrals and admissions policy’ that details the process of assessing potential residents and them having trial periods to the home before moving in. Each resident file contains a copy of their placement agreement/ contract with the home. Since the last inspection improvements have been made and these have now been signed by the Registered Person and the resident. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 8 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 and 9 Quality in this outcome area is adequate. This judgement has been made as improvements have been made to the care plans. However, discussion with one resident indicates that their needs are not reflected in their care plan. EVIDENCE: The care plans at the home are reviewed approximately every six months, with amendments made where necessary. This was observed in the care files for each resident, with each care plan individualised to their needs and interests. There is a risk assessment for each resident that details such areas as risks of alcohol consumption, self-harm or mental health relapse. Risk assessments are also in place for areas of health and safety, such as using hot water and use of the kitchen. Records indicate that the risk assessments are reviewed six monthly. The previous inspection required that a risk management plan be put in place for a resident who has been assessed as being unable to go out in their own. This restriction on the freedom is clearly documented in their care plan and risk assessment. The resident spoke to the inspector about how they would like the opportunity to go out on their own as they know the area well, and that they do not go out as often as they would like. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 9 Findings indicate that there is still no risk management plan in place to detail how the home manages meeting the needs of this resident when they want to go out, or how the home works towards the resident being independent in going out. This requirement has been restated. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 10 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, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made as the service does not demonstrate how it works to meet the needs of all the residents. EVIDENCE: On the day of inspection it was observed that one resident was watching television, another was in their bedroom getting ready for the day, and the third resident was out. The inspector was informed that this resident spends a majority of their time out of the house, going to church or visiting friends. One resident spoke at length about how they would like to go out more, but they are restricted due to them being assessed as being unable to go out on their own. They said that the home does take them out to do the shopping for the home, or to a café, but that they would like the opportunity to go out to places of interest, or be given the chance to go out on their own. As stated earlier in the report the home does not demonstrate how they accommodate the residents desire to go out independently, and a risk management plan needs to be developed to show how the service works to meet this need. This is the subject of Requirement 1 and 2. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 11 On display at the home there continues to be a ‘daily routine’ document that prescribes times throughout the day that activities are to be carried out, eg. “…9:05am – check residents awake and ready for breakfast …11:40am – residents to bathe as necessary …3:00pm – check residents rooms, clean as necessary and do their laundry …6:15pm – evening meal served…” Observations from this and previous inspections indicate that the routine of the home is not as rigid as the document describes and that the staff have a good awareness of what needs to be done throughout the day. The document does not reflect the flexible routines at the home and lead the reader to view the home as rigid and ‘task orientated’. It is recommended that this is removed, or a more flexible format developed to reflect what actually does occur in the home, as in its current form the document appears outdated. Residents are provided with three meals a day, prepared by the staff at the home. Various ingredients were seen in the kitchen to use for quick snacks or larger meal preparation. One resident said that they enjoy the food provided, stating “…I usually have a soup and sandwich for lunch, which is fine…”. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 12 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 and 20 Quality in this outcome area is good. This judgement has been made as residents are supported with their health and personal care needs. EVIDENCE: The care plans indicate that the residents are generally independent attending to their personal care needs, requiring some occasional prompting from staff to eg. have a bath. Records indicate that each resident’s care is reviewed annually by the Community Mental Health Team, with the input of the resident and staff at the home. The care files detail healthcare appointments attended by each resident, along with a record of where they have declined to go and the actions taken as a result of this. Medication at the home is administered via individual dossett boxes for each resident. These boxes are kept in an unlocked metal box that is not attached to a wall. It is required that the dossett boxes be held in a locked cabinet attached to a wall. A check was carried out of the medicine held in each dossett box compared to that on the medication chart. This was seen to correspond and had all been Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 13 signed appropriately. It is recommended that the medication chart include a description of each tablet to enable easy identification in case the resident declines one, or in the event of one being dropped or lost. The home has a ‘handling of medication – policy and procedure’ that describes guidance for staff on the use of household remedies, administration and storage of medication or what to do in event of an error. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 14 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 and 23 Quality in this outcome area is poor. This judgement has been made because the residents are not adequately protected from abuse. EVIDENCE: The home has a complaints policy that provides suggestions of different people that a resident can complain to, eg. home manager, social worker. Further work is required on this to provide the contact details of these people, along with updating to include details of the CSCI. The home has a policy and guidance in place to provide an awareness about abuse. Records indicate that two staff received training in March 2006 on a ‘POVA (Protection of Vulnerable Adults) Alerters’ course. The records did not evidence the content of this course and when one of the members of staff were spoken to they were not able to describe what they had learnt from the course. This would indicate that the course was not sufficient enough to ensure that staff are adequately trained in abuse awareness. The requirement is therefore restated, for all staff to receive training in the Protection of Vulnerable Adults. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 15 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, 28 and 30 Quality in this outcome area is good. This judgement has been made because the home is well decorated, bright and homely for the residents. EVIDENCE: On entering the home the improvements to the décor are instantly noticeable, with all rooms having been re-painted, new carpet throughout and new furniture in the residents bedrooms. This creates a much brighter, homelier and modern looking home that the residents appreciate. One resident commented that: “…there is lovely fitted carpet throughout, much improved, …it looked shabby before…”. Handrails have also been fitted on the stairwell, and pictures drawn by one of the residents are displayed around the home. The bathroom has been completely redecorated, making it much more welcoming and modern for the residents. The front room on the ground floor has been re-arranged into another lounge, also with new furniture. However, it is not clear if this is for the use of residents as the rear lounge still contains the dining table and armchairs. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 16 The cleanliness of the home is of a good standard and the staff work well to maintain this. Despite all the redecoration there are still no light-shades on any of the lights around the home. When asked about whether they would like these, one resident said “…yes that would be nice…would finish it off…”. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 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): 32, 34 and 35 Quality in the outcome area is poor. This judgement has been made as required recruitment checks are not carried out on staff and they are not adequately trained for their role. EVIDENCE: Standards 32 and 34 could not be properly assessed due to the Registered Person not being present during the inspection and so the staff records unable to be accessed. The previous inspection required that a Criminal Records Bureau check and POVA First check be carried out for all staff employed at the home. The Registered Person stated over the telephone to the inspector that this had not been done and so the requirement is restated. It was observed on the staff rota that a new member of staff had been employed since the last inspection. Their recruitment records were unable to be checked on this occasion. A further requirement from the previous inspection was for staff to have a contract detailing the actual hours that they work. This could not be assessed and so the requirement has been restated. The previous inspection found that none of the staff had previous experience of working with adults with mental health problems. It also found that none of the staff hold the NVQ level 2 in care qualification. Also none of the staff working at the home have received training in dealing with challenging Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 18 behaviours, or up-to-date training in medication administration, first aid or fire safety. It was observed that individual training files for each staff member had been started. These provide a record and certificates to indicate that staff had done some training relevant to their job, such as mental health awareness in 2006 and two staff having done basic food hygiene training in 2003. Progress has been made in getting staff sufficiently trained, though training still needs to be undertaken in first aid, fire safety and medication awareness to ensure that the health and safety of the residents is maximised. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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, 39 and 42 Quality in this outcome area is poor. This judgement has been made as there are a number of outstanding requirements from the previous inspection and subsequent requirements as a result of this inspection. EVIDENCE: There are a number of requirements that have been restated from the previous inspection and subsequent requirements as a result of this inspection. This demonstrates that the Registered Person does not actively develop the service to meet the requirements of the Care Homes Regulations 2001 and the residents do not receive a good level of service. There is a policy for implementing quality assurance at the service, with a format for a residents survey and questionnaire for relatives and friends to complete. There were no records to demonstrate that this had been carried out. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 20 Fridge and freezer temperature checks are carried out daily at the home. Monthly fire drills are also carried out along with a two monthly check of fire equipment by the staff. A recent visit by the fire officer required that a fire risk assessment be carried out, along with appropriate fire exit signage, the installation of a fire door on the rear lounge and all doors fitted with a self-closing device. The fire officer also required that an additional fire extinguisher be provided in the hallway, emergency lighting be installed and a more suitable fire detection systems put in place. It was observed that none of these requirements had been addressed and this is the subject of Requirement 10. Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 X 34 1 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 1 X 2 X X 1 X Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 22 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 YA7 YA9 Regulation 13(4)(c) Requirement The Registered Person must ensure that there are risk assessments and risk management plans in place for each resident. (Previous timescale not met) The Registered Person must demonstrate how the individual needs and wishes of each resident are met. The Registered Person must ensure that the dossett boxes are stored in a locked cabinet attached to a wall. The Registered Person must ensure that the complaints procedure includes the contact details of the CSCI. The Registered Person must ensure that all staff working at the service receive training in the Protection of Vulnerable Adults. (Previous timescale not met) The Registered Person must DS0000010231.V305290.R01.S.doc Timescale for action 31/08/06 2. YA12 YA13 YA14 YA20 12(3), 16(2)(m) 30/09/06 3. 13(2) 31/08/06 4. YA22 22(7)(a) 31/08/06 5. YA23 13(6) 30/09/06 6. YA24 23(2)(d) 31/08/06 Version 5.2 Page 23 Therese Care Home ensure that light-shades are provided on all lights throughout the home. (Previous timescale not met). 7. YA34 19(4) & Schedule 2 The Registered Person must 31/08/06 maintain a Criminal Records Bureau check with them as the current employer for each member of staff. A POVA First check must be received for all staff prior to their commencing work at the home. (Previous timescale not met). The Registered Person must ensure that the staff contracts detail the actual hours that staff are employed to work each week, including sleep-in duties. (Previous timescale not met) 31/08/06 8. YA34 Schedule 4, 6(e) 9. YA35 18(1) 31/08/06 The Registered Person must ensure that a training programme is formulated to ensure that care staff receive at least five paid training days a year and that this training is evidenced. The training must include fire safety, medication, food hygiene and first aid. (Previous timescale not met). The Registered Person must ensure that the requirements as prescribed by the fire officer (detailed on page 21 of this report) are addressed within the timescale. 30/09/06 10. YA42 23(4) Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 24 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 YA16 Good Practice Recommendations The Registered Person should ensure that the ‘daily routines’ document is removed or a more flexible developed to reflect what actually does occur in the home. The Registered Person should ensure that the medication chart includes a description of each tablet. The Registered Person should ensure that all care staff at the home undertake the NVQ level 2 in Care qualification. 2. 3. YA20 YA32 Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Therese Care Home DS0000010231.V305290.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!