Inspection on 28/06/05 for Therese Care Home

This inspection was carried out on 28th June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 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 27/06/06

Therese Care Home 16/01/06

Therese Care Home 09/12/04

Therese Care Home 29/07/04

Therese Care Home 03/12/03

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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 28th June 2005 9:50am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Therese Care Home Address 144 Gassiot Road London SW17 8LE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8767 5407 Ms Iolenta Castelino Ms Iolenta Castelino Care Home only (PC) 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (MD) of places Mental disorder excluding learning disability or dementia over 65 years of age (MD(E)) Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The home may provide accomodation and care for one named service user over the age of 65. The category MD(E) must be removed once this service user has left the home. Date of last inspection 9th December 2004 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. The home 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. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and took approximately 4 hours. A tour of the premises took place and care records were inspected. The one member of staff on duty and two of the service users were spoken to. What the service does well: What has improved since the last inspection? What they could do better: The home has a number of areas that need to be improved upon and these are highlighted in the report. Those areas requiring particular attention include further work on the assessment and care planning records to ensure that care provided to service users is adequately documented. These also need to include areas of risk identified for individual service users. The daily routines for the home are documented as quite rigid and do not demonstrate that service users are offered choice in relation to their daily Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 6 lives, such as times of waking and going to bed, the times for taking a bath and choice of meals cooked. A Requirement has been made to address this. There were no training records or training plan available for inspection and it is unclear as to the actual training provided to staff. Environmentally, the home is in need of redecoration in the hallways, bedrooms and bathroom in particular, as the walls looked ‘tired’ and stained, with paint and wallpaper noted to be coming off in areas. It has also been recommended that the use of the front room on the ground floor as an office is re-considered to increase the communal areas available for service users. 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 G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 5 The assessment process for potential service users is unclear and there is no evidence of the re-assessment of service users who have returned to the home following a change in their circumstances. The contracts in place at the home do noit demonstarte that they have been agreed by all parties. EVIDENCE: The previous inspection required that full assessments are undertaken for all service users admitted to the home. There have been no new admissions to the home since the last inspection. However, it was identified that one service user had been in hospital for a number of months earlier on this year and had returned to the home. There was no record in their file to demonstrate that they had been re-assessed prior to their return to the home. It is required that the Registered Person carry out a re-assessment of needs following any change in a service users’ circumstances, to ensure that the home can adequately meet their needs. The previous inspection further required that the admissions procedure for the home be reviewed to include full details of the assessment process for prospective service users. The admissions procedure was seen, though it was unclear as to whether it had been reviewed as there was no date on the procedure in use. The procedure did not provide details of the assessment process, only the admission procedure, so therefore this Requirement is restated. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 9 In each service user file there was a copy of their placement agreement/ contract at varying stages of being signed – with discrepancies noted where either the manager/ service user/ placing authority had not signed this, or noone had. It is required that each service user has a contract/ statement of the terms and conditions of their accomodation and the services provided, that has been agreed and signed by all relevant parties. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 The care plans do not provide sufficient information on the activities undertaken by service users, or the potential risks involved in these. EVIDENCE: The care plans for all the service users were examined. For each service user there was their photo and a front sheet containing basic information regarding contact details for professionals and relatives involved in their care. The assessment documentation was part of a ‘personal care plan’ that was in the format of a ‘tick-box’ for each area of need (eg. personal care, likes/dislikes). Apart from the ticking of boxes there was very little information regarding the actual assessed needs and how these are individualised to each service user. An example of this was that for one service user the ‘discharge summary’ from their previous placement detailed personal care needs as reminding to change outer and underwear, however this need was not documented in the home assessment/ ‘personal care plan’. A further example is where it is identified that a service user enjoys going out, but does not provide any further details about where, when or with whom. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 11 The previous inspection required that the care plans detail all the support needs of the service user and due to above examples this does not appear to have been met, so is restated. Risk assessments were seen to be in place for individual service users regarding health and safety issues and alcohol consumption. One service user discussed that they like to go out but that they are unable to do this alone, due to difficulties with short-term memory. The staff confirmed that the service user needs to be escorted when out of the home, yet due to only one member of staff on duty, their going out is reliant upon the Registered Person who takes the service user out once or twice a week. This is not documented either in the care plan or risk assessment. It is required that the risk assessment and care plan details the restriction of freedom for this service user when going out. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 15, 16 and 17 Service users are encouraged to pursue interests and maintain relationships with family and friends. The routines in the home do not take account of the rights and wishes of the service users or promote their independence. EVIDENCE: On display in the office area there was a document entitled ‘daily routine’ with times given for all activities throughout the day, such as: “…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…” One service user stated that: “…we have to go to bed by 10:45pm, sometimes I am not tired…”. The daily routine and the above comment does not demonstrate that service users are offered choice or their rights respected in relation to their daily lives Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 13 regarding waking and going to bed times, or times for taking a bath. The daily routine also does not indicate that service users are encouraged to develop skills and independence in keeping their rooms clean or doing their laundry. The staff member confirmed that staff carry out these activities, also that staff prepare the meals throughout the day. It is required that the Registered Person work with the service users to plan routines throughout the day to allow respect for individual wishes, flexibility of routines and developing independent living skills. The staff member stated each service user has different interests, stating that one service user prefers to spend time at home, chatting and watching the television. Another service user spends a lot of time out of the home attending some local day centres and frequently goes to church. The staff member further stated that service users have varying levels of contact with family members and that they are able to visit the home at any time. The assessment for one service user states that he “…absolutely loves…” going to the art group. The care plan indicates that the art group only occurs once every three months and it is recommended that the Registered Person promote this interest and work with the service user to pursue art-related activities on a more frequent basis eg. trips to art galleries, joining art classes/ workshops. Two service users spoken to discussed that the food provided by the home is good, one stating that there is: “…a lot of good food…which is nice…” The staff member stated that the Registered Person plans the menu for the home, and it is unclear as to whether the service users are involved in choosing meals throughout the week. A Requirement has been made to ensure that service users are involved in choosing meals and planning the weekly menu at the home. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 and 20 Greater flexibility and choice is required regarding the daily routines at the home. The systems for administering and recording medication are good. EVIDENCE: The staff member stated that each service user is independent in attending to their personal care needs, requiring prompting only. As stated earlier in the report, there is a daily routine at the home which gives set times for waking, meals and bathing. A Requirement has been made to address this to ensure that the routines are more flexible and take into account the wishes of the service users regarding when they want to do things. The medication for the three service users were checked along with the Medicine Administration Records (MAR) chart. Good record-keeping was observed in these, with no discrepancies noted. The MAR chart also corresponded appropriately with the prescribed medication. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The home has a satisfactory complaints procedure for the use of service users and relatives. EVIDENCE: There is a satisfactory complaints procedure in place at the home, which was seen to be included in the Service Users Guide. There have been no complaints recorded since the last inspection. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28 and 30 The home is clean and hygienic, however the décor is poor in areas and in need of re-decoration. The communal areas for use by service users is cramped and this could be increased through the use of a further room. EVIDENCE: There is a calm and relaxed atmosphere that provides a comfortable and welcoming feel to the home. This is enhanced by the caring approach of the staff and the friendliness of the service users. A tour of the building was carried out. The home is a two-storey terrace house with each service user having their own bedroom. The bedrooms vary in size from quite small to large, with the actual sizes detailed in the Service User Guide. The décor in each bedroom was observed to be ‘tired’ in appearance, with stained and chipped paintwork seen on the walls and ceilings. In one bedroom the wallpaper was creased and missing in some areas. The bathroom was observed to be in a similar state, with the walls stained and paint chipped off the bath panel. The hallways throughout the home were also observed to need repainting and it is required that the bedrooms, hallways and bathrooms are redecorated to create a more homely environment. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 17 It was also observed that there were no light-shades on any of the lights throughout the home and it is further required that these are installed, again to create a more homely feel. On the ground floor there is the kitchen, office and lounge/dining area for service users. The lounge/ dining area is very cramped, with two dining tables and three armchairs taking up most of the floor-space, this area is also a smoking area. The front room on the ground floor is used as the office area. The home accommodates three service users and does not require such a large office area. It is recommended that the use of this room be re-considered to create more space and a non-smoking area for the service users. Suggestions for changing this area could be to create a separate lounge area or larger bedroom to replace the smaller bedroom. Throughout the inspection it was observed that all areas of the home were clean and hygienic. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 35 The home has a small staff team that provide support to the service users. The staff training received and planned for is unclear. EVIDENCE: The staff rota indicated that there are currently three staff employed at the home, including the Registered Person. The inspector was informed that there is one staff vacancy which is currently being recruited for. The previous inspection required that a training programme is formulated to ensure that care staff receive at least five paid training days a year and that this training should be evidenced. It was also required that the training include fire safety, medication, food hygiene and first aid. The training files for staff were not available to be examined at the inspection and so this Requirement is restated. The previous inspection recommended that the care staff undertake the NVQ level 2 in Care qualification. The member of staff on duty said she had not commenced this training and so this recommendation has been restated. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 The home maintains adequate records regarding relevant health and safety checks. Feedback from service user, professionals and relatives on the quality of the service is not actively sought. EVIDENCE: The manager (Registered Person) was not at the home during the inspection. It was recommended at the previous inspection that the Registered Person commence the NVQ level 4 Management qualification. This could not be assessed on this occasion due to lack of training records, and the recommendation has been restated. Quality assurance questionnaires for relatives and friends were observed in the service user guide, along with a survey for residents to complete. Since the last inspection these had not yet been implemented and it is recommended that the Registered Person use these to seek feedback to develop the service. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 20 The health and safety checks for recording the daily fridge and freezer temperatures was seen to be well-maintained. The documentation relating to fire safety equipment checks and monthly fire drill records were found to be up-to-date at the inspection. Risk assessments for COSHH (Control of Substances Hazardous to Health) products and the use of kitchen equipment were in place. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 2 x 2 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 2 N/A 3 Standard No 11 12 13 14 15 16 17 2 2 3 x 3 2 2 Standard No 31 32 33 34 35 36 Score x 2 3 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Therese Care Home Score 2 x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 12 & 14 Requirement The Registered Person must ensure the admissions procedure for the home is reviewed to ensure it includes full details of the assessment process for prospective service users (previous timescale of 01/02/05 not met). The Registered Person must ensure that service users needs are re-assessed following any change in circumstances (eg. following a period in hospital) The Registered Person must ensure that each service user has a statement of the terms and conditions of their accomodation, that has been agreed by all relevant parties. The Registered Person must ensure that the care plans fully detail all support needs for each service user (previous timescale of 01/04/05 mot met). The Registered Person must ensure that any restrictions on the freedom of service users is documentated in their care plan and risk assessment The Registered Person must ensure that the routines of the Timescale for action 31/07/05 2. YA3 14(2)(b) 31/07/05 3. YA5 Schedule 4(8) 31/07/05 4. YA6 15(1) & (2) 31/08/05 5. YA7 & YA9 13(4)(c) 31/08/05 6. YA11 & YA16 YA20 16(f)(h) & 12(3)(4) 31/07/05 Page 23 Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 7. YA17 16(2)(i) 8. YA24 23(2)(d) home are flexible take into account the rights and wishes of the service users. The Registered Person must ensure that service users are involving in choosing and planning meals provided by the home. The Registered Person must ensure that the hallways, bathroom and bedrooms are redecorated. The Registered Person must ensure that lightshades are provided on all lights throughout the home. 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 of 01/04/05 not met). 31/07/05 31/12/05 9. YA35 18 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations It is recommended that the Registered Person work with the service user interested in art to pursue art-related activities on a regular basis eg. trips to art galleries, join art classes/ workshops. It is recommended that the use of the office area be reconsidered to create more communal space for the service users. It is recommended that care staff undertakethe NVQ level 2 in Care qualification. G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 24 2. 3. YA28 YA32 Therese Care Home 4. 5. YA37 YA39 It is recommended that the Registered Person commence the NVQ level 4 Management qualification The Registered Person should implement the use of the quality assurance questionnaires to seek feedback on the service. Therese Care Home G54-G04 S10231 Therese V235282 290605 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 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. 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