CARE HOME ADULTS 18-65
23 Vancouver Road Forest Hill London SE23 2AG Lead Inspector
Rossella Volpi Unannounced 13 May 2005 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. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service 23 Vancouver Road Address Forest Hill London SE23 2AG 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 8699 3762 The Regard Partnership Limited CRH Care Home PC Care Home Only 8 Category(ies) of LD Learning Disability registration, with number MD Mental Disorder of places 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Eight residents, of whom four may have both a learning disability and a mental disorder (dual diagnosis) Date of last inspection 22 November 2004 Brief Description of the Service: Vancouver Road provides a care home to a maximum of eight women and men with mild to moderate learning disabilities, who might have other support needs. A maximum of four service users might also have a diagnosis of a mental disorder. The overall aim is that of providing a specialist service in a nurturing and stimulating environment, which would enable users to develop or achieve independent living skills within a community setting. The home aims to achieve this through service users’ plans, developed and regularly reviewed by the service user with support from staff, advocates, local specialist teams and the placing authority. The plans are to provide a structure within which to address individual needs, choices and aspirations, backed by risk assessments, to assess the appropriate degree of support required so that risks are minimised. The home states that staff within the project have relevant experience in the field of learning disability and mental health.The provider is a company: ‘The Regard Partnership Ltd.’ who provides other residential homes and supported living in England and Wales. The statement of purpose says that the two directors are qualified nurses with experience in learning disability and mental health. The day-to-day running of the home is delegated to a manager, who leads a team of staff.The premises are a semi-detached house, with single bedrooms on three floors and a large garden. The home is not suitable for people who are not ambulant.The area is served by public transport, has a selection of shops and other civic amenities
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted during the day on 20 May 2005. The findings were informed by general observations, discussion with three residents, discussion with staff and inspection of records. Particular emphasis was given to reviewing with the care manager and the deputy manager their plans for development of the home and for addressing previous requirements. However, the area of management and conduct of the home was not reviewed in enough detail under the specific standards (37 to 43) on this occasion to enable an assessment as the manager had only recently been appointed. What the service does well: What has improved since the last inspection?
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 6 A care manager has been appointed, after a period of uncertainty due to the previous two managers leaving suddenly. The manager had applied for registration, but had not yet been assessed by CSCI. The manager, deputy and staff team were considering several ways to develop the service, to increase meaningful participation by the residents, their ability to influence the service and their independence. 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. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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) 1,2 Prospective residents’ needs and aspirations were assessed, so that a service tailored to their needs could be provided. Residents were informed about what could be expected from the home so that they could make an informed choice about the service and could challenge any aspects. There were some gaps in the information, that management was addressing by reviewing the statement of purpose and associated documents with the residents. EVIDENCE: The home had a statement of purpose and a service users’ guide, which were informative and periodically reviewed. Management was redrafting the documents, in consultation with the residents. This was both to ensure that they contained all information required by regulation, as required at the previous inspection and that they would be more meaningful to the residents and included the topics that residents considered important to them. Already the draft statement of purpose had included the arrangements for dealing with complaints, for respecting privacy and dignity, the fire precautions and emergency procedures in the home, to comply with a previous requirement. The service users’ guide was being updated to include the areas that residents asked to be included. The manager envisaged this work to be completed by August 2005. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 9 Nobody new had come to live at Vancouver Road for over one year. Inspection of files, at previous visits, evidenced a thorough assessment process, leading to comprehensive care plans, which included risk assessments, healthcare plans, service users’ choices and restrictions. Management said that pre-admission assessments would always be made for prospective residents. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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) 6,7,9 Residents’ changing needs and goals were reflected in their personal plans. Some improvements were being made, but not yet completed, to the way the information was recorded. Residents were supported to take control of their own life and guided into responsible risk taking. EVIDENCE: All residents had a care plan. Residents were aware of their plans and it was evident that they were involved in their reviews and the establishment of new goals. Residents indicated that staff gave them appropriate support. Staff were aware of the individual plans and of what support was necessary to achieve the goals. Plans included guidelines on behaviour triggers and appropriate responses, health care plans and risk assessments. Management was redrawing the plans in a new format. This was to enable a more thorough appraisal of the action taken to achieve goals and to ensure a more holistic approach to care planning, with the resident’ s wishes and aspirations at the centre of any decision about their lives. A recommendation made at the previous inspection, which arose from a discussion and a request from a resident, was discussed with the deputy
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 11 manager. This was about exploring suitable ways to enable the resident to discuss preferences and feelings with an appropriate person external to the home. This had been acted upon and follow up action taken, in discussion with the resident. A detailed discussion was held with one resident and followed up with the deputy regarding risk taking, which showed how staff continued to discuss the risks and gave support and advice to minimise them. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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) 12,13,14,15,16,17 Residents were supported to lead meaningful lives, appropriate to their peer group, aspirations and cultural preferences and norms. Staff endeavoured to ensure that residents had opportunities for education and training, work, integration into community life, leisure activities and to have a real say and influence about the running of the home. EVIDENCE: Records and discussion with residents or staff showed that most residents had links with the local community through work, college, day centres or attendance at church. One resident talked in some detail about the range of activities she had chosen to pursue and of the work or training commitments she or other residents were attending. These included paid work, community work, working as a trainee to acquire relevant certificates, attending college and/or day centres. (This was consistent with previous findings, with the information on files and with what staff had said). She also confirmed that the home effectively encouraged the pursuing of individual interests and hobbies. Individual and group outings were organised and chosen by users. This was often with staff support, but, in some cases, residents arranged their own
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 13 activities independently. Residents had the option, as part of their basic contract price, of a minimum seven-day annual holiday outside the home. Another resident also spoke, more briefly, about leisure activities and gave examples that showed flexibility in routines and the support received in making informed choices. Another resident was very busy pursuing his occupation for the day. The resident, with whom this was discussed, was satisfied with the support and advice received regarding personal and sexual relationships and in maintaining family links. Residents expressed satisfaction with the food at the home. It was apparent that healthy eating was encouraged and a variety of nutritious food and meals was offered, but respecting freedom of choice. Management was reviewing the arrangements for meals to make choice and participation more effective as, in recent years, residents had been less active in choosing or preparing meals. The manager discussed his plans and it was noted that residents were aware of them. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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) 18,19,20 Residents received personal and health care support which was responsive to individual preferences and which was targeted to meet their needs. Management was addressing the issues raised at the previous inspection regarding medications. EVIDENCE: Discussion with one resident and with staff confirmed that the home’s key worker system was effective in enabling consistency of support. It also continued to give evidence of the home’s commitment to working in partnership with families, friends or advocates, which the home had long recognised as essential to develop skills and knowledge to work appropriately with individual users. The local community team provided specialist support. Residents were registered with a local general practitioner (GP). Many of the other health care services were accessed through the GP practice and members of the primary health care teams. Residents were encouraged to go for dental, eye and other health checks as necessary. Residents with both mental health and learning disability needs were supported through the Care Programme Approach and had support from community psychiatric nurses. Health records were maintained on individual files.
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 15 There was a comprehensive medication policy. The home was working to implement the requirements imposed at the previous inspection on medication. A new time scale was agreed with the manager. Residents said that the way personal support was provided met their needs. At the previous inspection, one resident had some mixed feelings about being reminded, at times too insistently, to perform some personal care tasks. This could not be followed up with the person, who did not have time, on this occasion, to engage in conversation. However, the deputy manager illustrated what had been done to address the issue with the person and the placing authority. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 16 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) 22,23 Residents felt safe at the home. They received help and support to understand and minimise the risks (considerable in some cases), which some of their actions might pose. Management was taking action to support residents in expressing their views more effectively, assured that these would be listened to and acted upon. EVIDENCE: The home had a complaints’ procedure and encouraged feedback from residents. Staff interviewed were aware of their role in acting as advocates for the residents, if necessary. At the previous inspection there were some indications that the procedure might not be effective, despite staff efforts. (This is discussed in more detail in the previous report). The actions since initiated by management would address the concern regarding the complaints’ procedure. (This was regarding the review of the statement of purpose and service users’ guide and generally enabling residents to better participate and influence the service). The previous recommendation is repeated because such actions were still at an initial stage and some, by their nature, would take some time to show their effectiveness, although some progress was already noticeable. The home had an adult protection and a whistle blowing policy. The policies, which were considered satisfactory when last inspected, had not significantly changed in the last two years and therefore were not looked at in detail during this inspection. Management said that all staff had attended training on prevention of abuse. Staff were clear about their role and responsibilities and about safer working practices’ issues pertinent to the home.
23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 17 A situation that put one resident in a very vulnerable position was highlighted by the home at the previous inspection and followed up on this occasion with both the resident and management. There continued to be evidence of longterm work by staff to make the person more aware of the risks. It was positive that the resident spoke openly about this work, which the resident experienced as effective and supportive. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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 standard(s) 24,25,30 Residents lived in a home that they found comfortable and where they could personalise their space. Attempts had been made to embellish the environment to create a homely feel. Heavily stained carpets in the dining room and hallway detracted from this. EVIDENCE: The residents found the home comfortable and meeting their needs. There was evident satisfaction when showing their own bedrooms and how they had been able to personalise and decorate them to their liking. The accommodation was a semi-detached house, on three floors. The home was well maintained and spacious. All residents’ rooms were single, but none had en-suite facilities. There were adequate communal areas, including a large garden. The home was in a residential street, but close to a range of community facilities and served by public transport. It was not suitable for service users who were not ambulant. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 19 The premises were clean, but there were heavily stained carpets in the dining room and hallway. Staff said that recent attempts to clean them to remove the stains had had no effect. The laundry was sited away from the kitchen and food storage areas. Hand washing facilities were available in the kitchen and bathrooms. Soap dispensers were in use, along with disposable towels. The home had been inspected by environmental health (food hygiene section) in February 2004 and an external contractor had tested fire system and appliances in October 2004 (these were tested periodically by the contractor). 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,34,36 Residents benefited from a staff team that was supported and supervised to enable them to deliver a service consistent with the aims of the home and individual care plans. EVIDENCE: 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 21 Discussion with management and a member of staff confirmed that staff had clear job descriptions, received regular supervision, took part in staff meetings, had received copies of the General Social Care Council code of conduct and took part in a full programme of induction when employment commenced. Supervision was considered helpful and constructive. New training plans were being developed. Residents valued the commitment of staff and gave examples of how they were supported. The organisation was taking steps to ensure that at least 50 of care staff in the home would achieve a care national vocational qualification (NVQ) by 2005. Staff confirmed that the induction programme for new staff included ensuring that new staff would work with an experienced colleague at all times, until familiar with the service users and with the home’s safer working practices guidelines. As stated in then previous inspection, the manager who left in summer 2004, after managing the home for some time, was a mental health professional. It was understood that he gave much emphasis to in-house training and to guiding staff in this area. To demonstrate that this standard is met, the provider would need to state the range of skills and qualifications or training they consider necessary for the staff team to meet service users needs, with particular reference to mental health needs. This can then be assessed against the home’s statement of purpose and associated policies. Discussion with the newly appointed manager gave evidence that work had started, but was not yet completed, to re-appraise the range of skills and qualifications needed in the staff team. From discussion of the new recruitment procedure with management and inspection of two files, it was noted that the recruitment procedure included requesting applicants to submit their details in writing on an application form and the following up of references and other statutory checks. Management assured that personnel files had been reviewed to ensure that the necessary checks had been carried out for staff employed before the previous inspection. The application form still needed to be amended as it only asked for details of employment history for the past 10 years. This did not enable a full work history to be considered or gaps in employment, if any, to be explored. Some other information, that the provider might want to consider including in the application, was discussed during the inspection. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 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 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) 0 EVIDENCE: These standards had been assessed as being met during the proceeding twelve months and were therefore not inspected on this occasion. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 2 3 x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 x 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
23 Vancouver Road Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4,5 Requirement The statement of purpose and service users’ guide to be reviewed to make certain that the information is up to date and includes all that is required by the relevant standard and regulations. (Previous timescale, of 01/02/05, partly complied with. New timescale agreed). All staff who administer medication to have formal training and to read the home’s medication policy. (Previous timescale, of 01/02/05, not complied with. New timescale agreed). A list of designated staff (permanent and bank/ agency), who may administer/handle medication, to be maintained. The heavily stained carpets in the dining room and hallway to be replaced. The range of skills and qualifications or training, which the provider consider necessary in the staff team, to be clearly stated. All statutory checks, to ensure suitability of staff, to be conducted and to inform the
G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Timescale for action 31 August 2005 2. 20 18 31 August 2005 3. 20 18 31 August 2005 31 August 2005 31 August 2005 4. 5. 30 32 23 18 6. 34 19 31 August 2005
Page 25 23 Vancouver Road Version 1.30 decision to appoint. In particular all previous work and education history is to be obtained and any gaps explored. (Previous timescale, of 01/02/05, partly complied with. New timescale agreed). 7. 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. 2. Refer to Standard 20 22 Good Practice Recommendations That the providers policy on medications is consistently followed or reviewed. That management continues to review with residents, relatives, supporters, staff and external professionals, how best residents can be enabled to express concerns, if any. 3. 4. 23 Vancouver Road G52-G02 S25649 VancouverRoad V232627 130505 Stage 4.doc Version 1.30 Page 26 Commission for Social Care Inspection 46 Loman Street London SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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