Inspection on 27/01/06 for Victoria House

This inspection was carried out on 27th January 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Victoria House 17/04/08

Victoria House 06/06/07

Victoria House 23/11/06

Victoria House 21/08/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Victoria House 62/64 George Lane South Woodford London E18 1LW Lead Inspector Jackie Date Unannounced Inspection 27th January 2006 1:00 Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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 Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Victoria House Address 62/64 George Lane South Woodford London E18 1LW 020 8491 0465 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.caremanagementgroup.com Care Management Group Limited *** Post Vacant *** Care Home 6 Category(ies) of Learning disability (0) registration, with number of places Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2005 Brief Description of the Service: Victoria House is a six-bedded home for adults with learning disabilities and challenging behaviour. It is in a residential area of South Woodford close to local shops and amenities and to local transport networks. Residents need varying degrees of support with everyday daily living tasks but all require a high level of supervision because of their challenging behaviour. Three of the six residents can communicate verbally but the others have very limited communication. Some residents access day services, others are supported in community based activities by the staff team. The building does not have any adaptations for people with physical disabilities and would not be accessible to wheelchair users. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted for about four hours and took place during the afternoon. It was the second of the two inspections that each home must have during the inspection year. During the two visits all of the key standards have been checked. The deputy manager, staff and some of the residents were spoken to. All of the communal areas were seen and care and other records were checked. Since the last inspection there has been a change of ownership and change of manager. The main purpose of this visit was to monitor the progress of the requirements from the previous inspection and the operation of the service under the new organisation. Relatives and other professionals were contacted by telephone for their opinions of the service. In addition feedback forms were left for staff that were not on duty at the time of the inspection to give their comments on the service. What the service does well: What has improved since the last inspection? The sale of the home has been completed this gives more stability to the service. Although the work has not been carried out the organisation plans a number of improvements to the building. This includes a new roof, new windows, improvements to the garden and redecoration throughout. This will make a building more comfortable and homely for the residents. There is a lot of training available for the staff and this will help them to do their jobs better. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 6 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. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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 Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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 the following standard(s): These standards were not tested on this visit. However evidence from the last inspection was that information is available to enable the staff team to meet residents’ needs. If a vacancy arose the required information would be gathered on a prospective resident and they and their relatives could spend time in the home to find out what it would be like to live there. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the five standards. At the time of the last inspection standards two, three and four were tested and assessed as met. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 9 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 Residents’ plans contain detailed information so that staff can meet their needs but they have not been reviewed recently and do not necessarily contain up to date information about their needs. EVIDENCE: All of the residents have plans which give details of how they need/like to be supported. However the care plans have not been reviewed regularly as required by the previous inspection and information contained in them is not always up-to-date. The deputy manager said that they would be introducing the care planning process that is used by the new organisation and that all residents will have a review before this happens. The timescale for meeting this requirement has therefore been extended to allow for the new systems to be introduced, reviews to be held and the new care plans to be developed. The staff team has not changed and they do know the residents and are able to provide continuity of care whilst the changes are being implemented. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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, 14 & 16. The residents have opportunities for activities and to be part of the local community and this will be developed more by the staff team. The residents are supported, as far as possible, to make decisions about what they do. EVIDENCE: Some of the residents attend day services during the week. The staff team encourage and support them to take part in activities in the community. They visit the library and swimming pool and use the local shops. The home has a minibus that can be used for trips and outings. Some of the residents go to the Gateway club. Feedback from staff was that residents are going out more now and doing more activities. For example going to the cinema or to the Chinese restaurant for lunch. One resident has, at his request, stopped going to work on a local farm project and is now helping the handymen with various tasks. On the day of the inspection they had been to the nearby sister home to do some work. In addition to this the home has now got an allotment and it is planned that this resident will be working on it with the handyperson and possibly other residents. When he returned home it was evident that he had Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 11 had an enjoyable day and also that he was looking forward to working on the allotment. Some of the residents can and do use the keys to their rooms. On the day of the visit residents spent time in the lounge, dining area, or in their rooms. It was evident that they chose when and where to spend their time. Relatives spoken to said that they were happy with the support given to the residents and with the progress that they had made. Unfortunately the residents did not have a holiday last year but they have started talking about this years holiday and three of the residents want to go abroad. The deputy said the residents would have holidays this year. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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, 20 and 21 Residents receive personal care that meets their individual needs and preferences. The staff team support the residents to get the healthcare and medication that they need. Staff have not received the necessary training to ensure that they administer insulin competently and safely. EVIDENCE: Some of the residents require a lot of support with their personal care and details of the help that they need and how they prefer to be supported are in their individual plans. Residents are encouraged to choose what to wear. All of the residents go to the local doctor and specialist help is received from the community learning disabilities team. Staff take residents to all of their medical appointments. One of the residents has diabetes and staff have taken him to see the specialist diabetes nurse and she is going to visit the home to give the staff more guidance and advice about managing the condition. Feedback from this residents’ mother was that the staff team manage his diabetes well. Residents’ files have details of health care issues and show that residents have regular access to health care professionals. Records are kept of Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 13 medical appointments and these show that residents have checks from the optician, dentist and when needed the chiropodist and community nurse. Therefore residents’ healthcare needs are being met. Feedback from relatives spoken to was that the residents are well cared for and that “the staff are good”. None of the residents are able to self medicate and medication is administered by the senior member of staff on duty. Medication is stored in a locked cabinet in the main office. The system for the administration of medication had just been changed to the Boots Monitored Dosage System and all staff were due to receive training on this system a couple of days after the inspection. New Medication Administration Record (MAR) sheets had been provided but amendments had been required and additional items had to be written on to the sheets. These will all be rectified by Boots. In the interim, two members of staff are double-checking the medication against old MAR sheets. The deputy was advised that any handwritten amendments or additions to MAR sheets must be signed and dated by the person making the entry. The resident with diabetes is prescribed insulin, which the staff administer by means of a “penfine” with a snap on needle. The deputy described how this was done and seemed confident in this. However, the staff team have not had any specific training in administering medication in this way. The care worker administering insulin must receive training in the correct preparation of the prescribed dose and administration of a sub-cutaneous injection, specific to a named resident. The care worker must be assessed as competent to administer insulin. The community nurse who assumes responsibility for delegating this task or the approved trainer must deliver this aspect of the training in line with the Nursing and Midwifery Council (NMC) guidelines. Previous inspections have required that there is a policy/procedure with regard to ageing/illness or death of a resident but this has not been met. The emergency on call procedure does cover the immediate action to be taken in the event of the death of a resident. The new organisation will be introducing their procedures to the home. The timescale for meeting this requirement has therefore been extended to allow for this to happen. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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): These standards were not tested on this visit. However evidence from the last inspection was the complaints procedure is in a pictorial format to help residents understand how to complain. Also the staff have been trained in methods of restraint and how to deal with “difficult “ behaviour. Therefore they can manage this in a way that protects the rights and safety of the residents. EVIDENCE: The above standards were not specifically tested on this visit, as there were no outstanding requirements in relation to the two standards. At the time of the last inspection both standards were tested and assessed as met. There have not been any recorded complaints since the last visit. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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, 27, 28 & 30 The residents live in a clean home that is suitable for their needs. Improvements are needed to make the house more homely and to ensure that the residents live in a home that is appropriately decorated, maintained and furnished. EVIDENCE: The house is in South Woodford and is near to the local shops, bus routes and train station. There is a lounge, dining room, conservatory and sensory room. The hall, dining area and conservatory are quite bare and not very “homely”. There are enough baths, showers and toilets to meet the residents’ needs. Changes have been made to one of the cisterns to prevent residents breaking this. Previous inspections have required that further work is needed to make this as unobtrusive as possible. There is a garden that is used by the residents. The previous inspection recommended that the planned decking be fitted in the garden and the patio area improved. This was to improve the garden and to make it easier for residents to use. This work had not been carried out. The condition of the building has deteriorated since the previous inspection and Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 16 the requirement that all areas of the home must be appropriately decorated and should be homely and comfortable has not been met. However the new organisation has allocated funding for a lot of work to be carried out at the home. This will include a new roof, windows and doors and redecoration and new flooring throughout. The garden is to be decked and a barbecue built. At the time of the visit quotes were being obtained for the work. Therefore the timescale for completion of this work has been extended to allow for the work to be carried out. The home appeared to be clean and there were not any unpleasant odours. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 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 & 36 The staff team have remained fairly consistent and therefore residents benefit from being supported by staff that know them. Staff have the skills, experience and qualifications to meet residents’ needs. The staff team have not been receiving consistent or adequate supervision as a result of the change in management arrangements at the home. EVIDENCE: All of the staff team have experience of working with people with learning disabilities and have completed NVQ level 2. In addition some have also completed NVQ level 3. Staff spoken to said that they had already had some training from the new organisation and that a lot more is available to them in the near future. Feedback from relatives was that they were concerned about the changes of ownership and management but as most of the staff team were the same this had alleviated some of their concerns. They also said that the staff team were very good. Due to changes in the ownership and management of the home the staff supervision system has not been fully operational. Arrangements must be made so that staff receive regular, recorded supervision at least six times per year, to give an opportunity for monitoring of work and professional guidance. Also for staff to discuss any concerns individually. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 18 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 & 42 The arrangements for the management of the home are not adequate. Although representatives of the organisation have visited the home and have been involved in plans for the future the monthly unannounced monitoring visits have not yet started and these need to be carried out A safe environment is being maintained for the residents. EVIDENCE: A deputys post has been created and an appointment has been made recently. The deputy is supernumerary and works mainly from 8am to 4pm Monday to Friday. The deputy was previously a senior at the home and has worked there for many years. Relatives spoken to said that they have confidence in her and that she deals with any emergencies and problems well. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 19 When Care Management Group purchased the home there was not a registered manager. At the time of registration it was agreed that a registered manager from another of their homes would manage Victoria House on a full time basis for approximately three months whist recruitment was taking place. However, this person has not in fact been working at the home full time and the newly recruited deputy manager has been taking responsibility for the day to day management of the home. At the tome of the visit the deputy said that it was proposed that the manager of another local home would be managing both homes and that the deputies would continue to oversee on a day to day basis. This had not been discussed or agreed by the Commission. A meeting is scheduled with the organisation to discuss and agree the management arrangements for the home. The registered provider must appoint an individual to manage the home and this person must be registered by the Commission. In the interim more robust management arrangements must be in place. Care Management Group are now responsible for monthly monitoring visits. At the time of the visit these monitoring visits had not commenced. The monthly monitoring visits must begin and copies of reports of these visits must be sent to the Commission. All of the necessary health and safety checks are carried out and additional checks have been introduced. For example a weekly fire audit checklist that includes fire alarms, extinguishers and escape routes. Visual fire alarms are fitted for two residents that have hearing problems. In addition they will also being having “deaf guards” under their pillows. These vibrate when the fire alarm is activated. Therefore a safe environment is maintained. Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 20 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 X 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 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 2 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 X 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 2 X 2 X X 3 X Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 21 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 YA6 Regulation 15 Requirement Care plans must be reviewed with the resident and significant others at least every six months and updated to reflect changing needs. (Previous timescales of 31/03/05 & 31/07/05 not met) Any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. Any care worker administering insulin must receive training in the correct preparation of the prescribed dose and administration of a subcutaneous injection, specific to a named resident. The care worker must be assessed as competent to administer insulin. A policy dealing with the ageing, illness and death of a resident must be developed. (Previous timescales of 31 March 2005 & 31 July 2005 not met.) All areas of the home must be kept in a good state of repair externally and internally. DS0000066301.V277254.R01.S.doc Timescale for action 31/03/06 2 YA20 13 31/03/06 3 YA20 13 31/03/06 4 YA21 12,13 30/04/06 5 YA24 23 30/06/06 Victoria House Version 5.1 Page 22 5 YA27 23 6 YA28 16 7 YA36 18 8 9 YA37 YA37 8 8 10 YA39 26 Appropriate measures must be taken to secure the cistern lids as unobtrusively as possible. (Previous timescale of 31January 2005 and 31 July 2005 not met.) All areas of the home must be appropriately decorated. (Previous timescale of 31 March 2005 & 31 October 2005 not met.) All staff must receive regular recorded supervision at least six times a year with a senior/manager in addition to regular contact on day-to-day practice. Suitable and robust arrangements must be made for the management of the home. The registered provider must appoint an individual to manage the home and this person must be registered by the Commission. A representative of the organisation must visit the home unannounced at least once each month to check on the standard of care provided. A written report must be made and a copy of this lodged with the home and a copy sent to the Commission 30/06/06 30/06/06 30/04/06 31/03/06 31/05/06 30/04/06 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 Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Victoria House DS0000066301.V277254.R01.S.doc Version 5.1 Page 24 - 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. 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