Inspection on 30/06/05 for Vine, The

This inspection was carried out on 30th June 2005.

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 26 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vine, The 13/02/09

Vine, The 25/02/08

Vine, The 05/05/06

Vine, The 29/11/05

Vine, The 15/03/05

Vine, The 24/09/04

Vine, The 05/02/04

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 The Vine 58-60 Rosendale Road London Address 3 SE21 8DP Lead Inspector Sonia McKay & Vashti Maharaj Unannounced 30th June 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. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Vine, The Address 58-60 Rosendale Road, London SE21 8DP 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) 0208 670 9248 thevine60@btinternet.com LArche Lambeth Ms Lal Keenan CRH Care Home 7 Category(ies) of PC Care Home only registration, with number of places Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th March 2005 Brief Description of the Service: The Vine is registered to accommodate seven adults with a learning disability. All of the service users require varying degrees of support and assistance in their daily lives. The home is one of six residential care homes in Lambeth and Southwark, which are part of the local L’Arche community. The aim of the community is to create an environment which welcomes people with learning disabilities. Fundamental principles of the community are that each person has a right to friendship, to a spiritual life and to live in an environment that fosters personal growth. At the time of the inspection the home had six service users in residence. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of the Vine was conducted by two inspectors on one day. It commenced at 8am and was completed by 6pm. Staff recruitment and training records were examined on 4 July 2005 at the L’Arche head office. The inspection involved observing meal arrangements (breakfast), talking with service users and staff, inspecting home records and records of the care required and provided to each person. A tour of the premises, including all of the bedrooms occupied by service users also took place. Comments were also received from a family member and a health professional involved in the care of some of the service users. What the service does well: What has improved since the last inspection? The majority of requirements made in the previous inspection report had been addressed. Written confidential information about each service user is now safely stored in a lockable cabinet. The homes policy and procedure in regard to visitors to the home has been revised to ensure that adequate safeguards are in place to protect service users from abuse. Areas of the homes décor damaged when double glazed windows were fitted have been redecorated. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 6 A staff training needs assessment has been conducted to identify training that staff should attend to equip them to meet the needs of the service users living in the Vine. 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. Vine, The G52-G02 S22768 Vine The V236397 300605 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 Vine, The G52-G02 S22768 Vine The V236397 300605 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) 1, 2, 3, 4 & 5. Prospective service users have adequate information to make an informed decision to move into the Vine, after extensive opportunities to ‘test drive’ the home. Individual needs and aspirations are assessed and met and each service user has a written contract stating the terms and conditions of occupancy. The homes registration certificate does not adequately reflect the ages and needs of the service users accommodated and must be updated. EVIDENCE: There is an informative ‘Statement of Purpose’ and a ‘Service Users Guide’ to the home. Emphasis has been placed on making the guide accessible to service users with a learning disability and it contains many colour photographs, symbols and clear language. The staffing information in the Statement of Purpose is out of date and requires revision. (See requirement 1). L’Arche offers long term placements only and has a lengthy placement process, which is tailored to meet the needs of the individual and usually involves at least two brief visits to the home and three longer visits, including overnight stays. This allows the referred person the opportunity to experience life in the home before making a positive choice to move in for a trial period. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 9 Service users are described as ‘the people with learning disabilities in the L’Arche community. A recently admitted service user confirmed that he had visited the Vine on a number of occasions before making a decision to move in. A community care assessment compiled by the placing authority was in place, in addition to a Vine care assessment and care plan. There had been a detailed six week and six month placement review involving the core member and his family, social services and the community based behaviour support team. The views of existing core members are also taken into account during the placement process and trial period. L’Arche places emphasis on providing staff with communication support skills and provides staff with ‘Signalong training, and specialist training for communicating with adults with a learning disability. A database of photographs of all community members (core members and staff), significant locations and other useful objects is being developed to assist with this. Each service user has a contract of service and occupancy that has been explained to them if they are unable to understand the document themselves. Copies are available in individual care files. One service user has spent many years in the service and is now over the age of 65 years, the upper limit of the homes registration. There was evidence that steps had been taken to meet the service users increasing needs in terms of support, activity and physical environment (social services contracts a waking night worker from an agency to stay with the service user at night). The service user has retired from work (service users engage in employment activity in a range of L’Arche workshops or attend a local daycentre) and instead attends a L’Arche retirement group. Another service user has a physical disability, and adequate environmental adaptations are in place to meet her needs. Both service users are accommodated in ground floor bedrooms and have access to the communal areas of the home. (See requirement 2). Vine, The G52-G02 S22768 Vine The V236397 300605 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, 7, 8, 9 & 10. The changing needs and personal goals of each service user are reflected in their individual care plan. Service users are able to make decisions about their lives with assistance as needed. However, although the assistance in place is not fully independent (advocacy) of the service and this could be improved. Emphasis is placed on service user consultation and participation. Confidential information is handled appropriately. Risks are not adequately identified, assessed or minimised and this presents significant risks to the health and safety of service users. EVIDENCE: Individual care plans are reviewed annually and every six months new goals are reviewed/set with the individual, home staff and staff from the workshops. L’Arche are developing accessible service user plans. The four individual care plans examined were appropriate and detailed. Care records available indicated that steps are taken to meet the individual goals and care needs identified. Placing authorities had recently reviewed the care provided to the four service users whose files were examined. The service user, along with family members (if the service user wishes) and home staff attend the annual review. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 11 Home staff work creatively with the service user before an annual review to enable them to understand and contribute as much as possible to the process in ways of their individual choosing (video, photographs, spoken word, objects, music and drawings). The actual review meeting is held in a place that is comfortable to the service user (either at home or in a formal meeting room). The meeting aims to review goals from previous planning meetings and explore how new goals can be supported. The home has close links to the Lambeth community team for adults with a learning disability, who provide behaviour support and speech and language therapy as the need arises. A professional from the team spoke positively about the way home staff worked with the service users. L’Arche aims to provide each service user with a ‘reference person’ in the home to act as a keyworker. Discussion with staff on duty on the day of the inspection indicated that this was not presently available in the Vine (a large number of staff had only recently joined the team). This keyworking system is recommended, so that service users have a key member of staff to work with who have special responsibility for assisting them with planning and day to day arrangements. (See recommendation 1). Fully independent advocates are in short supply in the borough. L’Arche uses a semi-independent advocacy system with assistants from other homes or workshops who know the service user well. This is not ideal, but does ensure that someone from outside the home who knows the service user and sees them often is involved. A recommendation is made for L’Arche to pursue the services of fully independent advocates. (See recommendation 2). Service users are encouraged to participate in the day to running of the home and in community planning. They can take part in weekly house meetings, ‘talking group’ meetings with the director six times a year and community council elections. Service users are also involved in the assessment of new staff during their probationary period. One service user had recently entered a staff bedroom and attempted to drink a quantity of hair dye. Appropriate medical attention had been sought from an accident and emergency department and the service user had not suffered any ill effects. Another service user had recently been diagnosed with shingles. Risk assessments were not available for either issue and staff were unaware of the potential risks these occurences posed. Staff commented that they had been verbally advised to lock their bedroom doors to prevent one service user in particular from entering. Bedroom doors were observed to be unlocked during the inspection visit. A requirement is made to address these potential risks. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 12 (See requirement 3) A small lockable cupboard had been provided to store confidential service user information in, as required in the previous inspection report. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 13 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, 14, 15, 16 & 17. Service users have opportunities for personal development. They are able to take part in a wide range of leisure activities, and therapeutic employment. Appropriate relationships with family and friends are encouraged and supported. Service users are encouraged to be responsible in their daily lives. Meals are healthy and attractively presented and mealtimes are relaxed. Staff interact well with service users. EVIDENCE: L’Arche is a faith-based community and offers active support to each service user to develop their faith and spiritual lives. Service users who choose not to attend religious activities of any particular denomination are offered opportunities to engage in art, music and nature. Service users attend L’Arche workshops (weaving, stone work, gardening and candle making) or a local daycentre. The elder service user has retired and attends the retirement group instead. Service users commented that they enjoyed their daytime work and activities. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 14 The proximity of the other L’Arche homes provides a close community. Service users spoke positively about regular supper invitations with friends living in other L’Arche homes in the area. L’Arche Lambeth has been operating for more than 25 years and has developed good relationships with local individuals and organisations. Staff live at the Vine with the service users, with the intention of building a shared community and consistent engagement between the staff and the service users. Staff and service users were observed to be planning a weekend outing to the Southbank and evenings out for supper with friends. All service users are offered a minimum two weeks of holiday away from the home in each year, either alone (with staff support) or as part of a group with shared interest. Personal information held in individual care files contained detailed information about family and friends, their birthdays and family history. This enabled staff to support service users to maintain and develop family relationships. One service user spoke about regular visits to see parents and another proudly displayed family photographs. Guest bedrooms were also available if a service user wished to have a friend or relative to stay overnight. Observed interactions between the staff and the service users were respectful, natural and caring. The service users and assistants ate at a large dining table together in the communal lounge. Breakfast was being served as the inspection began. Service users and staff interacted very well and staff were observed to manage interactions between service users with tact and diplomacy. There was a very real sense of shared living and close community spirit. The mealtime was relaxed and only paced with a view to getting everybody to their activity or workshop on time. Each service user was having the breakfast menu of their choice, and the food prepared was fresh and appetising. Records of meals eaten examined indicated that a range of meals had been served. Food stocks were stored appropriately and contained plenty of fresh fruit and vegetables. Each service user chooses and helps to prepare an evening meal each week to the best of their ability. One service user commented that he liked the meals. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21. Service users receive personal care in the way they prefer and require. Physical health needs are addressed but are inadequately recorded. Emotional health needs are being met with professional input as needed. The home has made limited progress with regard to the arrangements for administration of medication. The outstanding issues noted at the last inspection could place service users at risk. EVIDENCE: Service users were well dressed, in styles that reflected their personal choice and personality. One service user had been assisted to dye her hair and was very pleased with the results. Care had also been taken to ensure that the service was able to cater for the additional needs of an ageing service user. Social services had supplied a small team of additional agency staff to provide night waking support. Same gender personal care support is provided by a staff team comprised of both men and women. Personal care routines were clearly layed out in individual plans, detailing the level of support required with each task. Staff Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 16 spoke confidently about the daily exercise routines prescribed for two service users by physiotherapists. Some information about the healthcare appointments attended is stored electronically and staff on duty were unable to access it or provide printed copies of the information required. It is essential that all information about current health needs be accessed by all staff providing care and support to ensure the health and safety of each service user. (See requirement 11). Recent reviews have identified the need to develop ‘Health Action Plans’ with each service user. An accessible template had been developed by local health teams. This is recommended to ensure that healthcare is pro-active. (See recommendation 3). The Vine refers people with emotional needs to the local community team for adults with a learning disability when necessary. A member of the behaviour support team spoke positively about the relationship between home staff and the service users. Medication At the last inspection, a thorough review was carried out and 8 requirements were made. A number of these remain outstanding. The home must ensure that these are actioned. These are: The registered persons must ensure that all medication available in the home is stock checked on a regular basis to ensure that ‘out of date’ medication is returned to the pharmacy and to ensure that medication is being administered appropriately. A stock check form has been devised but not yet implemented. It appears that a stock check has not been done since the last inspection, as out-of-date medication is still present. These items must be removed (see Requirement 16). The registered persons must ensure that medications to be used ‘as required’ are clearly documented on medication records, detailing the circumstances for which they are intended. One resident was recently administered an item which is used on an “as required” basis. This had been purchased over-the-counter, and no records of administration were made (see Requirement 17). The registered persons must ensure that all medications received into the home are accurately documented. Receipts are recorded on the Medication Administration Record (MAR) charts, not all items are recorded, and returns are not being recorded. Some medication which is no longer needed is being stored on top of the medication Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 17 cabinet. One resident’s bathroom contained prescribed external products which did not appear on the current MAR chart (see Requirement 18). The registered persons must ensure that any medication administered to service users is documented appropriately, including the signature of the person who administered it. There is evidence in care plan notes that two items have been prescribed for two residents in the last few months with no record of these being received or used on the MAR chart. There are also gaps where medication has not been administered but no reason is given (see Requirement 19). The registered persons must ensure that a photograph of each service users is available within the medication records. Photographs are missing for 2 residents (see Requirement 20). The registered persons must seek advice from the GP in regard to the use of home remedies (over the counter) for each service user. There was no evidence that this has been done (see Requirement 24). The registered persons must ensure that all staff involved in the administration of medication are provided with appropriate training on medication (this must include training on the maintenance and use of an oxygen concentrator in use at the home by one of the service users). The House Leader has received medication training at the L’Arche head office. All other members of staff who handle/administer medication must also receive formal training, as in-house training is not usually of a sufficient standard. Training must include both of the following aspects: • Basic knowledge of how medicines are used and how to recognise/deal with problems in use • The principles behind all aspects of the homes policy on medicines handling and records (see Requirement 21). A signature sheet has been put in place for staff who administer medication. It would be good practise to add a statement to this sheet that these members of staff have been trained and designated as competent to administer medication by the house leader. No staff should administer medication unless they have had formal training. The L’Arche medication policy provided on the day of the inspection was the old version, from October 1998. There is an updated version, version 2, which was provided by L’Arche prior to the inspection. The home must ensure that the older version is replaced, and all staff receive training in the updated policy. The updated version should include at the next revision the following topics, which are especially relevant to L’Arche residents: Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 18 -The supply of medication when away from the home i.e. while at work, day centres, holidays -Over the counter medication -Handling or medication errors -Use of oxygen The policy mentions the use of medication profiles for each resident, which are useful tools for identifying side effects due to medication, and also for determining what the consequence is of missed doses. These profiles are not available for 2 residents, and are not up-to-date for others (see requirement 22). There have been some changes to dose or frequency on MAR charts with no date/initials of the staff member making the change, or a cross reference to the authorisation for the change (see requirement 23). Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 19 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. The complaints policy and procedure is adequate but to be effective it must be followed when a complaint is made. This had not happened. Financial safeguards and procedures are in place but had not been followed by staff. This does not provide service users with adequate protection from financial abuse. EVIDENCE: The home has a good complaints policy. There is text version and a more accessible version for service users who may not be able to understand a text only document. A complaints poster is displayed on the notice board in a communal area and has colour photographs of people who can assist with a complaint, including the CSCI. Regular house meetings offered service users the opportunity to raise concerns. Although no complaints had been recorded in the homes record of complaints, a care log entry indicated that a family member had made a complaint to a member of staff. The action taken as a result had not been recorded. (See requirement 4). The home has revised the ‘visitors’ policy to provide service users with a suitable level of protection from abuse, as required in the previous inspection report. Overnight guests of staff must now be’ police checked’ in addition to being invited with the express permission of the service users. A record of visitors was available and was being used appropriately. Abuse awareness training is part of the L’Arche induction and formation training undertaken by all new staff. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 20 Staff were observed to manage instances of minor self injurious behaviour appropriately and spoke confidently about action to be taken if abuse was observed or suspected. A spot check of service user finances held in safe keeping by staff indicated that adequate systems were in place to protect service users from financial abuse, although these had not been followed. A bank account cash withdrawal had not been entered into the financial records kept in the home for the individual. Receipts of items purchased with the cash withdrawn were available and the balance of cash remaining indicated that none was missing. This is unsafe practice and steps must be taken to ensure that staff follow the financial procedures fully. (See requirement 15). Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 21 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, 29 & 30. Service users live in a comfortable and homely environment. Bedrooms and bathrooms meet their individual needs and are sufficient in number. Service users have the equipment they need to maximise their independence other than ramped access to the garden. Continence needs are not handled effectively and clinical waste is not handled safely. EVIDENCE: The large home is suitable for its purpose, comfortably furnished , homely and clean in most areas. Ramped access to the rear garden is not suitable to the service users with mobility problems, as the ramp ends abruptly and does not provide level access to the grassed area. This is a requirement of the previous inspection report that is not met. (See requirement 5). All bedrooms are single occupancy and suitable to the needs of the service users. Radiator covers are in place to prevent burns. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 22 The number of toilets and bathing facilities are adequate and meet the individual mobility needs of the service users. Communal areas are large and include a lounge/dining room, a smaller lounge with patio doors open on to a conservatory and the rear garden. One bedroom, used by a service user with continence needs had a very unpleasant odour. This is subject to a requirement. (See requirement 6). Bags of clinical waste were on the pavement outside of the home at the beginning of the inspection visit. Clinical waste must be safely stored in suitable waste bins to prevent the spread of infection. (See requirement 7). Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 23 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, 33, 34, & 35. Staff roles and responsibilities are clear. Recruitment procedures have improved but still do not provide service users with adequate protection. Staff training has improved, although high staff turnover has reduced the effectiveness of the training plan. EVIDENCE: House assistants within the L’Arche community are provided with board and lodgings. Staff at the Vine live on the premises and take turns to do duty. L’Arche is a Christian community, that requires staff to be part of all aspects of care and support and a committed community lifestyle. Staff are paid a small wage/expenses for a 40 hour week commitment to the home and L’Arche community. L’Arche assistants are volunteers, usually from abroad, who work in the homes for one or two years. A L’Arche framework of policies and procedures, provides staff with guidance. There had also been ongoing staff support and training from the home manager, the homes co-ordinator and other long standing community staff. The status of the assistants means that they normally do not have NVQ qualifications and the director of L’Arche has conceded that it will be hard for the organisation to meet this standard by 2005. (See requirement 8). Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 24 A number of new staff had recently arrived at the Vine, and as the home manager was away on leave, staff from elsewhere in L’Arche, familiar with the service users and the home, had been temporarily deployed to the service to provide a level of stability. There has been a high turnover of staff, which has been unsettling for service users at times (one service user has attachment disorder). Family members and professionals consulted also raised concerns about the frequent staff team changes. L’Arche should look at how staff retention can be improved. (See recommendation 4). Staff duty rotas were in place in the house diary. Full names had not been used and as the staff changed frequently this is particularly inadequate. This is the subject of a requirement in this report. (See requirement 9). Recruitment records are held at the L’Arche head office. They were examined on 4 July 2005. A recruitment co-ordinator has made progress in auditing staff recruitment records. The records are still incomplete in some cases. References taken up by telephone had not been authenticated in writing, and documents confirming the identity of individual staff, including recent photographs, were not in place. This does not provide service users with adequate protection and was the subject of a requirement in the previous inspection report that is not met. (See requirement 10). Training records are held at the L’Arche head office. They were examined on 4 July 2005. A training co-ordinator has made progress with compiling a team training and development needs assessment for each of the L’Arche homes and records of training undertaken by individual staff. L’Arche provides all new assistants with induction training in the first six weeks. ‘Foundation training’ is undertaken in the first year, this is a combination of ‘in house training’ and training provided by the local specialist learning disability team. NVQ training is provided for staff who are able to commit to more than two years. Working visa constraints prevent some staff from staying for more than a year so few have achieved this. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 25 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, 38, 39, 40 & 42. Service users benefit from a well run home. The manager is registered and competent but must undertake appropriate training to fully develop her skills. Service users are involved in the review of the services provided by the home, which is monitored by the registered provider on a regular basis. Systems and checks to promote the health, safety and welfare of service users must be improved. EVIDENCE: The registered home manager has been in post for five years and has undertaken to begin an NVQ level 4 in Care and Registered Managers Award this year. (See requirement 12). Staff members on duty on the day of the inspection spoke positively about the managers support, skill, approachability and inclusive management style. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 26 The L’Arche community has an annual development plan for quality assurance in place. The home is visited on a monthly basis by a representative of the responsible individual as required by Regulation 26 of the Care Homes Regulations 2001. Reports on the findings of these regular inspections are maintained in the home and supplied to the CSCI. The L’Arche policies and procedures are reviewed periodically and a number have been reviewed or developed in 2004, including physical restraint, challenging behaviour, risk assessment, internal incident reporting, internal financial controls, confidentiality, medication and transport. L’Arche has demonstrated that policy and procedure are reviewed in light of changing circumstances. COSHH (Control of Substances Hazardous to Health) information sheets were available, although products were available in areas of the home and this presents a safety hazard. (See requirement 13). The Gas Boiler annual safety certificate was available and was dated 13/12/04. Mains electrical circuitry had been safety tested on 31/01/01. The test certificate was noted to cover a five-year period from that date. Small electrical appliances had been safety tested by one of the house assistants. A record had been made of the items tested by an assistant on 21/09/04. Fire authorities had inspected the premises and confirmed that precautions were adequate on 11/01/05. Regular checks had been conducted on fire detection and emergency equipment both in house and professionally. Fire evacuation drills had been conducted with the required frequency and the outcome of the evacuation drills recorded. Environmental risk assessments had been conducted but were overdue for a review. (See requirement 3). Accidents had been recorded appropriately. ‘In house’ Health and safety responsibilities were nominated and records of checks maintained. A fire risk assessment and building floor plan were available. Fridge temperatures were checked daily. Environmental health inspectors had inspected the food handling arrangements in March 2005. The report recommends that staff receive accredited food hygiene training. The report also recommends that hot food probes be used to test that temperature of cooked meals to prevent food poisoning. This is a requirement of the previous inspection report that is not met. (See requirement 14). Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 27 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 2 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 1 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 2 1 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Vine, The Score 3 2 1 3 Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x 2 x G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 28 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 YA1 Regulation 4(1)(c) & Sch 1 Requirement The registered persons must ensure that the staffing information in the Statement of Purpose is reviewed and revised to include current staffing. The registered persons must apply to the CSCI for a minor variation to the registration certificate to allow them to continue to provide care to one service user over the age of 65 years, and two service users with physical disabilities. The registered persons must ensure that action is taken to minimise identified risks and hazards. The registered persons must ensure that a record is kept of all complaints made by service users or their representatives or relatives and the action taken in respect of any such complaint. The registered persons must ensure that the ramp built in the rear garden to provide level access to the garden, does so (the ramp ends abruptly and does not extend to the level of the grassed area. Previous requirement of Timescale for action 28 October 2005 2. YA3 14(1) 28 October 2005 3. YA9 & YA42 12(1)(a) &13(4)(a) YA22 17(2) & Sch 4(11) 9 September 2005 31 August 2005 4. 5. YA24 & YA29 23(1)(b) & 23(2)(n) 31 December 2005 Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 29 30/06/05 not met. 6. 7. YA24 YA30 16(2)(k) 16(2)(k) The registered persons must ensure that the home is free from offensive odours. The registered persons must ensure that the home has a policy and procedure in regard to the safe handling and disposal of clinical waste. Previous requirement of 27/05/05 not met. The registered persons must ensure that at least 50 of care staff hold an NVQ 2 or 3; are working to obtain one by an agreed date; or the registered manager can demonstrate that through past work experience staff meet that standard. The registered persons must maintain an accurate and full record of staff duty rotas. The registered persons must ensure that evidence of all information and documentation required by Schedule 2 of The Care Homes Regulations 2001 (revised in July 2004) is obtained for staff before they commence work in the care home. The revised recruitment procedure must be sent to the CSCI Southwark office. Previous requirement of 30/06/05 not met. The registered persons must ensure that the healthcare needs of service users are fully documented and accessible to staff. The registered persons must ensure that the registered manager has undertaken to complete qualifications at level 4 NVQ in both management and care. The registered persons must 2 September 2005 2 September 2005 8. YA32 18(1)(a) (c) 31 December 2005 9. 10. YA33 YA34 17(2) & Sch 4(7) 19(1) & Sch 2 31 August 2005 31 August 2005 11. YA19 12(1) & Sch 3(3) (k)(m) 9 & 10(3) 31 August 2005 12. YA37 31 December 2005. 13. Vine, The YA42 13(4)(a) 31 August Page 30 G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 14. YA42 15. YA23 16. YA20 17. YA20 18. YA20 19. YA20 & 13(4)(c) ensure that the practice of storing cleaning materials/prescribed topical products in bathrooms is risk assessed to ensure that adequate steps are taken to maintain the safety of service users. Previous requirement of 29/04/05 not met. 13(4)(c) & The registered persons must 16(2)(i) ensure that staff have training in food hygiene and are aware of the need to check hot food temperatures (using hot food temperature probes). Previous requirement of 30/06/05 not met. 17(2) & The registered persons must Sch ensure that a record is kept of all 4(9)(a) money or other valuables deposited by or on behalf of a service user into safe keeping. 13(2) The registered persons must ensure that all medication available in the home is stock checked on a regular basis to ensure that ‘out of date’ medication is returned to the pharmacy and to ensure that medication is being administered appropriately. 13(2) The registered persons must ensure that medications to be used ‘as required’ are clearly documented on medication records, detailing the circumstances for which they are intended. 13(2) The registered persons must ensure that all medications received into the home are accurately documented. 13(2) The registered persons must ensure that any medication administered to service users is documented appropriately, including the signature of the G52-G02 S22768 Vine The V236397 300605 Stage 4.doc 2005 30 November 2005 31 August 2005 31 August 2005 31 August 2005 31 August 2005 31 August 2005 Vine, The Version 1.40 Page 31 person who administered it. 20. YA20 13(2) The registered persons must ensure that a photograph of each service users is available within the medication records. The registered persons must ensure that all staff involved in the administration of medication are provided with appropriate training on medication (this must include training on the maintenance and use of an oxygen concentrator in use at the home by one of the service users). The registered persons must ensure that all medicaton profiles are completed for all service users to enable effective monitoring of side-effects and changes in condition which may be due to medication. The registered persons must ensure that all amendments to the dose or frequency on MAR charts are dated and initialled by the person making them, together with a reference to the medical authorisation. The registered persons must seek advice from the GP in regard to the use of home remedies (over the counter medication) for each service user. 31 August 2005 31 August 2005 21. YA20 18(1)(c ) 22. YA20 13(2) 31 August 2005 23. YA20 13(2) 31 August 2005 24. YA20 13(2) 31 August 2005 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. Vine, The Refer to Standard YA6 Good Practice Recommendations The registered persons should appoint each service user with a keyworker. G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 32 2. 3. 4. YA7 YA19 YA33 The registered persons should pursue independant advocacy services for LArche service users. The registered persons should develop Health Action Plans for each service user. The registered persons should look at ways in which staff retention can be improved. Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 33 Commission for Social Care Inspection SE London Area Office Ground Floor, 46 Loman Street Southwark London SE1 0EH 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 Vine, The G52-G02 S22768 Vine The V236397 300605 Stage 4.doc Version 1.40 Page 34 - 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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