CARE HOME ADULTS 18-65
Woodham House 336 Stanstead Road Catford London SE6 2SB Lead Inspector
Kate Matson Unannounced Inspection 24th October 2005 09:45 Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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 Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Woodham House Address 336 Stanstead Road Catford London SE6 2SB 020 8690 6237 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) Victor Morris Victor Morris Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th April 2005 Brief Description of the Service: Woodham House is a privately owned care home for up to 5 men with mental illness and a forensic history. The home is located on the busy south circular in Catford and is close to railway stations, bus services and local community facilities. The home offers accommodation over three floors with five single rooms and comfortable communal space including a large lounge, large dining kitchen and large garden at the rear. The home is in keeping with the local community and does not stand out as a care home. The stated aims and objectives of the service are to “support men discharged from psychiatric hospitals, medium secure units or special hospitals to independent living in the wider community, and to maximise their potential for normal risk taking. Ensuring privacy, dignity, independence, choice, rights and fulfilment.” On the day of the inspection there were no vacancies. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced statutory inspection was conducted over eight hours. The inspection included: discussion with three service users, two members of staff and the deputy manager; a tour of the premises, and examination of three service users files and other records. CSCI’s training manager accompanied the inspector who was being assessed in accordance with a course she is currently completing. The service users and staff are thanked for facilitating the inspection and accommodating this. Service users gave differing responses to how they wished to be referred, so the term “service user” has been used throughout this report. What the service does well: What has improved since the last inspection? What they could do better:
The Statement of Purpose and Service User Guide still lacked essential information highlighted at previous inspections which means that prospective service users do not have the information they need to make an informed choice about where to live. The service user contract still lacked essential information highlighted at previous inspections. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 6 The physical and mental health needs of service users are largely met though the system used to check the medication of service users who have responsibility for their own medication is disorganised. There had been deterioration in the environment since the last inspection. Although most staff have undergone appropriate training, the training plan does not show what training has been provided and how, the homes induction is not in accordance with Sector Skills Council guidance, and individual assessments of staff training need had not been completed. It was found that the registered manager does not manage the home on a full time basis and does not appear on the home’s rota. Also the unmet requirements from previous inspections may be explained by the registered manager not being in day-to-day control of the home. Although certificates for inspection of fire alarm, fire extinguishers and emergency lighting were now available as required from the previous inspection and fire drills were now taking place at the appropriate intervals, fire alarm tests were still not taking place weekly as required at the previous inspection. Also it was noted that the gas safety inspection was overdue however the deputy manager took action to address this on the day of the inspection. The provider must ensure that staff receive appropriate health and safety training including, infection control, control of substances harmful to health and risk assessment in order that they can assess and manage risks safely. It is also recommended that staff are asked to sign policies and procedures when they are introduced or reviewed to indicate that they have read and understood them. The provider must also ensure that food hygiene certificates are available for all staff involved in food preparation and that there is a qualified first aider on duty at all times as required. 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. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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 Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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): 1, 2 and 5 The documents given to service users do not contain the information they need about living at the home. The needs of service users are thoroughly assessed before they are offered a place at the home. The contracts supplied to service users do not include the information they need to protect their rights. EVIDENCE: It had been noted at previous inspections that the information given to service users needed to be reviewed. At this inspection it was found that the documents still lacked information required by regulation and included the details of the wrong CSCI office. It took the manager some time to find the documents and there were older versions in amongst the newer ones. This is of concern because the correct documents should be readily available to give to prospective service users or their representatives if they visit. Older versions of documents should be destroyed or archived when they are reviewed. It was noted at the last inspection that two of the service users files did not include evidence of needs assessments to ensure that the home could meet the person’s needs before offering them a place at the home. The manager was required to ensure that a copy of the assessment is available on the file. At this inspection the files of three service users were examined including one service user who was new to the home and this included details of a thorough assessment. Previous inspections had noted that the service user contract lacked some of the information required in order to protect the rights of service users. At this Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 9 inspection it was noted that although the newest service user had been supplied with a contract this information was still missing. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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 the following standard(s): 8 Although service users are consulted on, and participate in, aspects of life at the home, further work could be done to increase the effectiveness of meetings and service users’ involvement in them. EVIDENCE: Service users spoken to confirmed that they participate in the running of the home in terms of taking part in the rota for cleaning and cooking a weekly meal for the other service users with support where necessary. The deputy manager stated that a previous recommendation to involve service users in recruitment had been implemented and one service user had agreed to sit on the interview panel for new staff. Although service user meeting minutes evidenced that they were consulted about leisure activities including holidays, food and décor and furnishing of the home, service users could be encouraged to play a greater role. For example chairing the meeting and being encouraged to participate in drawing up the agenda before the meeting. In order to ensure the effectiveness of meetings some aspects of the meeting should be made more formal such as ensuring the minutes of previous meetings are made available and at the next meeting discussed with matters arising. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 11 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): These standards were not inspected but were inspected at the last inspection At the last inspection the following judgement was made regarding these outcomes: - Service users are supported to be independent and to take part in a variety of meaningful activities both at the home and in the local community. They are supported to have appropriate relationships. Meals are provided flexibly at the home and the food offered is varied, balanced and nutritious. EVIDENCE: Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 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): 19 The physical and mental health needs of service users are addressed and monitored; however, a checking system for people who take responsibility for their own medication is disorganised. EVIDENCE: As well as ensuring that close liaison is maintained with mental health services, care plans indicated that service users physical health care is considered at the home. Service users confirmed that they took responsibility for their own health care appointments but that staff would always remind them of appointments or accompany them where necessary. The practice of offering cigarettes as bingo prizes at the home had been stopped as required by the previous inspection. It was noted however that although staff randomly checked the medication of one service user who takes responsibility for his own medication, there was no system in place to ensure that this happens regularly. This must be addressed to ensure the health, safety and welfare of the service user concerned. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 13 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 inspected but were inspected at the last inspection. At the last inspection the following judgement was made regarding these outcomes: - Service users do not feel the need to complain though are clear about how to complain should the need arise. The home has policies in place to protect service users from abuse and staff are trained in appropriate areas to ensure that risk of abuse is minimised and they know how to respond in cases of possible abuse. EVIDENCE: Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 14 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): 26 and 28 Service users bedrooms promote their independence and the homes shared spaces complement and supplement these, however elements of the environment had deteriorated and could lead service users to feel that they are not valued. EVIDENCE: All service users have lockable individual bedrooms and with their permission four of these were seen on the day of the inspection. All of the rooms seen were furnished with all of the required items and three had en-suite facilities. It was noted at the previous inspection that rugs in two of the bedrooms were very stained and the provider was required to get them cleaned or replaced. The manager stated that this had been done but at least two of the rugs were again very dirty. Also a chest of drawers in one room was broken. The home offers shared space of a large lounge, large kitchen with dining area and a large garden at the rear. As service users have their own rooms, this amount of space appears adequate. However there had been deterioration in the environment in some of the shared areas. The carpet on the stairs and landing was dirty and the decoration in the bathroom needed repainting, particularly the door and a shelf. This deterioration of the environment could lead service users to feel that they are not valued and must be addressed.
Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 15 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): 35 Although most staff have undergone appropriate training, the training plan does not show what training has been provided and how; the home’s induction is not in accordance with current guidance, and individual assessments of staff training need had not been completed. EVIDENCE: The deputy manager stated that all staff have either completed NVQ’s courses, are currently completing courses, or are signed up to complete appropriate courses to ensure that service users are supported by a competent staff team. At the last inspection the provider was required to develop a formal training and development plan based on an assessment of the needs of the staff team as a whole and the needs of the service users. It was also recommended that the manager contacts the London “Skills for Care” office (formerly TOPSS) to ensure that the homes training programme meets Sector skills workforce training specifications. At this inspection the deputy manager stated that she had used the Skills for Care website to inform the development of the staff training plan which was examined. Although the training plan identified some areas of training that staff were to receive, it gave no indication how the training was to be provided, or indeed when or whether any of it had been achieved. The deputy manager was informed of the further work that was required in order to meet this requirement. It was also found from discussion with staff and examination of the staff induction list that the homes induction programme did not meet the Sector Skills Council specifications. In particular
Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 16 the induction did not appear to adequately cover health and safety topics such as infection control, control of substances harmful to health, and risk assessment and how staff are trained to be aware of risks and manage them safely. The provider must ensure that the homes induction programme meets the specification of the Sector Skills Council in order to ensure that staff are trained to work with service users safely. These issues are discussed further under Standard 42. In addition the provider must ensure that staff have an individual training and development assessment and profile in order that their training needs are assessed and their progress monitored. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The registered manager does not work sufficient hours at the home to ensure it is effectively run. Service users are regularly canvassed for their views of the home. Systems and training at the home do not protect the health, safety and welfare of service users adequately. EVIDENCE: The registered manager is appropriately qualified to manage the home holding appropriate qualifications in care and in management. However, he is also the registered provider and it was found that although he visits the home most days he does not manage the home on a full time basis and does not appear on the homes rota. The unmet requirements from previous inspections may be explained by the registered manager not being in day-to-day control of the home. The manager must address this concern as a matter of urgency and either ensures that he works sufficient hours at the home to ensure that the home is effectively managed or appoint a manager and submit an application for their registration as soon as possible. At the last inspection it was found that surveys of the views of service users, relatives and professionals were completed every six months. The deputy
Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 18 manager had produced a report of the previous surveys though it was noted that the report had not been publicised and also it included information gathered outside of the surveys that was not acknowledged. It was noted that the format of the surveys could be improved to ensure that service users are encouraged to comment more widely on more aspects of the service and that each of the surveys is made more appropriate for its intended participants. At this inspection the manager confirmed that although the completed surveys were not available the surveys had been reviewed and the latest quality assurance report was seem pinned on the service users notice board and stated clearly the sources of information. It is recommended that results of service users surveys are also included in the service user guide to the home as they help prospective service users to make a more informed choice about where they want to live. The registered provider is reminded that if he is not in day-to-day control of the home he must complete unannounced monthly visits to the home to monitor the quality of service provided, and provide reports of these visits to the manager and CSCI. At the previous inspection it was noted that a fire drill had not been carried out for over eight months, rather than four times per year as required and fire alarm call points were tested approximately every two to three weeks instead of every week as required. Also the servicing of the fire alarm, fire extinguishers and emergency lighting was overdue. At this inspection it was found that fire drills were now taking place at the appropriate intervals, however fire alarm tests were still not taking place weekly. Certificates of inspection were now available for the fire alarm, fire extinguishers and emergency lighting as well as the electrical installation, though it was noted that the gas safety inspection was overdue. The deputy manager contacted the home’s health and safety representative who advised her that this was booked for the week of the inspection and confirmed that this would be taking place in the next couple of days. As already discussed under Standard 35 the homes induction training was not adequate to ensure that staff are trained to work with service users safely. If the Sector Skills Council specifications are followed this should be addressed however it was also noted that food hygiene certificates were not available for all staff involved in food preparation and there was not a qualified first aider on duty at all times as required. The provider must ensure that staff have appropriate training in order to protect the health, safety and welfare of service users and staff. The provider must ensure that staff receive appropriate health and safety training including, infection control, control of substances harmful to health and risk assessment in order that they can assess and manage risks safely. It is also recommended that staff are asked to sign policies and procedures when they are introduced or reviewed to indicate that they have read and understood them. Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 19 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 1 3 X X 1 Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X 2 X 2 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X 1 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Woodham House Score X 2 X X Standard No 37 38 39 40 41 42 43 Score 1 X 3 X X 1 X DS0000028745.V254350.R01.S.doc Version 5.0 Page 20 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 and 5 Requirement The registered provider must review the statement of purpose and service user guide to ensure that they include all of the information listed under Standard 1 of the National Minimum Standards, and Regulations 4 and 5 of the Care Homes Regulations (Previous timescales of 31/01/05 and 31/07/05 not met) The registered provider must ensure that the service user contract includes all of the information listed under Standard 5.2 (Previous timescales of 31/01/05 and 31/07/05 not met) The registered provider must develop a system to ensure that regular checks take place of service users who are self medicating The registered provider must ensure that the rugs in service users bedrooms are cleaned or replaced. The registered provider must ensure that the broken chest of drawers identified on the day of
DS0000028745.V254350.R01.S.doc Timescale for action 31/01/06 2 YA5 5(1)(b)(c) 31/01/06 3 YA19 13(2) 31/12/05 4 YA26 23(2)(d) 31/01/06 5 YA26 23(2)(m) 31/12/05 Woodham House Version 5.0 Page 21 6 YA28 7 YA35 8 YA35 9 YA35 10 YA37 11 YA42 12 YA42 the inspection is repaired or replaced. 23(2)(d) The registered provider must maintain a high environmental standard in the home. The stairs and landing carpet must be cleaned or replaced and the bathroom redecorated as indicated. 18(c)(i) The registered provider must ensure that the home has a staff training and development plan based on an assessment of the needs of the whole staff team and the needs of the service users (previous timescale of 30/09/05 not met) 18(1)(c)(i) The registered provider must ensure that the homes induction programme meets “Skills for Care” specifications. 17(2) Sch The registered provider must 4(6)(f) ensure that staff have an individual training and development assessment and profile in order that their training needs are assessed and their progress monitored. 8 The registered provider must ensure that the registered manager appears on the duty rota and works sufficient hours to ensure that the home is effectively managed. 23(4) The registered provider must ensure that fire drills and fire alarm tests are completed at the appropriate intervals (previous timescale of 31/07/05 not met, though fire drills were now completed at appropriate intervals) 16(2)(i) The registered provider must ensure that all staff involved in food preparation have a certificate of appropriate food hygiene training. 31/01/06 31/03/06 31/01/06 31/03/06 31/01/06 30/11/05 31/03/06 Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 22 13 YA42 13(4) 14 YA42 The registered provider must ensure that there is an appropriately trained first aider on duty at all times. 18(1)(c)(i) The registered provider must ensure that staff receive appropriate risk assessment training in order that they can assess and manage risks safely and health and safety training including, infection control and control of substances harmful to health. 31/03/06 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA8 Good Practice Recommendations It is recommended that older versions of documents are destroyed or archived when they are reviewed. It is recommended that service users be encouraged to play a greater role in service user meetings. For example chairing the meeting and being encouraged to participate in drawing up the agenda before the meeting. It is recommended that in order to ensure the effectiveness of meetings some aspects of the meeting should be made more formal such as ensuring the minutes of previous meetings are made available and at the next meeting discussed with matters arising. It is recommended that results of service users surveys are also included in the service user guide to the home. It is recommended that staff are asked to sign policies and procedures when they are introduced or reviewed to indicate that they have read and understood them. 3 YA8 4 5 YA39 YA42 Woodham House DS0000028745.V254350.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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