Care Home: 20 Rye Road

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What the care home does well The service users enjoy different activities including trampolining, working at a City Farm and going to day centres. They have enjoyed growing vegetables in the back garden.The staff team is well trained. Several staff members have worked at the home for a long time so the service users know them well.Both of the service users have been on holidays they have enjoyed over the last year.Choice Support has a range of ways to make sure that the service provided at the home is suitable for the people who live there. What has improved since the last inspection? All of the requirements made atthe last inspection have been met. This means that the improvements have been made to the building and it is now more homely and clean.Improvements have been made to the way staff deal with medication and the service users` health care needs are now recorded properly. What the care home could do better: We have made two requirements and threerecommendations.We found that service users` contracts included some mistakes that need to be changed.We also found that service users` daily records had not been signed by staff and did not include all of the information about what they have been doing.A change to the way medication instructions are written down is needed.When we visited, on a very hot day, the central heating system could not be turned off and some part of the home were very hot. We have made a requirement about this. Key inspection report Care homes for adults (18-65 years) Name: Address: 20 Rye Road Rye Road, 20 London SE15 3AZ The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Pritchard Date: 1 8 0 6 2 0 0 9 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should:  Be safe  Have the right outcomes, including clinical outcomes  Be a good experience for the people that use it  Help prevent illness, and promote healthy, independent living  Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home:  3 stars – excellent  2 stars – good  1 star – adequate  0 star – poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Care Homes for Adults (18-65 years) Page 2 of 31 Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by:  Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice  Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983  Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services.  Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: 20 Rye Road Rye Road, 20 London SE15 3AZ 02076398401 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : choicesupport@choicesupport.org.uk www.choicesupport.org.uk Choice Support care home 2 Number of places (if applicable): Under 65 Over 65 2 0 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 2 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 31 A bit about the care home 20 Rye Road is a care home providing personal care and accommodation to two people with a learning disability. Both of the current residents are men and there are no vacancies. Choice Support, a voluntary organisation, provides the care and owns the building. Choice Support manages a significant number of residential and other services for people with learning disabilities. The home is an end of terrace house situated in a residential street; it is indistinguishable from the other houses in the area. The home is within walking distance of public transport routes and community facilities, which include shops, churches, pubs and cafes. The two single bedrooms and bathroom are on the first floor. There is a garden to the rear. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 31 How we did our inspection: This is what the inspector did when they were at the care home We went to the home on two days in June and July 2009. We did not tell anyone that we were going to visit. While we were there we spoke to the people who live and work in the home; we had a look around the building and in the garden and we looked at paperwork. Before we visited the Registered Manager had sent us information about the home. Page 7 of 31 Care Homes for Adults (18-65 years) What the care home does well The service users enjoy different activities including trampolining, working at a City Farm and going to day centres. They have enjoyed growing vegetables in the back garden. The staff team is well trained. Several staff members have worked at the home for a long time so the service users know them well. Care Homes for Adults (18-65 years) Page 8 of 31 Both of the service users have been on holidays they have enjoyed over the last year. Choice Support has a range of ways to make sure that the service provided at the home is suitable for the people who live there. What has got better from the last inspection All of the requirements made at Care Homes for Adults (18-65 years) Page 9 of 31 the last inspection have been met. This means that the improvements have been made to the building and it is now more homely and clean. Improvements have been made to the way staff deal with medication and the service users health care needs are now recorded properly. What the care home could do better We have made two requirements and three Care Homes for Adults (18-65 years) Page 10 of 31 recommendations. We found that service users contracts included some mistakes that need to be changed. We also found that service users daily records had not been signed by staff and did not include all of the information about what they have been doing. A change to the way medication instructions are written down is needed. Care Homes for Adults (18-65 years) Page 11 of 31 When we visited, on a very hot day, the central heating system could not be turned off and some part of the home were very hot. We have made a requirement about this. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact : Alison Pritchard Regulatory Inspector Care Homes for Adults (18-65 years) Page 12 of 31 Care Quality Commission CQC London Citygate Gallowgate Newcastle upon Tyne NE1 4PA Phone: 03000 616161 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535. Care Homes for Adults (18-65 years) Page 13 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 14 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedure for admissions is good and includes consideration of assessed needs and ensuring that information is provided about the service. The statement of terms and conditions for service users residency at the home must be accurate. Evidence: There have been no admissions to the home in the last year and none are planned. The admission procedure that Choice Support follows includes obtaining assessments, introductory visits to the home, a trial period of twelve weeks and consultation with current service users. Information about the home can be made available in a format which suits the the need of the potential service user. The current service users have service user guides which are written in plain English, with drawings and photographs. There is a statement to say that the document is available on tape or in other languages on request. In one of the files we saw a licence agreement which states the service users rights and responsibilities. It appeared that this document had been adapted for one originally written for the other service user but had not been checked well enough for accuracy. Although the persons photograph was included on the document the other persons Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: name had been mentioned three times. See requirement. Care Homes for Adults (18-65 years) Page 16 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are involved in care planning and consulted about the goals that are important to them. Full details about how these goals are worked towards should be recorded. Information is kept securely. Evidence: Person centred planning systems are used throughout Choice Support. Each service user has a key worker who is responsible for co-ordinating the care planning process. The service users meet with their key workers every six weeks to review progress towards goals that they have identified. We saw that two of the goals identified for for a service user at a meeting on 22nd May were firstly, to see a friend who lives in another Choice Support service, and secondly to visit a pub once each month. At our second visit to the home on 1st July we looked through the service users daily notes to check progress towards these goals. We found no reference to either of these events taking place, although no reasons were noted to show that they might be difficult to achieve. When we raised this with the Registered Manager she said that the records did not accurately reflect the service users activities. This shows that further input is needed on the purpose of records and the importance of keeping them accurately. We also noted that Care Homes for Adults (18-65 years) Page 17 of 31 Evidence: many of the records were unsigned and some contaibned entries which were unclear. See recommendation. Choice Support has a variety of ways to ensure that service users are involved in the running of the organisation. Service users may join a group called Surprise which is consulted by the organisation, although none of the service users from this home are involved. The home is working towards making all of the information accessible to service users. More careful proof reading of documents would help to further this aim. Risk assessments are carried out to support service users involvement in activities which may involve risk. Both of the service users are assisted with communication. There are guidelines on their files about how this is best undertaken. The organisation is registered under the Data Protection Act and personal information is kept lcoked away, separate from communal areas. Care Homes for Adults (18-65 years) Page 18 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users are involved in a range of activities in the home and in the community. They have been on holidays which they have chosen. The staff know the people who are important to the service users and consideration of how they will stay in touch with them is included in care planning. Evidence: The two service users attend day services for people with learning disabilities. In addition they follow a range of activities, including trampolining; working at a City Farm; going to Church; attending social clubs and an art class and shopping. The service users had been on holiday with staff members, one had been to Spain and the other to Bognor. One of the service users was planning, and looking forward to, a barbecue to celebrate his birthday. We noted that the service users have been enjoying tending their garden, growing vegetables and keepiong the area tidy. The service users have friends who live in other services run by Choice Support. They are Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: encouraged to keep in touch with them and with family members. As noted above, the records should include contact of this kind as well as details of their involvement with community facilities. The service users are visited occasionally by an independent advocate who has known them for several years. Service users have keys for their bedrooms and we observed that staff asked their permission to enter their rooms. Service users told us that they enjoy their meals, the menu is planned with consideration for their preferences and needs and include a range of fresh and nutritious items. Care Homes for Adults (18-65 years) Page 20 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from arrangements to look after their health needs and manage madication. There are two areas for improvement in the recording of health monitoring and medication administration instructions. Evidence: We saw Health Action Plans in service users files. We noted that one of the plans did not include all of the relevant information. For example an entry in the plan about exercise did not include information about trampolining which the resident had begun in the month prior to the completion of the plan. The home records aspects of service users health; we saw charts monitoring service users weights and incidents of epilepsy. The weight charts we saw were not in good order, one that we saw was unnamed and although weights had been recorded they did not include any indication that they had been monitored. None of the records were signed and no comments about the weights were recorded. See recommendation. The home has contacts with members of a multi-disciplinary health team for people with learning disabilities and we saw information to confirm that appropriate referrals have been made to the team. Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: We saw information to confirm that the medication taken by one of the service users had been reviewed by the GP. One of the medication administration records included hand written instructions on the administration details of items of medication. It is recommended that such hand written entries are signed by two members of staff to verify the accuracy of the entries. See recommendation. Care Homes for Adults (18-65 years) Page 22 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users know how to complain and staff know what to do in response. There are a variety of measures in place to protect service users. Evidence: The complaints procedure of Choice Support meets the required standards and includes details of the timescales within which complaints will be investigated. There were no complaints recorded in the complaints log that we saw during our visits to the service. There have been no safeguarding issues at the home in the last year. Safeguarding is now a fixed agenda item at staff meetings and in supervision. Liaison with Choice Support early in 2009 showed that it is working with RESPOND, a specialist organisation which assists people with learning disabilities. Workshops are planned for staff and service users on issues including feeling safe and disability and hate crime. Senior staff within Choice Support have received training in Deprivation of Liberty Safeguards. Care Homes for Adults (18-65 years) Page 23 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service users benefit from a safe and homely environment. Redecoration has improved the appearance of some parts of the home. Problems with the central heating meant that some areas of the buidling were uncomfortably hot when we visited. Evidence: There has been redecoration of some of the communal areas since our last visit to the home and these are now in better condition. Work has also been done to improve the garden area and residents showed us around and showed us their new shed and the tomato plants which they have planted. Our second visit to the home took place on a very warm day. We were surprised to find that the radiators in service users bedrooms and in the bathroom were on and warm. We were informed that the boiler was to be replaced; it had been judged safe but the timer did not operate properly. See requirement. The home was satisfactorily clean when we visited and there were no unpleasant odours. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough well trained staff to meet service users needs. Evidence: The staff team consists of, in addition to the Team Manager, an Assistant Team Manager and three care staff. When the service users return from the day activities there are generally two members of staff on duty, but on occasions this drops to one member of staff on duty. There is always one member of staff sleeping in the home, with additional assistance available through the on call system. In March 2009 a check of the recruitment procedures of Choice Support services located in London and South East regions was completed. The majority of files checked were staff that had been recently recruited to the organisation and were a cross section of all grades and posts. Some recommendations were made but the overall judgement was that the procedures were robust and contribute towards protecting service users from harm. Two of the three care staff have received training to NVQ 2 or above. The training and development plan for the home highlights the need for the other members of staff to achieve this qualification. Additional training needs identified are in communication skills, including Makaton sign language, healthy eating and IT. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good management arrangements in place in the home and within Choice Support. Quality Assurance systems are given priority within Choice Support. Health and safety is managed well. Evidence: The Team Manager is responsible for both this home at Rye Road and another one in East Dulwich, also part of Choice Support. She splits her time between the two homes, as does the Assistant Team Manager. The Team Manager is now registered under the Care Standards Act. She has been judged suitably qualified and experienced for her role. Choice Support has a number of Quality Assurance processes in place. These were judged in March 2009 to be robust and very thorough. A Lead Analyst analyses all of the information, producing regular reports for senior management to ensure that areas of concerns are tackled at the earliest opportunity. The QA process includes annual service audits, finance audits, Regulation 26 reports, health and safety audits, REACH data, whole service reviews and annual external audits. Quarterly reports are made to the local authority which funds the service users placementsd and these contribbute to the monitoring of the service. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: Heath and safety records showed that the fire risk assessment was last revieiwed in April 2009, that drills are conducted regularly and that fire safety equipment is regularly tested. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 31 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 5 5 The service users contracts must be accurate and not include references to other service users. 21/09/2009 This will help to protect the service users legal rights. 2 26 23 02/11/2009 The central heating system must be fully operational. This must include the facility to regulate the temperature in the building. This will ensure that the service users can control the heating according to their preferences. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 29 of 31 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 6 19 The daily records should be completed fully, accurately and signed by the member of staff making the entry. The home should include on the weight monitoring chart a space for comment and if any action is necessary. This should be completed each time weight is monitored to make the process purposeful. The records should be signed. It is recommended that hand written medication administration instructions are signed by two members of staff to verify the accuracy of the entries. 3 20 Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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