Care Home: 26, Cross Street

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What the care home does well Provides a stable staff and management team that provides consistent care and support to residents. Provides good support for residents to lead individual lives and to take part in activities they enjoy. Provides good opportunities for personal development. Supports residents to develop their skills and abilities. Promotes residents` participation in their community. Promotes residents` participation in the routines of the home. Provides a comfortable and homely environment. Supports residents to develop and maintain positive relationships with their friends and families. Identifies any changes in residents` needs and ensures access to appropriate care and support. Works well with other professionals where necessary. What has improved since the last inspection? The home has done good work in creating person centred plans that are accessible and that involve residents in their development. Residents are more involved in developing their care plans. Care plans have been developed using a format that is more accessible to residents. Some residents have received good support to achieve life-changing personal successes. What the care home could do better: Carry out risk assessments in all areas necessary to minimise risks to residents. Review these assessments regularly. Ensure that no medication is used past its expiry date. Repair the flooring and tiles and repaint the ceiling in the bathroom. Consider renewing Criminal Records Bureau disclosures more often. Provide all staff with individual supervision at least six times a year. Provide staff with opportunities to contribute their ideas about how the home is run. Arrange fire drills and fire system tests more often. CARE HOME ADULTS 18-65 26, Cross Street Hampton Hill Middlesex TW12 1RT Lead Inspector Simon Smith Unannounced Inspection 22nd November 2007 2:00 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 26, Cross Street Address Hampton Hill Middlesex TW12 1RT 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) 020 8783 0973 F/P 020 8783 0973 London Borough of Richmond upon Thames Mr James Edward King Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 2006 Brief Description of the Service: 26 Cross Street is home to eight adults with a learning disability. The building is owned by The building is owned by London and Quadrant Housing Association and the service is managed by the London Borough of Richmond. The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport networks. Staff support is available 24 hours a day. The cost of the placement varies for each person and based on individual assessments of need. The people who live at the home pay a contribution towards this. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a range of sources when making judgements about the home. These included visiting the home and talking to residents and staff. Some written information was checked, including residents’ files and health and safety records. Surveys were given to residents and staff. The inspector was made welcome during the visit and wishes to thank all those who gave their views about the home. The home met 24 of 32 National Minimum Standards assessed at this visit. Three Standards were exceeded and five Standards were almost met. Residents said that they like living at the home and feel safe and well cared for. Residents also said that staff treat them well and that they can have privacy when they want it. Residents do much for themselves and enjoy being involved in the day-to-day routines of the home such as at mealtimes, shopping for the home, organising the garden and recycling. Some residents have achieved life-changing personal successes in the last year and have received good support from staff to accomplish these goals. What the service does well: Provides a stable staff and management team that provides consistent care and support to residents. Provides good support for residents to lead individual lives and to take part in activities they enjoy. Provides good opportunities for personal development. Supports residents to develop their skills and abilities. Promotes residents’ participation in their community. Promotes residents’ participation in the routines of the home. Provides a comfortable and homely environment. Supports residents to develop and maintain positive relationships with their friends and families. Identifies any changes in residents’ needs and ensures access to appropriate care and support. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 6 Works well with other professionals where necessary. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a thorough assessment process that ensures residents’ needs are identified at the time of admission. Residents are able to visit and stay at the home before deciding to move in. Residents are issued with a written agreement that sets out the terms and conditions of their placement. EVIDENCE: Residents’ needs are assessed before they move into the home and there are clear procedures for admission. These include visiting for meals and overnight or weekend stays before moving in on a trial basis. Residents’ needs are reviewed through annual reviews carried out by the local authority and monthly reviews by their key workers. One resident moved into the home in April 2007. There was evidence that the new resident has had good support to settle in well. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 9 Residents’ files contained a licence agreement that outlined the terms and conditions of their residency. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans contain good individualised information about residents. Care plans are person-centred and regularly reviewed. Residents are involved in the development of their care plans. Residents receive good support to make choices about their lives. Risk assessments must be carried out where necessary to minimise risks to residents. Risk assessments must be regularly reviewed. EVIDENCE: Care plans contained good individualised information about residents’ needs, strengths, skills and personal preferences. The home has done good work in 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 11 developing person centred plans that are accessible and involve residents. One resident showed the inspector his person centred plan, which was very individualised and made good use of photographs to indicate the resident’s likes, dislikes and identify important people and places. There was evidence that residents receive good support in making decisions about their lives. For example one resident recently tried a new job but found it unsuitable. Staff supported the resident to find a new job that he prefers. One resident meets with an advocate regularly. Keyworkers work with residents to identify goals that are important to them. Progress towards achieving these goals is monitored every month. Keyworkers also contribute a report to the resident’s annual review and carry out risk assessments where necessary. Some risk assessments needed review. For example one resident’s moving and handling assessment was dated May 2004 but had no evidence of review since that time. There was also insufficient evidence that risk assessments are completed in all necessary areas. For example there was no evidence of a risk assessment for residents who travel independently to minimise the risks involved in this activity. See Requirement 1. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents receive good support to develop their skills and abilities. Residents are involved in the daily routines of the home. Residents have active social lives and are involved in their local community. Residents receive good support to maintain relationships with their friends and families. Residents’ rights and responsibilities are promoted. Residents contribute to the home’s menu and enjoy the food provided at the home. EVIDENCE: 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 13 Staff provide good support for residents to develop their skills and abilities. One resident is planning to move on to a more independent setting and has had support from staff to develop the skills needed to achieve this. Residents have a home based day each week and usually use this time to carry out tasks such as personal shopping, cleaning and laundry. Residents are also involved in the routines of the home. For example one resident chooses to do the recycling for the home and to keep the garden tidy. Residents lead busy and fulfilling lives and receive good support to access a range of opportunities. One resident works three days each week and another resident works in a café once a week. One resident attends a resource centre four days each week. Staff said that the resource centre staff also provides some one-to-one staff time to support the resident in maintaining friendships. Residents are involved in their local community and go out regularly to local shops, pubs and restaurants. One resident travels independently. Two residents go to church every week. All residents attend a social club once a week. There was evidence that keyworkers have time to go out with their key clients and that staff have supported residents in developing and maintaining friendships. All residents have some contact with their families. Staff said that some residents visit their families at holiday times and that other residents have regular phone contact with friends and families. The home holds events such as barbecues and a Christmas party, to which residents invite their friends and families. Residents said that they can invite friends for dinner at the home. Interaction between staff on duty and residents was positive during the inspection. Residents are treated with respect and staff listen to what they have to say. There is a commitment to person-centred planning and to involving residents in developing their care plans. Residents have unrestricted access to all communal areas and are able to choose how they spend their time at the home. The inspector shared a meal with residents and staff, which was a relaxed and enjoyable experience. Discussion with staff and residents demonstrated that much thought goes into the menu and to maintaining a high standard of food. Residents are involved in planning the menu and said that they enjoy the food provided by the home. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 14 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is accessible to residents. Residents receive good support to access community and specialist healthcare resources. The home seeks the advice and input of other professionals where necessary. Arrangements for medication are appropriate but the home must ensure that no medication is used past its expiry date. EVIDENCE: There was evidence that staff have worked hard to ensure that information is accessible to residents. For example residents used the pictorial staff rota during the inspection to find out which staff were on duty later that day. As highlighted earlier in this report, residents’ care plans are developed with their 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 16 input and are in accessible formats. Some residents have specific communication needs. Staff have skills in these systems of communication. Residents’ healthcare conditions are monitored well and all accidents and incidents are recorded. Care plans provided evidence that medical appointments are made if needed and that appropriate healthcare professionals are involved in residents’ care where necessary. Staff said that district nurses currently visit one resident and that one resident sees a speech and language therapist regularly. One resident’s independence and quality of life has improved through an operation to improve his eyesight. Medication is stored appropriately and there are clear, written procedures governing the administration of medication. The home has an arrangement with the supplying pharmacist for advice and annual inspections. Staff said a general practitioner reviews residents’ medication regularly. Medication training is included in the induction for all staff and refresher training is provided. Medication records were checked and found to be accurate. One topical cream was still in use despite more than six months elapsing since the date of opening. The home should ensure that no medication is used past its expiry date. See Requirement 2. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for the management of complaints. Training is provided for staff in the Protection of Vulnerable Adults. EVIDENCE: The London Borough of Richmond has an appropriate Complaints procedure and a Whistle-blowing policy, which enables staff to report any concerns they have about bad practice. There have been no complaints made about the home since the last inspection. The home works within the local authority policy on the Protection of Vulnerable Adults and staff attend training in this area. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well decorated and well maintained. A number of improvements need to be made in the bathroom. The communal rooms of the home are comfortable and homely. Residents’ bedrooms reflect individual preferences. The home is clean and hygienic. EVIDENCE: The home is situated in a pleasant residential area and has good access to local community facilities, open spaces and public transport. It provides 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 19 purpose built single storey accommodation and there is off-street parking for several vehicles. A good standard of decoration has been achieved throughout the home and there is a well-maintained garden. The communal rooms include a living/dining room, utility room and kitchen. All residents have their own bedroom, which they are able to personalise as they wish. All areas of the home were clean and hygienic. A number of issues need addressing in the bathroom. Some sections of the vinyl flooring were lifting at the edges, which presents a trip hazard. The ceiling needs repainting. Some tiles had been damaged by contractors during recent works and need replacing. Staff were trying to remedy these problems on the day of inspection but these repairs should be carried out by the housing association. See Requirement 3. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable staff and management team who know residents and their needs well. Staff communicate effectively with one another and share information well. Staff are appointed following an appropriate recruitment and selection procedure. Staff have access to training appropriate to their roles. Staff should receive supervision more often. EVIDENCE: The manager and most staff have worked at the home for some time and know residents well. There are good systems of communication between staff. Staff read the Communication book each time they begin a shift and attend a 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 21 handover between shifts. Medication and monies are also checked between shifts. Each shift has a nominated team leader. There was one vacancy on the staff team at the time of inspection but staff said that this vacancy is covered by a member of bank staff who has worked regularly at the home for several years. There was evidence that the local authority has obtained Criminal Records Bureau disclosures for staff but some of those seen were dated some years ago. Although there is no legal Requirement to renew Criminal Records Bureau disclosures the London Borough of Richmond should consider renewing Criminal Records Bureau disclosures for staff approximately every three years. Staff said that they have good access to training and that they have refresher training in mandatory areas every three years. All but one member of staff has achieved NVQ level 3. Staff said that they have supervision but that this is often when specific issues need addressing rather than at regular intervals. Staff supervision records demonstrated that some staff have had supervision often enough but that others have not had supervision recorded for over six months. This issue was also raised in the last inspection report. See Requirement 4. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an experienced and committed manager. Consider how best to enable staff to contribute their ideas about how the home is run. There is a commitment to seeking residents’ views and to running the home in residents’ best interests. Fire drills and fire system tests must take place more often. EVIDENCE: 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 23 The manager and deputy manager have worked at the home for a long time and have achieved NVQ level 4. Staff said that the manager is committed to maintaining high standards and to ensuring that residents receive a high standard of care and support. Some staff felt the manager could be more open to their ideas and input about how the home is run. This issue has been highlighted in previous reports. Residents’ income and expenditure is recorded appropriately and accounts are reconciled monthly. Staff said that the local authority auditor had audited the home’s finances earlier in the year. There is a commitment to running the home in residents’ best interests and to seeking their views about how the home is run. Residents’ meetings are held about once a month. One resident has begun to chair these meetings. The Landlord’s Gas Safety record was issued in April 2007. Engineers tested the fire alarm system in February 2007 and the emergency lighting was checked in July 2007. Staff check the fire alarm each week using different call points, though these tests had not been recorded for 17 days at the time of inspection. The most recent fire drill recorded in the fire log took place in July 2006. Fire drills must be held at least twice each year. See Requirement 5. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X X 2 X 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA9 Regulation 13(4) Requirement The Registered ensure that: • Person Timescale for action must 29/02/08 Risk assessments are completed in all areas necessary to minimise risks to residents Risk assessments are reviewed on a regular basis. 29/02/08 • 2 YA20 13(2) The Registered Person must ensure that no medication is used past its expiry date. The Registered Person must: • • • Repair the vinyl flooring Repaint the ceiling Replace the broken tiles 3 YA27 23(2) 29/02/08 in the bathroom. 4 YA36 18(2) 12(5) The Registered Person must ensure that all staff receive individual supervision at least six times a year. DS0000017360.V356902.R01.S.doc 29/02/08 26, Cross Street Version 5.2 Page 26 This Requirement was also made in the last inspection report. 5 YA42 23(4) The Registered ensure that: • Person must 29/02/08 Staff check the fire alarm system each week and record the results of these tests Fire drills take place at least twice each year. • 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 YA34 YA38 Good Practice Recommendations Consider renewing Criminal Records Bureau disclosures for staff approximately every three years. Consider how best to provide staff with opportunities to contribute their ideas about how the home is run. 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 26, Cross Street DS0000017360.V356902.R01.S.doc Version 5.2 Page 28 - 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. 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