Care Home: Bowley Close, 4

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What the care home does well The staff team is experienced, familiar to the residents and provide individualised care throughout the day. There are good relationships between staff and service users. Service users are supported to keep in touch with their family by making and receiving visits. There is good contact with health care professionals who provide advice on how best to care for the service users. All of the staff team have achieved or are working towards a qualification in care. What has improved since the last inspection? The following improvements have been made; o Medication records are signed at the time that medicines are administered. o The registration certificate is properly displayed in the home. o Complaints records contain detailed information. o Daily notes of service users` activities and welfare are signed by staff. o New settees have been provided in the living room. What the care home could do better: We have not made any requirements at this inspection but we recommend that service users` health care needs are recorded using the `health action plan` format. We also recommend that improvements are made to the decorative state of the first floor bathroom and to the kitchen cupboards which are showing signs of wear and tear. CARE HOME ADULTS 18-65 Bowley Close, 4 Farquhar Road London SE19 1SS Lead Inspector Ms Alison Pritchard Key Unannounced Inspection 1 & 11th December 2008 1pm st Bowley Close, 4 DS0000007076.V370464.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 Bowley Close, 4 DS0000007076.V370464.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. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bowley Close, 4 Address Farquhar Road London SE19 1SS Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager Type of registration No. of places registered (if applicable) 020 8670 2360 4bowley@choicesupport.org.uk www.choicesupport.org.uk Choice Support Awaiting application for registration Care Home 4 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0), Mental disorder, excluding of places learning disability or dementia (0), Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 (four) people with learning disability and mental disorder, 1 (one) of whom may be over 65 years of age. 15th August 2006 Date of last inspection Brief Description of the Service: 4, Bowley Close is a home for four people with learning disabilities who may also have mental health problems and present behaviour which is challenging. The home is located in a cul de sac close to the centre of Crystal Palace. It is purpose built and it and the other homes in the close are managed by Choice Support. Each service user has a single bedroom. There are shops, sports facilities, pubs and restaurants nearby. Public transport routes are close by allowing easy access to other parts of London. The road from Bowley Close to Crystal Palace is steep and could be difficult for anyone with a mobility problem. In December 2008 there were three residents living at the home. The previous Manager stated that relevant information about the home is made available in the service brochure and that is supplied to Social Services departments who may wish to refer potential residents to the home. CSCI inspection reports available to anyone who requests a copy, including social workers of current residents. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and carried out over two days in December 2008. The inspection methods included discussion with the Acting Manager; observation of care practice; a tour of the building; inspection of files and a range of records and policy documents. Relatives, staff and involved professionals were sent survey forms so that they could contribute to the inspection process if they wished. We are grateful for the contributions received. The CSCI has access to information gathered through notifications from the home. A document called an ‘Annual Quality Assurance Assessment’ (AQAA) was completed by the Acting Manager of the home and returned to the inspector. It provides information about how the home is addressing the National Minimum Standards along with factual information about the operation of the home. All of this information has been taken into account in compiling this report. The Acting Manager and staff facilitated the inspection visit. They were helpful and courteous throughout the process. What the service does well: The staff team is experienced, familiar to the residents and provide individualised care throughout the day. There are good relationships between staff and service users. Service users are supported to keep in touch with their family by making and receiving visits. There is good contact with health care professionals who provide advice on how best to care for the service users. All of the staff team have achieved or are working towards a qualification in care. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 6 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. Bowley Close, 4 DS0000007076.V370464.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 Bowley Close, 4 DS0000007076.V370464.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): 1, 2, 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The policies and procedures for admitting new residents ensure that both the home and the potential resident have enough information to decide whether it would be a suitable place for the person to live. EVIDENCE: There have been no new admissions to the home for some time and none are planned, currently there are no vacancies at the home. The service user guide has been drawn up using plain English and photographs. It is also available in other languages and on audio tape. The admission policy of Choice Support includes encouraging introductory visits. The policy of Choice Support is for social work assessments to be obtained before admission and for placements to have a twelve week trial period. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning identifies service users’ goals. The service users’ views are listened to and people of importance to them are consulted about their care. Risk management allows service users to follow a range of activities. EVIDENCE: Each of the service users has a range of care guidelines in place which enable staff to work consistently towards meeting service users’ goals. Reviews of the guidelines had taken place within the last six months. All of the service users have key workers who co-ordinate the care planning process. There have been no reviews of the placements carried out by social workers recently and the Acting Manager has been in touch with placing authorities to request that meetings are arranged. We saw that staff listen carefully to service users, and are aware of their communication methods. Family members and an advocate are invited to contribute to decision making about matters of importance. The managing organisation has links with a service called ‘Surprise’, (previously known as Customer Watch), which is a forum through which people Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 10 with learning disabilities can express their views on the services provided through Choice Support (Southwark). This ensures that the opinions of service users generally are included in the overall planning of the organisation. The people who live at the home meet with each other and staff at meetings so that they can discuss issues of general concern. The last meeting minutes that we saw were from a meeting of 31st August 2008. Since the inspection we have discussed this with the Manager of the home and he has informed us that he has since held a meeting with service users on 4th February 2009. We saw a range of risk assessments which assess how to minimise risks to service users in a range of activities including leaving the home, medical treatment, swimming and using the home’s sensory room. The majority of risk assessments had been reviewed within the last six months. Personal information is stored with due regard for confidentiality. Choice Support is registered under the Data Protection Act and there is a confidentiality policy to ensure that staff handle personal information with care. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users take part in a range of activities. Work is planned to assess whether the leisure opportunities available to them can be increased. Meals are designed to reflect service users’ needs and preferences. EVIDENCE: The service users have opportunities to join in a range of activities in the community and at home. One of the service users is being supported to leave the home more frequently, specialist help with this matter has been sought. Two of the service users visit a social club, one goes swimming and one attends a day centre. The acting Manager is hopeful that the advice of a service user involvement worker can be sought to increase the service users’ activities. Activities in the home include watching television, art work and assisting with household tasks such as cookery and laundry. On the first floor of the home is a sensory room which is a useful resource for the service users. It is equipped with a range of equipment including machines which produce light effects, and a sound system. There is a karaoke machine available for service users. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 12 All of the residents have regular contact with family members, by making and receiving visits. Visitors are welcome at all reasonable times. The service users are able to spend time privately in their rooms if they so wish, or to join other service users in the communal areas. The routines of the home are flexible and can be adjusted to take account of service users’ activities and needs. The meals served reflect the service users’ preferences, nutritional needs and their cultures. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 13 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): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users benefit from a staff team which understands their physical, medical and emotional needs. Recording is generally good but one improvement is recommended. EVIDENCE: The service users’ files showed that there is a range of health care professionals, appropriate to their needs, involved with the service users. we found good records of the outcome of medical appointments on the service users’ files. There were many papers relating to these issues on the files. We found a blank template for a ‘health action plan’ and ideally this format would be used to summarise and collate the information held in the file so that it is easier to manage and track progress towards meeting health care goals. We saw papers for one service user recommending that a preventive health care be conducted. The Acting Manager was unsure whether the check had been undertaken. He assured us that he would find out and make any necessary arrangements. See recommendation. The staff are familiar with the residents’ communication patterns and are responsive to their physical and emotional needs. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 14 None of the residents look after their own medication. The medication is stored safely. The GP has approved the use of certain ‘homely remedies’ and the use of medication used on an ‘as needed’ basis. Appropriate records of changes of medication, signed and dated by the GP, are kept. On our first visit to the home we found that one resident had been given some medication given on an ‘as needed’ basis. However there were no records explaining why this had been deemed necessary. This was pointed out to the member of staff on duty. This must be part of the routines of staff when giving medication in this way. The Acting Manager has addressed this issue, when we returned to the home the records had been completed. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 15 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): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and safeguarding procedures contribute to the protection of service users. EVIDENCE: There have been no complaints made about the services offered at the home over the last year. The procedure is included in the service user guide and includes the required information. The Annual Report issued by Choice Support includes information that the organisation has conducted a thorough review of their policies, procedures and training to ensure that they are aimed at the protection of people who use their range of services. Choice Support introduced a new ‘safeguarding adults policy and procedure’ in March 2007. The judgement of the CSCI is that this is a thorough document, which is clearly written, and links all the aspects of safeguarding. The policy also introduces an internal protection committee. It is judged that this demonstrates that Choice Support is actively working to improve processes and practice. There are safe arrangements for keeping service users’ valuables, including checking balances of cash at each shift change and management checks . When recruitment records were inspected we found that they contribute to the protection of people who use Choice Support services as they are thorough and meet the legal requirements. Staff are given a handbook, which includes a summary of the safeguarding policy and the whistle-blowing policy. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 16 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): 24, 25, 27, 28, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is in reasonable condition but the environment would be improved by some redecoration and refurbishment. Some matters needed attention on out first visit and had been dealt with when we returned. EVIDENCE: The home is a two storey house which has one bedroom on the ground floor and three on the first floor. There is adequate communal space. A communal lounge and dining room is on the ground floor and a sensory room is on the first floor. New settees had been bought for the living room, they were comfortable and attractive. The Acting Manager told us that new dining chairs have been ordered to replace the ones which we saw which were worn and damaged. Two bedrooms that we saw were personalised with residents’ own items. The third one is appropriate for the needs of the service user. There are plans to close the homes in Bowley Close and the issue of finding appropriate placements for the service users is being explored. In the meantime it is important that acceptable minimum standards are maintained in the home. We recommend that the first floor bathroom is redecorated as it is in a poor state. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 17 See recommendation. Since the inspection the Acting Manager has informed us that arrangements have been made for the redecoration of both bathrooms. On our first visit to the home one of the bedrooms had an unpleasant odour, this had been dealt with on our second visit. Also on our first visit we found paints stored in a cupboard which contained the electrical fuse box. This could have presented risks and we pointed this out to the member of staff on duty. When we returned the paint had been removed. A new hob has been ordered for the kitchen, some of the cupboards are in need of replacement. See recommendation. The home was satisfactorily clean during our visits. Laundry facilities are appropriate for the needs of the home. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 18 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): 32, 34, 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient trained staff available to care for the service users. Recruitment procedures are safe and contribute to the protection of service users. EVIDENCE: In addition to the Acting Manager there are six full time staff including two who work only at night time. There is one vacancy on the staff team. Interviews for the post had been arranged. The rota is planned so that individual care can be provided for all of the service users, in keeping with their individual needs. the team is made up of male and female staff allowing same gender care to be provided. Inspectors visited the head office of Choice Support to examine recruitment files. We examined twelve recruitment files. Staff members from all levels were represented in the selection and they are employed at a variety of registered care homes run by Choice Support in Southwark and Lambeth. The files were in good order and all but one item specified by Regulation was present in the files. All of the files had the required checks and references, including Enhanced CRB checks, two references, full work histories and verification that they are physically and mentally fit for their work. We found that the majority of files did not contain a recent photograph of the employee. We discussed this Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 19 with a member of the Human Resources team and he has agreed to ensure that this is amended. We were pleased to see that service users have been involved in the recruitment process and see this as an area of good practice. Of the seven staff all had achieved or were studying towards NVQ2, two of the care staff have NVQ3. All of the staff team are to have training in working with people who have challenging behaviour. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 20 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): 37, 39, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements are good, effective monitoring systems are in place. Health and safety of service users and staff are protected. EVIDENCE: There has been no registered manager at the home for some months. Temporary management arrangements were put in place and in October 2008 the post was filled. We have been assured that the managing organisation intends to submit an application of the post holder to the CSCI for registration under the Care Standards Act. The Acting Manager is studying towards the necessary qualifications for the post. The indications are that the current management arrangements are satisfactory. A full assessment will be carried out as part of the registration process. There are a number of ways that Choice Support monitor the quality of the service provided at the home. Managers of other homes within Choice Support carry out monthly visits. Senior managers within the group conduct audits of Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 21 the service based on standards set by an organisation called REACH. It is aimed at assessing service users’ experience of life in the home. The Directors, Managers and Trustees of Choice Support meet regularly with representatives of service users who sit on a ‘service user forum’. They are involved with reviews of policies and procedures and two people with learning disabilities are part of the organisation’s Quality Assurance sub-committee. A national survey by Values into Action (VIA) had been commissioned by Choice Support to assess the opinions of service users. At a more local level the Registered Manager completes a quarterly report for the residents’ placing authority. These monitoring systems supplement the internal scrutiny and act as a further safeguard for residents. We saw records that confirmed that health and safety checks are carried out to make sure that systems work properly. Fire alarms are tested weekly, drills are conducted regularly and the gas and electric appliances had been tested and certified as safe. Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 3 5 X 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 2 25 3 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard YA19 Good Practice Recommendations We recommend that service users’ health care needs are recorded using the ‘health action plan’ format. This will ensure more effective monitoring of health care needs. We recommend that improvements are made to the decorative state of the bathroom and to the condition of the kitchen which is showing signs of wear and tear. 2. YA24 YA27 Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Bowley Close, 4 DS0000007076.V370464.R01.S.doc Version 5.2 Page 25 - 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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