Care Home: Dorrien Walk, 25

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What the care home does well There is a consistent staff team. This means that residents have a chance to get to know them well. There is also a culturally diverse staff team that is reflective of the residents. Staff are well supported by the management team. The service promotes independence for residents who have a learning disability and continues to offer good individualised specialist care for residents who need high levels of support. The service respects the rights and wishes of the residents as well as understanding their individual needs while protecting them and keeping them safe. There is a new, accessible, audit tool called the Reach Standards that has been introduced that is used to base the standards of the quality of the service on and this has been implemented in the home. What has improved since the last inspection? The staff are looking at different ways and types of activities the residents can access in the community. Redecoration of the home is ongoing and the laundry area has been improved. What the care home could do better: The service needs to make sure it follows up on the risk assessment relating to the possibility of the residents being trapped in their home by fire with no means of escape. Key inspection report Care homes for adults (18-65 years) Name: Address: Dorrien Walk, 25 Dorrien Walk, 25 Drewstead Road London SW16 1AR     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: Lynne Field     Date: 3 0 0 6 2 0 0 9 This is a review of 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 2 1 0 stars - excellent stars - good star - adequate 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. that people have said are important to them: They reflect the things 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 29 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 29 Information about the care home Name of care home: Address: Dorrien Walk, 25 Dorrien Walk, 25 Drewstead Road London SW16 1AR 02086770414 02082998598 choicesupport@choicesupport.org.uk www.choicesupport.org.uk Choice Support care home 2 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) : Number of places (if applicable): Under 65 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 - Code 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 Brief description of the care home Dorrien Walk is a small, two bedroom, one-storey home on an estate off Drewstead Road. The home is managed by Choice Support Southwark, a large provider of services for people with learning disabilities. The home is registered for 2 adults who have profound multiple disabilities with learning disabilities. This service was especially set up in 1997 for the two service users who live there. Dorrien Walk has a small back garden. The home is a ten-minute walk from the high street. However, access into some of the shops of interest has proved difficult for people with disabilities. The manager said the current fees payable by each service user is #29-20 for food and Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 2 Brief description of the care home #32-95 towards the rent per week. Additional charges are made for things such as hairdressing and clothing. These fees are topped up by the placing authority. Care Homes for Adults (18-65 years) Page 5 of 29 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 peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced inspection was carried out over one and a half days in June 2009. We met both residents and two staff on the first day of the inspection. We arranged to go back to meet the manager and were able to attend a staff meeting where we also met the deputy manager and three other staff. Both the manager and deputy manager and all staff we met were very positive about the service and the residents. We checked relevant policies and procedures as well as tenants files, the care plans and building maintenance records held in the home. During both visits we were able to observe how staff interacted with residents and how residents responded to staff. As part of the inspection process we used information collected and collated by the Provider Relationship Manager, CQC, relating to staff recruitment as well as information gained at the site visit relating to staff training and supervision. Care Homes for Adults (18-65 years) Page 6 of 29 What the care home does well: What has improved since the last inspection? What they could do better: 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 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 7 of 29 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 8 of 29 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. Prospective residents needs and aspirations are assessed in such a way that a service tailored to their needs is provided. Evidence: The statement of purpose, and a residents guide, which includes the complaints procedure has remained unchanged since the last inspection. The homes admissions procedure states Care management assessments are required for all prospective residents including personal and medical histories before a prospective resident would be considered. We have been told that this service was set specifically for the two residents who live at the home and there have been no recent admissions to the home since that time. We were told that if a vacancy arose, the home would follow their procedures outlined in the statement of purpose and residents guide and this would be in line with the current ethos of the day. Prospective residents would be invited to visit the home with family members or friends to help them decide if the home could meet their needs. Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: Completing an assessment based on personal history, care management assessment. This would be followed up with a full needs assessment. Residents are provided with individual contacts and a statement of terms and conditions that is signed by their care manager and family member. Care Homes for Adults (18-65 years) Page 10 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are thorough and reflect residents needs and goals. Residents participation in the running of the home has been encouraged where feasible, with the support of the care staff. Risk assessment reviews take place and are recorded. Staff have easy access to this information, which is kept, in the homes office. Evidence: Each resident has a daily activities book that is part of the person centred plan. These are reviewed annually or before if necessary by the residents key worker and the resident. They try to get family involved where possible but for one resident whose parent is not always able to travel this is not always possible or practical. The manager said they are changing all documents in an accessible format. We were able to see some of the documents and how they were being developed. This includes the abilities of each resident and how residents are able to do small household tasks with Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: the support of the care staff, such as make a cup of tea. Residents abilities are also listed such as is able to select their own clothes. Residents are supported to take a pride in their appearance and to buy clothes that are both age and culturally appropriate. The staff are working with the residents to continue develop communication passports. This is ongoing as other activities are tried. These give information about each resident and are part of the person centred plan. We were told these have been written in the style the staff think the residents would write if they could do it themselves. The home has put a lot of effort into gathering information about residents previous lives as well as up to date information. The file is in collage form. There are lots of pictures, textures and information of how and what the residents like in their lives. The communication passports are covered in different textured material, so the resident is able to identify their own file through touch. One member of staff came up with the idea of putting scent on the material, so it could be identified by smell as well as touch. We were told staff use specific key words and phrases when they speak to one resident because they understand these and we were able to observe this in action. There has been a change to the staff team but staff who work in the home know the residents well and are able to interpret what the residents need and want through the residents body language, gestures and sounds. We met two new members of staff who are learning about the residents. They said they have worked in other houses in the service and had experience with communicating with residents who have no verbal communication. The activities sheet that records residents daily activities includes ordinary daily living tasks. Residents are supported by the staff team to make tea or help with vacuuming the floor. Residents are encouraged because of their attention span is limited, to do a little and often. One resident has been accessing Choice Supports multi-media project so they can tell their story on a DVD and both residents have been able to access sensory amenities. One resident vocalisations and hums were taped to a guitar accompaniment. Individual risk assessments have been carried out. These are monitored and reviewed by the staff with residents every six months or when the need arises. Details of any changes to the risks are recorded in the residents care plans, with details of how to manage the risk. Care Homes for Adults (18-65 years) Page 12 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are enabled to lead varied lives including taking part in age, peer and culturally appropriate activities, leisure activities in the local community. Staff are sensitive to residents needs and wishes and they are actively encouraged to develop daily living and social skills. Evidence: We saw the residents activities timetable, which includes developing independent living skills within the range of the residents abilities. The timetable includes a full list of the residents interests and activities they participate in during the course of the week. The residents have their own car that is adapted to take both residents and their two carers. The manager said the car needed to be renewed because of the age it was. They had completed new risk assessments for the residents being assisted into the car. The manager observed that because the residents had aged they were having Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: more difficulty getting into the car and needed to be pushed up a ramp in their wheelchair and this was posing a risk to the carers. Because of this they planned to have different adaptations made to the car. This included a side step and grab rail. The ramp would be lower and there would be an electric winch to pull the wheelchair into the car. One resident particularly enjoys going to Vauxhall City Farm and the staff take them there in the car. Another resident just enjoys being driven around in their car. The psychologist has said this could be because the movement has soothing effect. Staff said residents continue to enjoy going to the Poppin cafe on a Saturday to meet up with friends. We saw by looking at the activities sheets in the residents files there are regular places they go to each week and staff said residents appear to enjoy these activates very much. This includes going to church every Sunday and the Gateway club. The manager said the staff are very good and are continually looking for different activities the residents can enjoy and do. As part of developing their daily living skills the residents are supported by staff to make drinks for themselves. One resident particularly enjoys using the blender to make Smoothies. One resident has recently enjoyed making cakes with the support of staff. Individualised menus designed to reflect each residents health and cultural needs. One resident has been supported to lose weight but they are still having a varied diet they enjoy and this will help maintain their mobility. Each resident has a cultural needs assessment on file and there is a record and history of their life and background. It includes information about each residents cultural and ethnic background and information from their early childhood through to the present day, is ongoing and staff continue to add to it and develop it as necessary. The staff are of the same ethnic group as the residents and are able to support them in their cultural needs with regard to food and clothes. The manager said the staff continue to plan and look for new activities for the residents to experience. In the past residents have been involved in training managers and recruiting new staff. When we visited the organisations head office as part of the inspection, we were told how valuable their input was and they were paid a small fee for doing this. Care Homes for Adults (18-65 years) Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed and cover all aspects of a residents life including physical and emotional well being. Residents receive personal support, in the way they prefer. Medication is managed and administered safely by the staff following the homes medication policies and procedures. Evidence: We found care files contain information for staff on residents both residents who need personal support with their preferred personal care routines. The home operates a key worker system with each resident having two members of staff from within the team to co-ordinate their support and care planning. Each resident possesses an individualised health action plan in the form of a booklet. The record of health appointments attended indicated that staff supports each resident if this is what the resident requires, to attend an appropriate range of health care Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: appointments in line with their individual health care needs. One resident follows a dietary plan which the hospital dietitian has given them to follow to help reduce their weight. This is on going and both residents eat a healthy diet. We noticed the resident appeared slimmer that the time we were here last. The manager said they encourage the resident to eat more fresh vegetables and fruit. The hospital has weighing scales that the resident can sit on which confirmed the resident had lost weight. This is positive because there had been concerns that if the resident continued to gain weight. The extra weight would affect their weight bearing ability and this would limit their transferring skills. The manager said they have noticed that the transfer skills of the residents have changed and they have modified how they assist residents to get into the car. Staff said they monitor residents health needs and support residents to keep appointments and health care professionals including community pharmacist. We were able to see relevant documentation kept in the residents files such as the outcomes of reviews and outpatients visits. Both residents are supported to attend their 6 monthly medication reviews and attend audiology and optometry services as well as their more routine services such as dentistry and chiropody. In the past the manager had asked for best interest meetings to be held about when a resident needed dental treatment and this was happening for another resident who also was not able to make an informed decision. We were told and saw records confirming this involved the residents key worker, the manager, social worker, the dentist and input from the residents family member. The manager said they had voiced concerns and asked for the meeting because they felt without treatment the resident could end up having emergency treatment, which could be avoided if they had regular treatment. We were told there were other concerns regarding health issues and discussed the impact of the Mental Capacity Act and the use of IMPCs. The resident has been referred to the hospital for treatment and they are waiting for an appointment. Residents medication is stored securely in a locked medication cabinet in the staff office. Both residents had medication reviews and routine blood tests. Copies of the results were recorded in their personal file in their health care booklet. Homely remedies are signed as being able to be given by the GP. We checked the medication with the manager and this was correct. The manager said they conduct a weekly audit. On the day of the inspection they were waiting for the local pharmacist to come to do a check of the medication. We were shown the report by the local pharmacist who comes into the home every six months to check the medication. This indicated there were no issues that needed to be addressed by the home. The staff and manager said there had been issues with ordering and receiving the medication but they had liaised with the pharmacist and had been resolved. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: We were told staff have medication training and medication administration records as part of their induction and the organisation have medication training in their refresher program. The manager said if staff made a medication error, this would be discussed in supervision and they would be sent on medication refresher training immediately. Care Homes for Adults (18-65 years) Page 17 of 29 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. Residents are protected by the homes policies and procedures. The organisation has developed a robust system and checks are in place to safeguard the residents and protect them from abuse, neglect and self-harm are consistently carried out. Evidence: We checked the complaints book and noted there were no complaints. The home has a complaints policy, a copy of which is in the residents guide. A member of staff said they are aware of abuse and protection policies and how to deal with cases of suspected abuse. Any suspicions are reported to the manager to deal with, who will deal with it in an appropriate way following the homes adult protection policies and procedures. The manager said if there is a vulnerable adult protection issue, the home would follow the homes Adult Protection policy and the policy of the placing authority. They said they had been on refresher training on Adult Protection training for managers. In this training they discussed all aspects of abuse such as what is called Low Level Abuse such as speaking to another colleague over the resident, or speaking in a language or using mobile phones, could lead to more serious forms of abuse. We were told the organisation has taken very seriously the Deprivation of Liberty Safeguards Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: and organised training for its senior staff that started on 26th March 2009. The home had issues around safeguarding residents finances. This was addressed under the adult protection policies and procedures. The manager said the home and the organisation have put further systems in place to protect residents from this type of abuse in the future. The residents care managers have been involved and best interest meeting have been held. At the present time both residents accounts are still frozen. The organisation has written to the DSS and Choice have been given permission to be the residents Trustee as there is not anyone else who can do this. We saw the residents finance book in which all financial transactions are recorded and signed by two members of staff. At the present time the organisation is lending the residents money until money in their accounts is accessible. Both residents daily financial records were inspected and were found to be in order. Care Homes for Adults (18-65 years) Page 19 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a comfortable, homely, well-maintained environment that has been designed to meet their specific needs. The home is bright, clean, comfortable and safe with all spaces accessible to wheel chair users. Residents rooms are comfortable and are decorated to reflect their personalities. The home has specialist equipment to facilitate access to the building for residents and maximise their independence. Evidence: Dorrien Walk is a one-storey home with a ramp up to the front door. The home was set up over ten years ago to house the present residents and is suitable for the residents with their physical disabilities as it is all on one level. The home is comfortable, homely, warm and well maintained. The home is cleaned daily to keep it clean and free of unpleasant odours. The manager said they have tried to emphasised ownership of the home by putting framed, poster sized portraits of the residents on the lounge wall. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: Both the home and garden are accessible to wheelchair users. All the rooms are easily accessible with wide doors to accommodate wheelchairs. Both residents are visually impaired but they are familiar with the layout. They are able to find their way around the home and to their bedrooms independently. The bedrooms are individual in style and reflect the culture of the resident. One resident has a small toilet off the bedroom, which they are able to use independently. We were told they were planning to redecorate the residents bedrooms. The staff said they were planning to go to the local market to look for material with Africa prints to reflect the residents culture. And because they feel this is what the residents like. The main living area is large and the garden can be accessed from the patio doors via a ramp. The garden has been very attractively landscaped and flagstones had been laid, one resident, who in particular enjoys the garden and the tactile feel of the different textures and the scent of the plants, is now able to access the garden. The organisation adapted the layout to allow the resident to move around the garden independently in their wheelchair. The kitchen has been adapted to meet the present residents needs. Worktops are at a level to enable the residents to sit at them and prepare meals with the support of staff, which allows for greater independence. We were told they hoped to refurbish the kitchen in the near future The main bathroom has a hoist that the residents use to help them get into the bath with minimum support from staff. This has helped promote their independence. The bathroom this had been redecorated since the last inspection in July 2008. The large cupboard where the washing machine and the dryer are situated next to the bathroom has also been redecorated. The office has been redecorated but not fully refurbished. Staff said they were not able to access the computer unless a manager was there to sign them in. The manager explained this was because at the present time there was confidential information stored on it that could be accessed by staff. They said all staff would have e training and a new policy was being developed around electronic working and would be rolled out and staff would be asked to sign up to this. Staff said it would be time effective to have it working because they could do much of their paper work in the home rather than having to wait for a manager to be at the home. Care Homes for Adults (18-65 years) Page 21 of 29 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. Overall staff recruitment procedures were found to be robust therefore ensuring people who used services were protected from harm. The home is supported by an effective staff team that know the residents well. Having regular staff meetings and formal supervision supports the staff. Personal and professional issues need to be clearly identified, agreed and addressed. Evidence: The manager told us that recruitment includes formal interview, taking up two references, CRB checks and POVA checks prior to appointment and all staff have an employment contract which include details of their terms and conditions of employment. As part of the last inspection we arranged to visit the organisations head office where all the staff files are kept. 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. We checked the files to assess compliance with Regulation 19 of the Care Homes Regulations 2001. We looked specifically at Schedule 2 of the Regulations, which specifies the range of documents required in respect of people working at a care home. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: The files were in good order. 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. On 4th March 2009, Debbie Westhead, who is the Provider Relationship Manager, CQC for Choice Support services conducted a staff record check relating to recruitment procedures of services located within London and South East Regions. This was done as part of a number of initiatives to improve performance of the services. Choice Support has an agreement with CSCI regarding centralised staff records. Thirteen staff files were checked at random. The majority were staff that had recently been recruited to the organisation and were a cross section of all grades and posts. It was found that the majority of files, seven out of thirteen, did not contain a recent photograph of the employee. All staff have a photograph taken for their ID pass and we were told at the last inspection they can probably be used to provide a photograph for the file, as this is required. We were pleased to see from the files that residents were involved in the recruitment of staff. Since the visit the regional director has confirmed the service managers based at Barry Road maintain a file for each of the registered managers which include supervision notes, training records and appraisal records. We were told there is a supervision policy in place and individual training needs are set out in staff annual appraisals. One member of staff recently completed NVQ2 in promoting independence and four other staff has obtained NVQ3 in promoting independence. As part of the inspection, we were able to attend the staff meeting. All staff are on duty for this and we met five staff the deputy manager and the manager. All staff confirmed they had staff supervision every six weeks. They said they had training in person centred planning, medication refresher training, working with families and the protection of vulnerable adult training was in the training programme. The regular staff meetings used to be held at Barry Road but this has now changed. Copies of their supervision records are kept there. If any member of the staff team have any personal or professional issues that need to be addressed and monitored, support and development plans need to be agreed and in place. All support and monitoring meetings and outcomes should be recorded. We spoke to two staff and the deputy manager privately. The deputy manager said she had just completed her probationary period and said she had a formal induction training before starting at the service. The manager told us the training is aimed at updating and improving staff skills. There continues to be an emphasis on POVA Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: training and all staff attend this to refresh their knowledge and this is discussed in supervision and at staff meetings. Care Homes for Adults (18-65 years) Page 24 of 29 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. The home has a clear management structure in place to ensure that the service received by tenants is consistent, well managed and planned but the manager needs to submit an application to become registered. Senior management in the organisation need to ensure the management of the home are supported at all times and there is regular monitoring of all aspects of the service. Evidence: The present manager is the manager for another Choice Support home in Croydon and she worked in Dorrien Walk until she was promoted to deputy manage several years ago. Since then she has become the manager of that home and is in the process of applying to become the registered manager of both services. The manager demonstrated a clear understanding of the needs of the residents and her responsibilities in ensuring that the home meets the registration standards. The home now has a deputy manager which will help run the service more efficiently. The deputy manager is based in the home and the manager is based in the home in Croydon. The manager said they do different shifts in each home so they are familiar with all the Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: residents and staff of both homes. The home had a policy on health and safety and we were shown the health & safety records held in the home. Certification was in place regarding the Landlords Record of Gas Safety, Portable Electrical Appliance testing, and Certificate of Electrical Installation. Records showed that regular checks of the fire alarm call points were made and that fire drills were conducted. Staff confirmed that they attended mandatory health and safety training, which included fire safety. The home recently had a fire risk assessment check done. This has high lighted the high risk to residents of not being able to escape the fire if the front door is blocked by a fire. We were told this has gone to the housing officer to be assessed and resolved. The premises and the maintenance is now checked at Reg 26 visits and health and safety checks that are completed in registered services. We were told by the provider relationship manager that it is anticipated these arrangements will identify maintenance issues earlier and therefore speed up repairs. We were told about the quality assurance checks and processes that the organisation has in place. These were robust, very thorough. A Lead Analyst checks all information and produces regular reports for senior management to ensure that areas of concern are tackled at the earliest opportunity. The quality assurance checks consists of annual service audits, finance audits, Reg 26 reports, health and safety audits, REACH data, whole service reviews and annual external audits. The organisation has also made good progress with its Quality Checkers. There are currently 21 quality checkers through out the organisation, these are people who use services and when they visit a service they produce a full report. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R 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 27 of 29 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 Requirement 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 Requirement Timescale for action 1 42 12 The registered person must 28/08/2009 promote proper provision for the health and safety of the residents. There is a high risk to residents of not being able to escape the fire if the front door is blocked by a fire and this must be followed up. 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 3 4 34 34 34 42 There should be evidence of qualifications and training from previous employers. All applicants should complete a full employment history and gaps in employment should be investigated. all files should contain a recent photograph of the staff. There is a high risk to residents of not being able to escape the fire if the front door is blocked by a fire and this must be followed up. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 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. 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