Care Home: Jean Garwood House

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Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Jean Garwood House 25 Bramley Hill South Croydon Surrey CR2 6LZ The quality rating for this care home is: three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Janet Pitt Date: 0 8 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). 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 CSCI 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 30 Information about the care home Name of care home: Address: Jean Garwood House 25 Bramley Hill South Croydon Surrey CR2 6LZ 02086817338 02086048904 jgh@garwoodfoundation.org.uk 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) : Garwood Foundation care home 14 Number of places (if applicable): Under 65 Over 65 14 14 0 0 learning disability physical disability Additional conditions: Room number 11 is to be used for 1 respite bed. Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 30 A bit about the care home Jean Garwood House is sited in a residential street close to the centre of Croydon on Bramley Hill. The house is fully registered as a residential care home for adults with physical disabilities and learning disabilities. Some residents visit their families at weekends and so the numbers in residence can vary at certain times. The ground floor of Jean Garwood House provides 11 single residents rooms. The shared rooms in the home consist of a lounge and dining room. Corridors in the home are wide and long and easily accessed by wheelchairs. Bathrooms are located either end of the long corridor, as are the toilets. All ground floor bedrooms exit onto a patio area that surrounds the house. The first floor has been converted into a semi-independent living unit for three people and has now been registered as such. The fees range from #623/week. Care Homes for Adults (18-65 years) Page 5 of 30 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 30 How we did our inspection: This is what the inspector did when they were at the care home The quality rating of this service is three star. This means that the people that use the service experience excellent quality outcomes. One inspector undertook this unannounced inspection. The home provided us with an Annual Quality Assurance Assessment [AQAA], which details how they view the service provision. A site visit was made over two days and lasted a total of six hours. During the second site visit we were able to speak with people who lived in the home. Records relating to care planning, staffing and policies and procedures were among those examined. We walked around the home and spoke with staff members. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well What has got better from the last inspection The home makes sure that people are safe by the way it recruits staff. They make sure that the persons full employment history is known. When the member of staff starts work, the home makes sure that they are supervised to do their job. Care Homes for Adults (18-65 years) Page 8 of 30 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Janet Pitt Caledonia House 223 Pentonville Road London N1 9NG 020 7239 0330 Care Homes for Adults (18-65 years) Page 9 of 30 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 10 of 30 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 11 of 30 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. People can be confident that their needs will be assessed and they will be asked about what they want. Individuals have information on what services are provided as part of the fee. Evidence: The homes AQAA says that: care plans and risk assessments are discussed with prospective residents. They identified that some more work is needed on involving the person more in the process. We looked at assessments and found that they covered areas such as personal care needs, health needs, communication and risk taking. Only one person has been admitted to Jean Garwood house since the last inspection. This person was able to visit for meals on a few occasions and stay for a trial weekend. This meant they could test drive the home and meet other people who lived there. It was clear in the assessments looked at that individuals had had an input into what had been written. As mentioned in the AQAA this work is ongoing and the home have planned training on principles and methods of care assessments. This will make sure that individuals or their representatives can be confident that all needs will be Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: identified. Each person has a contract showing what is included in the fee. Care Homes for Adults (18-65 years) Page 13 of 30 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. People who live at Jean Garwood can be confident that they will be treated as individuals and have real choices in what they do. Evidence: The home has said in its AQAA that care plans are person centred and people are able to make their own decisions. Staff think that they have got better in involving individuals in decision making. When we visited in the morning to meet people in the home, we saw them being asked about inviting someone for dinner. This person was a carer at the day centre and had helped on holidays and days out. Agreement was reached on when to invite their guest over. Some people said that they wanted this individual to go on an outing with them soon. The manager said that they could talk to the person when they came for a meal to arrange something. We looked at care plans and saw that they lead from the assessment of need. There were good details on individuals needs, for example behaviours and how to deal with situations. Plans for night time routine included information on what covers a Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: person wanted, whether they had a light on or the door open. There were plans for individual health needs, for example if a person had epilepsy warning signs for possible fits were written down. We found that individual needs and choices were central to the care given at the home. There were comprehensive risk assessments in place for each person. These covered areas such as friendships, money, social situation, travelling and sexuality. Also, vulnerability, mobility and personal hygiene. The manager confirmed that some people in the home were in relationships and able to spend private time together if they chose and also to go on holiday. Special friendships were sensitively recorded in a persons plan. Some people who live at Jean Garwood House said that they were able to do things themselves, such as washing and dressing, but staff would help if they asked them. We also had a chat about shopping and what places individuals liked to visit. These ranged from any clothes shops to specific ones. This was dependant on how the individual was able to deal with crowded situations. We found that six monthly reviews of plans were done by the home. Placing authorities do annual reviews. There was evidence of the person being involved and when able they are asked to sign to review. We saw that documentation is live, areas like, religion or cultural needs are revisited and updated by staff when they get to know a person better. Each person has a care passport that is in an easy read and pictorial format. This can be taken out when they visit the community or go on holiday and give a good overview of their individual needs. Care Homes for Adults (18-65 years) Page 15 of 30 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. People who live at Jean Garwood House are able to chose how they spend their day. They are able to take part in a range of activities and can enjoy a fulfilling social life. Mealtimes and menus are flexible and cater to their tastes. Care is given to make sure that all people are treated as individuals. Evidence: The homes AQAA says that people are able to participate in educational activities if they chose. Contact with family and friends is supported and changes have be made to the physical environment of the home, so there are private, quiet areas for individuals to see visitors. The AQAA showed that funding is available for holidays and the activities-holidays coordinator is helping all the people that live in the home to plan a cruise in the future. This is a holiday that all individuals want to go on. We found on the site visit that individuals are able to do a wide variety of things. These ranged from community activities coordinator such as bowling and the cinema Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: to holidays. Individuals told us that they did a range of things at the day centre, such as poppy making, arts and crafts and cooking. One person said they had been able to visit the main poppy factory and the workers there thanked them for their hard work throughout the year. Some have gone on day trips to France with the day centre. Also there are music therapists, Wii games, pottery, cycling and art and crafts available at the centre. Some peoples activities have already booked holidays and one person has four planned. These include holidays at the homes caravan in Bognor and ones with family members. People said that they were able to see their family and friends. Visits to family members are arrange at regular intervals. Two of the people that live in the home have a special friendship and have time to enjoy each others company. One person said they enjoy clothes shopping. Individuals able to chose what they wear and staff support if needed. All individuals were well presented and obviously took pride in their appearance. The manager said that recently some people had been to a disco and came home quite late, around midnight. She said that staff will go the extra mile to support people. One person said they want to go and see a show in the West End again. We were told by staff that people they travel by public transport and use taxis. There were details in care plans of preferred forms of transport. Some people sign and the home recognise need for staff to be able to sign. Training in signing is being sought for staff. One person has their own computer with Internet access and the manager said that if other people in the home wanted Internet access this would be provided, but no-one has shown an interest in this at present. We saw that individuals have special places where they want to sit in the dining room. The weeks menus are planned with people, and record is kept of what has been served. Mealtimes are flexible and menus are in picture format. Drinks and snacks are always available and staff said that people are encouraged to make their own food and drinks. One person kindly invited us for a cup of tea next time we visit the home. Care Homes for Adults (18-65 years) Page 17 of 30 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. People can be confident that their needs will be met on an individual basis. They are able to make real choices about personal and health needs. Individuals can be confident that medications are handled and administered safely. Evidence: The homes AQAA states that there is a key worker system in place. The key workers are rotated every six months. We found that people who live in the home are happy with their key workers and support they are given. Care documentation reflects their personal preferences and a personal care passport is available. This gives an overview of need and how it should be met. The passports are in easy read and picture format. Peoples wishes for end of life care are covered in plans,and show what people want to happen. Help with making wills is available. An independent solicitor visits individuals. Copies of wills are kept on peoples files. Also, there were details of people to be contacted, whether the person wanted a burial or cremation,and where they wish to die. We found that medications are kept securely in a locked cupboard. Records showed Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: that there was no-one on sedating medications for behaviours. All health appointments had been recorded and it was easy to see when seen a person had visited the GP, dentist or optician. Staff reported that the GP visits to do flu jabs. People are support by staff to attend the doctors surgery. One person declined a medical test. It is recommended that staff do not use the word refused, when recording an individuals choice in whether to do something. Care Homes for Adults (18-65 years) Page 19 of 30 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. People can be confident that any concerns or complaints they have will be listened to and acted upon if necessary. Individuals are protected from harm by good Safeguarding procedures. Evidence: The home reported in its AQAA that they have not received any complaints. there has been one Safeguarding investigations undertaken by the local authority, but the incident in question related to something that happened six years ago. Therefore no evidence was available to be able to carry out a proper investigation. We saw the complaints procedure displayed in the home. There is an easy read and pictorial format available if needed. People spoken with at the site visit said they knew how to raise any concerns they had. Our observation of interactions between staff and individuals confirmed that people were able to speak openly. Some people also said if they had any concerns they would not hesitate to raise it with their key worker or the manager. The majority of the people have lived at Jean Garwood House for a number of years and said they are settled and happy. Staff records showed that training had been given recently on Safeguarding. Mental capacity training had also been undertaken by staff. We saw literature on Deprivation of Liberty ready to be given to staff for reference purposes and to action if needed. Care Homes for Adults (18-65 years) Page 20 of 30 Care Homes for Adults (18-65 years) Page 21 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals live in a home that is clean and tidy. Work is ongoing to improve all areas of the home. Refurbishment that has been completed has been done to a high standard and is tailored to the needs of the people that live in the home. Evidence: We had a look around the home. Recent decorating, for example the kitchen, is done to a very high standard. The new kitchen has space for individuals to do their own cooking and drink preparation. Work surfaces in this area are lowered and can be accessed by people who use wheelchairs. There are separate areas for staff to cook and prepare drinks. Three people share a living room and kitchen upstairs. This kitchen has a work surface which is height adjustable. The sitting room is homely, with photographs and personal possessions. People in the flat have a tumble dryer and washing machine so they can do their own laundry. The manager said that there are plans to build a wet room downstairs. Individuals in the home will still able to have bath if they want one, as there is another bathroom on the ground floor. People can access a garden that is neat and tidy with space to sit. They are able to do gardening. Care Homes for Adults (18-65 years) Page 22 of 30 Evidence: The main lounge has large TV and DVD and video player for people to use. There is a television in the dining room, which can receive radio stations. The home has a small quiet space and the manager said that they plan to buy some screening to make it more private. Corridors and doors in the home wide enough for wheelchairs. The AQAA states that the main laundry area needs redecorating, this was confirmed at the site visit, when we saw the facilities. People said they had their own possessions in their rooms. The one respite room is empty, we saw that it had a wash hand basin and sufficient furniture. This room had a profiling bed. The manager informed us that people chose their own beds. People are able to lock their rooms if they chose, we saw keys in some locks. The manager made sure she respected peoples privacy, as no one was in the home at time of first site visit. so only the empty room was viewed. Care Homes for Adults (18-65 years) Page 23 of 30 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. People who chose to live at Jean Garwood House can be confident that staff are recruited safely. Attention is paid to making sure that staff receive appropriate training and supervision to carry out their duties. Evidence: Requirements were made at the previous inspection relating to staff supervision and making sure employment reference had been obtained from employers. The home stated in its AQAA that these requirements had been addressed. When we looked at staff files we were able to see evidence that this had happened. Each member of staff has a supervision contract. There were records of supervision sessions happening. If necessary objective setting and performance management was in place to make sure staff reached an acceptable standard in undertaking their duties. We found a good recruitment process in place, which followed the homes policy. it is recommended that interview notes that are made are kept in accordance with Employment Law. The deputy said that they made notes, but these are not always retained. There was information in staff files relating to checks being carried out, such as Criminal records and proof of identity. It is recommended that any cautions as well as convictions is requested on application forms, so that the home is aware prior to a Care Homes for Adults (18-65 years) Page 24 of 30 Evidence: criminal records check. Each file had a clear format and contained a recent photograph of the staff member. Training records were in one section and areas of recent training included fire safety, infection control and food safety. Each person had an individual training record. Care Homes for Adults (18-65 years) Page 25 of 30 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. People who live in the home are able to contribute to the running of the home and their views are listened to. Action is taken if needed to make sure needs are met on an individual basis. Individuals are supported by a stable staff team who are person centred in their approach. Evidence: The homes AQAA states that they have a Quality Assurance system in place. Using this system they develop an annual plan. When we looked at the most recent survey results, we found a high level of satisfaction with the service provision, particularly activities. Surveys had been sent to people who use the service and their representatives. Areas asked about included food, personal care, independent living and the environment. When we looked at staff records we found that the majority of staff had been at the home for a few years. The manager and deputy both have years of experience in care settings. The manager reported that initially people who live in the home were not happy with key workers rotating, but through effective communication and support, individuals are Care Homes for Adults (18-65 years) Page 26 of 30 Evidence: now happy with this arrangement. This was confirmed when we spoke with people on the site visit. Care Homes for Adults (18-65 years) Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 1 2 18(2) Supervision sessions for all staff must occur at a rate of at least 6 sessions per year. 01/07/2007 Met at inspection 09 Care Homes for Adults (18-65 years) Page 28 of 30 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 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 18 It is recommended that use of the word refused is reviewed. This will make sure that records demonstrate that individuals have real choice. It is recommended that any cautions as well as convictions are requested when a person applies for a job. It is recommended that interview notes are retained in accordance with Employment Law. 2 3 34 34 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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