Care Home: Longley Road

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What the care home does well There is a committed manager and staff team who have worked at the service for varying periods of time. Findings from this inspection indicate that the service is run in the best interests of the people who use the service and that they are at the forefront of any planning and decisions made. The atmosphere is relaxed and comfortable, and we observed positive interactions between the people who use the service and the staff. What has improved since the last inspection? At the previous inspection there had been eight areas where the service had to improve. The service has taken action on all of these areas, plus the recommendations made, which represents a very positive response to the findings of the inspection and good developments to the service. In particular, good improvements have been made to the care planning, medication system and staff training. What the care home could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include more transparency in the processes of quality monitoring that takes place at the service, and ensure that risks of high water temperatures are managed to ensure the safety of people who use the service. Key inspection report Care homes for adults (18-65 years) Name: Address: Longley Road 89 Longley Road London SW17 9LD     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: Louise Phillips     Date: 0 1 1 2 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 24 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 24 Information about the care home Name of care home: Address: Longley Road 89 Longley Road London SW17 9LD 02087679933 02087679966 cward@signhealth.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): SignHealth Name of registered manager (if applicable) Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia sensory impairment Additional conditions: Date of last inspection Brief description of the care home 89 Longley Road provides accommodation for six adults who have a mental health need and a hearing impairment. All people who use the service have their own flat with bedroom/lounge, kitchen and bathroom. The home also has a communal kitchenette/dining room, lounge and laundry room for use. The home is situated in a quiet residential area in Tooting and has an attractive, large back garden. It is close to local amenities and public transport links. The property is owned by Wandle Housing Association and operated by SignHealth, a charitable organisation. The people who use the service and staff communicate by using British Sign Language (BSL). 1 9 0 2 2 0 0 9 6 6 6 Over 65 6 6 6 Care Homes for Adults (18-65 years) Page 4 of 24 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: This inspection took place over one day and included a visit to the service by a Regulation Inspector. During the inspection we looked at the environment, and at records and relevant documentation held at the service. We also spoke to staff and observed what was going on in the service. Since the last inspection the team leader has now become the manager of the service, and was present during our visit. Care Homes for Adults (18-65 years) Page 5 of 24 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 6 of 24 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 7 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The assessment process is appropriate to ensure the service is the right place for people to move to. Evidence: We looked at the care files for two people who use the service. The files contain relevant information about the referral and assessment process, along with relevant information from relevant health and social care professionals involved with the person. As part of the assessment process an up-to-date needs assessment is gained from the social worker involved in their care. Care Homes for Adults (18-65 years) Page 8 of 24 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people who use the service are appropriately identified and relevant support plans in place. Evidence: During the inspection the care files of two people who use the service were looked at. Since the last inspection a new care plan format has been introduced, as well as an improved way of recording information about the person. The care plans are in a much more simple, and easier to understand format, detailing the area of need, support to be given and actions necessary to do this. There are different care plans for each area of need, such as social needs, their mental health and diet. Each is very individualised and kept under regular review to ensure they are current to the persons needs. This has enhanced the daily recording about what people who use the service do Care Homes for Adults (18-65 years) Page 9 of 24 Evidence: throughout the day, and it was positive to see that people are encouraged to record what they have done in their own daily notes. In one care file, a pictorial person centred plan had been developed to support the person with their plans to move on from the service. The manager said that approximately half of the staff team had undertaken training in person centred planning, and that training is planned for the rest of the staff team to do this. Each file contains a risk assessment that details how risks can be minimised in the areas of inappropriate interactions, medication, and personal care needs. These are also in a good format, where there is clear identification of the risk or hazard to the person, the staff support required in this, actions to be taken and the aims of this. Care Homes for Adults (18-65 years) Page 10 of 24 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 use the service are supported to pursue individual interests and activities both inside and outside the home. There is a relaxed atmosphere at the service. Evidence: The manager and staff spoke knowledgeably about the people who use the service, and have a good understanding of their needs. We observed positive interactions between the staff and people who use the service. The activities that people get involved in are varied depending on their individual wishes and desires, where they are supported to go to college, keep fit classes, seeing their friends and family and having people to visit. The manager said that most people who use the service are very independent in their lives and that staff provide support Care Homes for Adults (18-65 years) Page 11 of 24 Evidence: where necessary. At Longley Road each person has their own flat and there are a communal kitchen and lounge area,with a computer where people can access the internet, as well as videos and a DVD player for use. The manager spoke about a number of different activities that have taken place at the service during the last year, including a celebration of Black History month, trips out, garden parties, weekly bingo and movie nights. She said that some activities, such as swimming, have been tried, though people who use the service were not interested in this. However, she said that the Sunday lunch at a local pub has been a success, with people who use the service now independently planning this and going out together. Most people who use the service have been on individual holidays of their own choice this year, whilst others have preferred to stay at the service and go about their daily lives. People have their own flats, where they buy and prepare their own food. Staff told us that they will assist where necessary if people need support with shopping and cooking. Care Homes for Adults (18-65 years) Page 12 of 24 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are support appropriately with meeting their health and social care needs. Good improvements have been made to the medication systems at the service. Evidence: People who use the service are independent in attending to their personal care needs. The care files holds records of all health care appointments that people attend, and care plans also detail the level of support that people have with any specific physical needs. Regular reviews of peoples care takes place with the involvement of the Community Mental Health Team (CMHT) and the person. Medication held at the service is appropriately stored, with a new lockable medication cabinet having been installed since the last inspection. We looked at the medication held for two people who use the service, where the Care Homes for Adults (18-65 years) Page 13 of 24 Evidence: information on the Medication Administration Record (MAR) corresponds with that prescribed. A weekly medication audit has been commenced at the service, with daily checking of the MAR charts also taking place. The manager said that they work closely with the pharmacy to ensure that all medication is up-to-date for the people who use the service. Staff training records indicate that staff have receive training in administering medication. Care Homes for Adults (18-65 years) Page 14 of 24 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. There are systems in place to reduce risks to people who use the service and addressing complaints. Evidence: The home has a satisfactory complaints procedure and format for the logging of complaints and concerns. The complaints book details any complaint or concern received, and of the steps taken to address these. The home has a copy of the Wandsworth safeguarding adults procedures so that staff are aware of the local authority protocol for dealing with any issues of abuse. The training records indicate that staff have received training in safeguarding vulnerable adults. Care Homes for Adults (18-65 years) Page 15 of 24 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. The environment is homely and suitable for the people who live there. Evidence: The home is on a residential street, with good access to local community facilities and public transport. There is a large garden to the rear of the home. Each person who use the service has their own flat that they clean themselves, with the support of staff if needed. Within their flat, people have their own bathroom and kitchen area. People are also able to use the communal lounge and kitchen areas, on the the ground floor of the service. All areas were observed to been clean and tidy on the day we visited. On the day of the inspection the service was in the process of being repainted throughout, and new flooring being installed. This includes each persons flat, where they were able to choose the colours that they wanted for their walls and carpet. At the last inspection some areas in the environment were observed to need Care Homes for Adults (18-65 years) Page 16 of 24 Evidence: addressing. The service has taken action on all of these, apart from lowering the high cupboards in the communal kitchen area. The manager said that this was something that they have been trying to address with the housing association who own the property, and is ongoing. Care Homes for Adults (18-65 years) Page 17 of 24 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. Staff receive training relevant for their role. Appropriate recruitment checks minimise risks to people who use the service. Evidence: The recruitment files for two staff were seen to contain the required information about recruitment checks, such as two references, Criminal Records Bureau check and copy of proof of identification. They also contain information regarding the staff members application and correspondence relating to the offer of their job. We saw evidence to confirm that new staff receive an induction to working at the home, and also that they are reviewed for a period of probation. We looked at the training records for two staff. Records indicate that they receive training in areas such as deprivation of liberties, safeguarding, mental health awareness, challenging behaviours and mental capacity act. The manager said that first aid training is ongoing for staff, and confirmed that this had been planned for. The manager said that all the staff are trained up to Level 2 in British Sign Language (BSL), apart from herself, where she said she is starting an intensive BSL level 2 Care Homes for Adults (18-65 years) Page 18 of 24 Evidence: course in January 2010. A training action plan is in place at the service to record the training needs of each staff member, the aims of this and the costings involved. The manager said that there is a healthy training budget for the service and that the organisation supports staff to attend relevant training. Care Homes for Adults (18-65 years) Page 19 of 24 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 manager is competent and understands the responsibilities of their role. Findings from this inspection indicate that the service is progressing in a positive direction for the benefit of the people who use the service. Appropriate health and safety checks are carried out to minimise risks to the people who use the service. Evidence: At the last inspection of the service the team leader had just started working at the service, and was acting up in the manager role. Since this time they have now become the manager of Longley Road. The manager told us that she is in the process of applying to the Commission to be the Registered Manager for Longley Road. A support worker has also recently been promoted to the team leader position. The manager demonstrates a positive commitment to her work at Longley Road, and Care Homes for Adults (18-65 years) Page 20 of 24 Evidence: this is evidence by the positive response to the findings of the last inspection, where all the requirements and recommendations made have been met, resulting in positive developments to the service. The manager spoke positively about the staff team, saying that there is good team work and that the staff work well with the people who use the service. She also told us that she gets good support from her line manager. Quality assurance takes place through regular house meetings and the people who use the service completing satisfaction questionnaires about the staff, support they receive and activities provided. These occur approximately every six months. However, it is not clear how this information is summarised and the results fedback to people who use the service, and also how feedback is used to develop the service. Visits in accordance with Regulation 26 of the Care Homes Regulations 2001 take place, where the line manager goes through the monthly reports of the service, that have been compiled by the manager. The information about the visit is quite vague, and it is recommended that the CQC format (available on the CQC website) is used for recording these visits so that the process of these are evidence more clearly. The service holds relevant certificates and records to indicate that appropriate checks are carried out areas of health and safety, including the electrical system and gas safety. The manager said that since the last inspection new thermostatic control valves have been installed on all sinks throughout the service to regulate the water dispersed. Weekly checks of water temperatures are carried out, and these indicate that there are still some ongoing issues regarding water being too hot or too cold. The manager said that feedback she has received from gas engineers is that this is due to the structure of the building. An environmental risk assessment needs to be put in place to demonstrate how the service manages this to ensure the safety of the people who use the service. Care Homes for Adults (18-65 years) Page 21 of 24 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 22 of 24 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 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 39 42 The CQC format for recording Regulation 26 visits should be used to record the processes taken during these visits. A risk assessment needs to be put in place to detail how the service ensures the safety of people who use the service, where the water is dispersed at higher than recommended temperatures. Care Homes for Adults (18-65 years) Page 23 of 24 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 24 of 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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