Care Home: Mitcham Lane

What the care home does well Mitcham Lane provides a homely and safe environment for people to live in. People who use the service make choices about their day to day life including meals, activities and outings. Staff reported that they offer people a good quality of life, treat people who use the service as individuals, try to meet peoples diverse needs and they worked well together. One resident said in their survey that "the home provides us with a stable home and everything for our general upkeep". Another said that staff really persevere and help us". Staff surveys said that they provided "a holistic approach to the care of residents". Another said that the home did well by focusing on the individual and their needs, working with and supporting residents to promote independent living. What has improved since the last inspection? A covered smoking area has been built in the garden for residents and staff use. The home is more resident focused with residents being actively encouraged to get involved. What the care home could do better: Ensure that no one starts working in the home until all recruitment checks are in place. Paper towels and liquid soap must be available in both bathrooms. A policy should be devised in relation to sexuality and relationships. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Mitcham Lane 229 Mitcham Lane London SW16 6PY     The quality rating for this care home is:   two star good 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: Davina McLaverty     Date: 1 7 0 6 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. 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. 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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 27 Information about the care home Name of care home: Address: Mitcham Lane 229 Mitcham Lane London SW16 6PY 02086773336 02086773336 cassis@blueyonder.co.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) : Mr Abdelkrim Damousi,Mr Clifford Steven Oakley care home 4 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 229 Mitcham Lane is situated in a residential area in Streatham, close to local bus routes. The home provides personal care for black males who have mental health needs. Male members of staff support all residents. Each resident has their own room and there is a communal lounge and kitchen/diner. The home is domestic in character and provides a homely atmosphere. There is a level garden area, accessed via patio doors from the dining area. Information about the home is available in the Statement of Purpose and Service User Guide. Care Homes for Adults (18-65 years) Page 4 of 27 Brief description of the care home The fees currently charged by the home range from £1100 to £1200 per week. Care Homes for Adults (18-65 years) Page 5 of 27 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 quality rating for this service is 2 stars. This means the people who use this service experience good outcomes. The inspection included an unannounced visit to the service on the 17th June 2009. We met three of the four residents, the manager, proprietor and one staff member. We also looked at a number of records, which included two residents files, care plans, health and safety records as well as the environment. In addition , the inspection took account of information received about the service since the last inspection. Care Homes for Adults (18-65 years) Page 6 of 27 Prior to the inspection, we also contacted the residents who live at the home and staff who worked there. We asked them to complete surveys about their experiences. Six surveys were returned, three from staff and three from residents. All comments in the surveys were positive. We asked the manager to complete an Annual Quality Assurance Assessment (AQAA), which is a self assessment of the service and is also referred to in the report and helped us to form some of the judgements made. The manager is aware of the homes strengths as well as areas that the home can improve upon and plans for the future are well documented in the AQAA. One of the residents spoken to on the day of the inspection stated that they liked being at the home and were satisfied with the care and support provided. Comments included its nice here, staff are good and help us to do the things we want to do, I like my room and the food is good. 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 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 8 of 27 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 9 of 27 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. Potential residents are appropriately assessed to ensure that the service can meet their needs. People are expected to visit to test drive the home. Evidence: The home has an admissions policy which details the assessment and admission procedure. No person would be admitted without a full assessment. The assessment for each resident includes looking at all areas of need, insight into their mental health needs and any medication issues. Admissions to the service are planned, and would include day visits and overnight stays. Particular attention is placed on interacting with existing residents at the home. A care plan is then developed and reviewed with the resident. One file was examined and details of the assessment was in place and appropriate information was seen from relevant health and social care professionals, detailing any particular areas such as social needs and any areas of risk. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: The AQAA states that the home plans over the twelve months to work more closely with residents Community Psychiatric Nurses( CPN) to empower residents to take more control of their recovery and rehabilitation. Evidence of this was seen during the inspection. Care Homes for Adults (18-65 years) Page 11 of 27 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 residents are met through appropriate care planning and support. Evidence: The support planning for residents is documented in individualised care plans which involve residents in identifying their needs and how these can be supported. Two files were looked at during the inspection. The care plans were seen to be individualised and identified relevant issues, which stemmed from the assessment process. The files contained a lot of information about areas particular to individual residents, such as community activities, medication, independent living and support needs around daily living skills such as personal hygiene or domestic skills. The manager stated that the home is working more closely with the Community Mental Health Team (CMHT) and that they are currently working on a recovery and advanced directive project led by a CPN. This is resulting, albeit, slowly with residents taking Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: more control of their lives. Feedback from residents is that they liked living at the home, they feel well cared for and well treated by the staff, and that their privacy is respected. One resident spoken with said its better than his last place and staff are alright!. In discussion with the manager he stated that there are regular discussion with residents by their key workers, as well as himself, as motivation is a major factor in all the residents lives, in that they find it difficult to always see things through due to their short concentration span resulting from their mental health condition, which means that progress is very slow. Risk assessments were seen to be in place and again these focused on the risks to each individual, detailing how they was going to be addressed. Both files examined also had a recent Care Plan Approach ( CPA) which detailed the plan of action from the psychiatrists who remain involved with the residents. Care Homes for Adults (18-65 years) Page 13 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is flexible to the needs of the residents, and supports them to gain maximum independence in their life. Evidence: On arrival at the home all four residents were home. We spoke with two, one of whom said that the days were yours to do what you wanted. This was confirmed by a staff member, who said that staff try to encourage residents to use their time constructively. The manager described how each resident likes to spend their day , saying that one goes up town shopping a lot, another often goes for walks and to the local shops, whilst another likes to have a flutter on the horses. He also spoke of trying to support some of the residents go to college or to get involved in more constructive activities in the community. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: Residents are encouraged and supported to carry out household tasks from cooking to cleaning. A cook/cleaner is employed twice a week the rest of the time staff and residents prepare the meals. Feedback from residents is that the food is good and that they can have what they want. A record is kept of the meals served. It was observed that interactions between staff and residents was positive with a good rapport developed between both parties. Staff were seen to use appropriate address when speaking to residents and residents were seen to be very much at home. Residents have keys to the front door and their bedrooms. Residents and staff said that visitors are welcomed and staff encourage and support residents to remain in contact with their families. The AQAA states that over the next twelve months the home will continue to review processes to include residents and whenever possible involve families to to ensure that residents are not isolated and enjoy the benefits of a modern society. Care Homes for Adults (18-65 years) Page 15 of 27 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. The service is responsive to the healthcare needs of the residents and systems are in place to maintain residents well- being. Evidence: Residents are independent in their personal care and staff support is by the way of encouraging and prompting only. A record is maintained of all healthcare appointments that residents attend.Records indicate that there are regular reviews of each residents care and that healthcare issues are dealt with promptly. The medication records for two residents was looked at and the information on the Medication Administration Record( MAR) corresponded with prescribed medication kept in the locked medication cabinet. that on the medicine chart. Evidence was seen of refresher training in administering medication for staff. We also saw the book used to record medication coming into the home and medication returned to the pharmacist. Care Homes for Adults (18-65 years) Page 16 of 27 Care Homes for Adults (18-65 years) Page 17 of 27 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 appropriate procedure for addressing complaints and ensuring that risks to residents are minimised. Evidence: The home has an appropriate complaints procedure. Since the last inspection there has been no formal complaints made. Residents spoken to and information detailed in the surveys confirms that people are aware of the complaints procedure. There are policies and procedures in place regarding Whistle Blowing and Safeguarding of Vulnerable adults and what to do in the event of this. There is also a copy of one local authorities procedures. Since the last inspection there has been one referral to the Safeguarding team which was satisfactorily addressed. Records showed that staff have received refresher training on Safeguarding of Vulnerable adults. Care Homes for Adults (18-65 years) Page 18 of 27 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 home provides a comfortable environment for residents which meet their needs. Evidence: The outside of the home is in keeping with the other properties and is not recognisable as a care home. The home provides a homely environment to residents. A comfortable lounge with television is available on the ground floor. A large kitchen/dining room is available on the ground floor which leads to the garden area which was neat and tidy. Since the last inspection the proprietor has put up a sheltered smoking area for the residents who are all encouraged to smoke outside. The proprietor and manager stated that most residents abide by this rule and understand why they should not smoke inside. One residents bedroom is located on the ground floor and a bathroom is available downstairs. The three other bedrooms and office is upstairs where there is a second bathroom. Bedrooms seen were very much lived in, one resident spoken to said that he was very happy with his room. Bathrooms were adequate although both lacked paper towels and liquid soap and a requirement was made to address this. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: As stated previously staff and residents take some responsibility for carrying out the domestic tasks. A part time cleaner /cook is employed twice a week. On the whole areas of the home were clean and tidy on the day of the inspection, although we advised that the curtains in the lounge be re-hung and the dining room table if not replaced be covered with a table cloth at mealtimes due to the cigarette marks on the table. A small office is available on the first floor where records are stored securely. Care Homes for Adults (18-65 years) Page 20 of 27 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 have a very good awareness of the needs of the residents, however, improvements need to be made to the records relating to staff recruitment to ensure that no one starts working in the home until all the required checks have been received as this could put residents at risk. Evidence: The manager demonstrated a very good awareness of the needs of the residents and spoke of his and staff work to try to engage residents in various activities. The files of three staff were looked at. Only one contained all the required recruitment information such as references, photo, application form, copy of identification and Criminal Bureau check. One file only had one written reference on it ,although the manager stated that two had been received and was seeking a copy of the second one. The other file had no written references although there was a note on the file indicating that verbal references had been sought, however, the document was not dated or signed by anyone. The manager acknowledged that this was not satisfactory and agreed to follow up. The staff team continues to be culturally representative of residents in the home. Staff Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: were observed to get on well with residents. Supervisions were seen to be taking place regularly and staff reported in their questionnaires that they continue to feel supported in their roles. Regular staff meetings take place which allows information to be passed on and for staff to be kept up to date with organizational an management developments. The proprietor stated that all mandatory training had been updated and evidence was seen of this on the files looked at. Care Homes for Adults (18-65 years) Page 22 of 27 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 approachable and caring and has a good knowledge of the residents. Attention is given to ensuring that the health safety and welfare of residents is promoted and maintained. Evidence: The manager is experienced and suitably qualifies to manage the home. Responses in surveys were positive regarding the management of the home. Staff said that they felt supported and included in delivering support to the residents. The quality assurance system in place seeks the views of residents but should be expanded further and include staff, relatives and other stakeholders eg Care Managers. Health and safety documentation was in place The proprietor was aware that the five yearly electrical testing and the portable appliance test was due.Other records seen included fridge and freezer checks and fire drills/fire alarm testing. All were found to Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: be in order with appropriate records being maintained. The proprietor is a regular visitor to the home and is very aware of the residents needs and will take them out or get involved in certain activities with them. Monthly regulation 26 visit reports were in place and the manager notifies the Commission of significant events under Regulation 37 of the Care Standards Act. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 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 27 13 Liquid soap and paper towels must be provided in both bathrooms. To provide good hygeine. 28/08/2009 2 34 19 The Registered Persons must ensure that all checks have been received before employees start to work in the home. To ensure residents safety 23/07/2009 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 Care Homes for Adults (18-65 years) Page 26 of 27 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. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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