Care Home: Norbury Crescent (20)

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What the care home does well People receive care to an excellent standard. Individual needs are catered for and every effort is made to ensure that a people`s dignity and independence is maintained. Each person has a very individualised care plan. To enable staff to understand one individual a handbook of signs they uses. The handbook shows a photograph of the individual using the sign, alongside the Makaton sign and a description of it meaning. To promote equality and the person`s right to make independent decisions advocates are used. Advocates (from a recognised body outside of the organisation) help individuals to make informed decisions about their lives, this makes sure the person`s needs are clearly heard. What has improved since the last inspection? Three requirements were made on the last inspection. All have been complied with. Staff have received the required training, notices concerning the Providers monthly assessment of the service have been received and the gas certificate was seen. Seven recommendations were made and have progressed. CARE HOME ADULTS 18-65 Norbury Crescent (20) 20 Norbury Crescent Norbury London SW16 4LA Lead Inspector Jean Stuart Key Unannounced Inspection 30th January 2008 3:00 Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norbury Crescent (20) Address 20 Norbury Crescent Norbury London SW16 4LA 020 8679 6168 F/P 020 8679 6168 sohailedwin@blueyonder.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Michael McDonagh Mrs Denise McDonagh Sohail Edwin Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2006 Brief Description of the Service: 20 Norbury Crescent is a large house set in a quiet road near local shops and amenities. The home is close to buses and a train station. The home has three floors has four single rooms a large living room, kitchen diner. There is a separate laundry room. Staff sleeping-in facilities are located on the top floor of the building. There is a large garden at the back of the house. Fees charged for the service range from £1000 to £2700 a week. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means people who use this service experience excellent quality outcomes. This inspection was unannounced and completed over one day. The site visit lasted five hours. Four people, three members of staff, and the manager were spoken with. The views of various professionals from various care services were sought. Records relating to care plans, staff recruitment and medication were seen. A tour of the premises was undertaken. Information from the home’s Annual Quality Assurance Assessment has also been included in this report. 20 Norbury Crescent provides a small family setting that is very person centred. It is a house on an ordinary street within the local community. One person refers to staff “as family”. The house is comfortable, homely and clean. A care manager reported that the service has given an individual “confidence, support, and shown them how to be independent”. A relative said the care is “very satisfactory” During this visit four people were spoken with, three members of staff and the manager. Returned survey forms included four from people living in the home, one from staff, four from relatives, and three from care professionals. All survey forms agreed that the home “always” meets people’s needs. All people appeared to be calm and very settled and did not display any anxiety. The local community is used a great deal by people who go to the bowling alley, cinema and shopping for their own items with staff help. One person reported they “ help with the food shopping for the household”. Freedom (bus) passes are used to get around and sometimes a taxi. People are encouraged to help in the house and look after their own bedroom. An individual said that “they with the housework, and Hoover and put their own washing in the machine”. Local day centres are used for day time activities. Assessments and care plans are comprehensive and record good quality information about the support needed by each person and how this should be given. Risk assessments are up to date and protect the person from harm. The complaint procedure is in a pictorial format and is accessible to people. Advocates are being used for two people who are being asked to make decisions about their futures. Staff receive training and provide good support to individuals. Professional indicated on survey forms that staff have appropriate knowledge and skills for the job. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 6 The manager is competent and ensures people are kept safe. What the service does well: What has improved since the last inspection? What they could do better: All National Minimum standards have been achieved. Three areas could be further developed. To help people understand how care is to be provided alternative ways such as a pictorial plan of care or a verbal record of what happens could help. The work to the shower room to be completed, and a good standard of maintained should be achieved when ever possible. Please contact the provider for advice of actions taken in response to this Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1.2. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are provided with good information to help them make a decision about where they would like to live. Significant time and effort is spent making admissions personal and well managed. People are fully assessed to make sure that their needs can be met. EVIDENCE: A person spoke about visiting several homes when deciding where to live. They visited 20 Norbury Cresent and found “it was the place they wanted to live”. Another person said that living here was “their choice”. Four people live at the home and two assessments were seen. Assessments are to an excellent standard, and are always completed with the individual, their representatives, and any other professionals involved with their care. As stated in the AQAA (Annual Quality Assurance Assessment) each person is “a special and valued individual”. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Care plans in place have good information on peoples needs. Norbury 20 works creatively with people to ensure life needs are met and goals addressed. Individuality is recognised and people make their own daily living decisions with support as required. Risk assessments are in place to make sure individuals are independent and remain as safe as possible. EVIDENCE: A person said staff is here to support and “help me with decisions”. Goals for each individual are clearly set out with time scales for achieving them. People are encouraged to live as independently as possible. To help people understand how they are to be cared for alternative formats should help people Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 11 understand how they are to be cared for . Two possible options could be a pictorial plan of care or a verbal record of what happens to help people Changing needs are recognised and the home promotes the well being of each individual to make sure their life is as fulfilling as possible. Individuals are encouraged to make decisions about their own lives. All staff are expected to have knowledge of Makaton sign language and of the individuals own signs for words. An example of how a person says thank you was seen, this was also reported in the paperwork. Another person will write down what they want to say. Staff ensure equality by making great efforts to understand what is being communicated to them. Person centred planning is used for each individual. This is a comprehensive record of an individual’s personal care, social, recreational and emotional needs. If possible the person will sign their own care plan promoting their own contribution to decision making. Care plans are revised every six months, the monthly report by the key worker contributes to the review. Staff and the AQAA supported the homes ongoing practices. People and significant others know of the persons assessed and changing needs, promoting quality care. People are in control of their lives and direct their service. Risk assessments show the action required to minimise any risk. Risk assessments promote a person’s independence and ensure the individual is safe. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Central to the home’s aims and objectives is the promotion of the individuals right to live an ordinary and meaningful life. People enjoy a good range of activities, both at home and in the community, meeting with friends and family, visiting bowling alleys and restaurants, these are activities of their own choosing. Meal times are arranged around individual needs and viewed very positively and are seen as an enjoyable time EVIDENCE: People reported that they decide on what they want to an individual spoke about a recent trip to the cinema using their freedom (bus) pass. They arrived at the cinema late and decided, “to go to the pub for a coke or an orange juice”. People make active use of the local community. People have also been Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 13 on holiday to Turkey and to America, the photos of these holidays are displayed around the house. The service understands the importance of enabling people to achieve their goals, follow their goals and be intergrated into the community. When at home people move between their room and the lounge or kitchen. As stated by the manager all individuals take some responsibility for their own room. One person was seen tidying their room. An individual reported that they are happy “to help with the hovering and setting the table”. They reported that they “help staff but do not cook”. On all survey forms it was agreed by people that they can do what they want to do. People are free to spend time as they wish. One person was sorting out magazines to “take to the charity shop”, they reported that they go to “a local shopping centre regularly”, and they “use the library”. Another person came and joined us in the office for a part of the inspection. Showing clearly that people have access throughout the house. From talking with people and observing reactions to staff it could be seen that people are aware of the routines of the home and of what was happening that evening. The group was calm and comfortable. The menu is available in the kitchen and lists the special diets that some people require. Staff spoke of different people’s dietary needs. Advice from the dietician has been sought. People are given the opportunity to live a meaningful life. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People receive effective personal and health care support based on individual needs and preferences. Knowledgeable staff deliver good care recognising physical and emotional needs. The home’s medication policies and procedures protect people from harm. EVIDENCE: One person stated that have help with their “money and going shopping”. These activities were documented on the care plan. For another individual there is a daily routine clearly stated and reflecting when the person likes to takes a bath, and the morning getting up routine. The AQAA points out that care is given in such a way to promote independence, and dignity. The care given on the day reflected this. We saw that a log is maintained of peoples’ medical appointments. People’s health care needs are documented in their care plan. Psychiatric help is Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 15 arranged when required. Recent communication with the home showed that the manager is very aware of the need to monitor people’s health and that the local G.P.is used as required. Staff are trained in health care matters, The files reflect medication training and staff confirmed this. One professional reported “medication is well managed”. Training ensures medication is given safely and that the well being of service users is protected. People receive effective personal and health care support, which recognises the individuals’ dignity. . Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Individuals know how to make a complaint. The complaint procedure is pictorial and made available to everyone. There is a clear complaints procedure with timescales for actions. People feel safe and secure. EVIDENCE: Individuals are able to state their ongoing daily concerns to staff. As seen during this visit all staff know the importance of taking peoples view seriously and responding to the issues raised. When necessary the home will ensure an advocate and a solicitor is available for people, ensuring that equality is promoted in how this matter is taken forward. On survey forms people reported how they would show staff if they were not happy, one person said they would speak with their key worker. To minimise the risk to people, staff records indicate they have received training in abuse, this was confirmed when speaking with staff. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 17 People who use the service are supplied with a complaint procedure they can use. The complaint procedure is available to everyone and an additional copy is also available next to the front door. People feel safe and well supported. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30. People who use the service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home provides accommodation that meets the needs of people staying there. Maintaining a pleasant environment is a high priority, and is a continous challenge due to the nature of the client group. However it is homely and clean, safe and comfortable. EVIDENCE: All bedrooms are single rooms and reflect the individuality of the individual. For one person the room reflected their enjoyment of programmes about superheroes, also a collection of magazines, and books from the local library. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 19 There is a selection of communal areas. There is a lounge, a large kitchen, a conservatory and the ground floor office, which can be used by people and staff. The kitchen is large enough to accommodate anyone who might want to help with tasks. A person spoke of how they invite a friend to the bedroom and they “watch videos together”. There is adequate space for the people living their and any family/friends who might chose to visit. We saw that improvement to bathroom facilities mentioned in the AQAA were progressing or complete. There is a new bathroom down stairs installed December 2007. One person has an ensuite bathroom. The work to the first floor shower room is ongoing and should be completed. Bathrooms are clean, presentable and where required meet specialist care needs. As explained by the manager, some members of the household present behaviour which means the environment is difficult to maintain. Items attached to walls are now loose, picture frames are broken and photographs as a temporary measure are on card and balanced on a table top. The door frame to the lounge is damaged. The manager was able to show a maintenance log indicating the regular work is carried out to the environment. The money spent on the environment is in the best possible way so that outcomes are improved as much as possible for people. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35. People who use the service receive excellent quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Competent and experienced staff team ensure that people who use the service are well supported. The roles and responsibilities of staff are clearly defined and understood. All recruitment checks are complete before a person starts work. Staff is appropriately trained to support people. The service ensures that staff are available at all times to support the needs, activities and goals of individuals. EVIDENCE: An individual spoke highly of staff, and the work they do. People know the team well and are able to communicate with them freely, they use the spoken word, or Makaton sign language and signs individual to the person. Care is highly individualised. Staff have the skills to communicate effectively with people and provide care which focuses on individual needs. The service plans for the needs of people who use the service. There is a diverse staff team that has a balance of skills, knowledge, and experience to Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 21 meet peoples needs. Staff records show that National Vocational Qualifications (N.V.Q.), are completed, as are courses on the protection of vulnerable adults, Makaton sign language, moving and handling and other courses. This was confirmed when speaking with staff. There is a proactive approach to recruitment and equality and diversity is recognised in the recruitment process. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The registered manager is highly competent to run the home, he is very aware of the aims and objectives to be achieved. People, their representatives and stakeholders contribute to an annual development plan. This plan considers how the service can be developed in the best interest of the people living there. EVIDENCE: The manager has passed to staff best practice in how care is to be given. Equality and diversity issues are given priority and all individuals are Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 23 encouraged to achieve their goals with staff support if required. The service has an understanding of equal opportunity issues for people and staff. Records required for the protection of people are up to date. People and staff have regular meetings. Records of meetings were seen. The home proactively monitors its health and safety performance and consults specialist agencies as required. The AQAA shows regular servicing of the provision of gas, and electricity, we saw evidence of this on the day. As stated in the AQAA “the service users needs will continue to be our priority” we saw evidence of how this is fulfilled during this visit. Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 4 2 4 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 4 28 x 29 x 30 4 STAFFING Standard No Score 31 x 32 4 33 x 34 4 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 4 4 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 4 x 4 x 4 x x 4 x Norbury Crescent (20) DS0000025876.V356659.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA24 Good Practice Recommendations The home should develop an individual care plan in a format the person can understand. The home should ensure that a good level of maintenance is provided. 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