Care Home: Selhurst Road 166A

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What the care home does well Generally, prospective residents are being provided with the information they require, and the opportunity to visit, to enable an informed choice as to whether the home is likely to be suitable in meeting their needs. However, both the Statement of Purpose and the Service User`s Guide need to be reviewed and updated. Residents admitted to the home have been fully assessed and know that their individual needs will be met. Residents are being encouraged and supported to participate fully in the dayto-day life and routines of the home, and to develop an independent and community orientated lifestyle.Residents are being consulted regarding decisions that affect them, and are having their rights and responsibilities recognised in their daily lives. Residents are being assessed regarding potential risks to their health and safety, and enabled to take responsible risks wherever possible. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents` rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements. The health and personal care needs of residents are being met, and their privacy respected. The home has an appropriate complaints policy and procedures in place, which is in a format suitable for the home`s residents. Residents live in a safe, hygienic and well-maintained environment with access to pleasant and appropriate communal facilities. Residents` rooms are safe, comfortable and pleasantly decorated, being well suited to their individual needs. Residents have sufficient aids and adaptations with which to maximise their independence. The home presents as being clean, pleasant and hygienic. Residents are having their needs well met by an effective, appropriately trained and qualified staff group. Residents are being safeguarded by the home`s recruitment policy and procedures. However, one staff member requires an up-to-date CRB check. Residents are living in a home that is generally being well managed and being run in their best interests. Generally, the home is demonstrating, through the development of its quality assurance processes, that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, a Development Plan needs to be put in place.Selhurst Road 166ADS0000028564.V365817.R01.S.docVersion 5.2Page 8Residents` rights and best interests are being safeguarded by the home`s record keeping. However, policies and procedures need to be more regularly reviewed and kept up-to-date. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, the home`s risk assessments need to be reviewed and updated. What has improved since the last inspection? To enable each resident to have an understanding of the terms and conditions of their placement, a new service user agreement, appropriate to the communication needs of residents living at the home, has been put in place. The home has developed person-centred care plans. These reflect the views and preferences of the residents as to how their daily needs and aspirations are to be met. Residents are benefiting from staff who are well supported. Supervision is now taking place on a regular, two-monthly basis. CARE HOME ADULTS 18-65 Selhurst Road 166A 166a Selhurst Road South Norwood London SE25 6LS Lead Inspector Peter Stanley Unannounced Inspection 19th June 2008 09:30 Selhurst Road 166A DS0000028564.V365817.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 Selhurst Road 166A DS0000028564.V365817.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. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Selhurst Road 166A Address 166a Selhurst Road South Norwood London SE25 6LS 020 8653 8891 T/F 020 8653 8891 NO EMAIL www.choicesupport.org.uk Choice Support 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) Miss Paulette Angela Parchment Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 2 28th June 2007 Date of last inspection Brief Description of the Service: Selhurst Road is situated off the main thoroughfare, in a residential area of South Norwood. The property consists of a large, wheelchair accessible bungalow, which provides a single bedroom for each of the residents. It is well placed for access to local facilities such as shops, the post office, cafes, pubs and the library, and within reasonably easy access to the centre of Croydon. The home is a few minutes walk from a bus route and close to a mainline rail station. Selhurst Road is registered to provide a home for two adults, in the younger adult age group, with a learning disability (although a variation has been granted with regard to the age of one resident who is over the age of 65). Selhurst Road 166A DS0000028564.V365817.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 2 stars. This means the people who use this service experience good quality outcomes. 166a Selhurst Road is a small purpose-built home, run by Choice Support, the providing organisation. The home is registered for two adults with learning disabilities. There is one long-term resident over the age of 65 for whom a variation has been granted. Both adults have their own bedroom and there are spacious communal facilities. This is a very small care home and provides a homely environment with one-to-one key worker support. This key inspection was conducted over one day and involved consultation with Pauline Parchment, who has been managing the home since 1.3.05, and who has been registered as manager with the CSCI. The inspector examined staff and service user records and other documentation relating to the management and running of the home. These included residents’ health action plans, care plans, review notes and risk assessments. Staff records examined included staff rotas, supervision, appraisal and training records. The inspector met both residents, and was able to engage verbally with one resident, and non-verbally with the other resident. Both residents were supported by Choice Support to complete CSCI questionnaires. A close relative of one resident also completed a questionnaire. The feedback received was very positive, with both residents indicating that they feel settled and well supported living in the home. We completed an inspection of the premises and looked at documentation relating to the day-to-day running and management of the home. This included policies and procedures and records relating to the logging of accidents, incidents and complaints (none having been recorded). Documentation relating to health and safety was also examined; this included the home’s risk assessments, servicing and maintenance certification. The inspector also referred to the pre-inspection Annual Quality Assurance Audit (AQAA), which has been completed by the home’s service manager, Jonathan Macy. In line with an agreement made between the Chief Executive of Choice Support and the CSCI Provider Relationship Manager, all staff recruitment records are now located within the Human Resources section of Choice Support’s regional office at Westminster Bridge Road in London, The inspector visited this office on 27/06/08 and inspected the relevant staff records. Whilst records were generally satisfactory, an up-to-date CRB check is required for one staff member. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 6 The report includes reference to a random inspection, which had previously been completed on 13 December 2007. This included one new requirement, for the Policy on Capacity to Consent to be reviewed and updated in the light of the statutory provisions included within the recent 2007 Mental Capacity Act. This has been implemented. The home has achieved excellence in 3 of the 8 sets of standards, and is evidenced to be providing a generally good level of service for the two residents. The home is developing a person-centred approach to care, and there is close monitoring of residents’ health, welfare and support needs. There is also good development of individuals’ lifestyles and interests, with respect for individual preferences and choices. The home provides a very pleasant and homely environment in which to live and the manager and staff present as caring and enabling in their approach. There is evidence from feedback at reviews that residents’ rights are being respected, and that the home is providing an enabling and inclusive home environment. Of 7 requirements from the last key inspection, 5 have been met and 2 partly met. A Development Plan for 2008 needs to be put in place, and key policies relating to whistle blowing and the management of aggression need to be reviewed and updated. From this inspection there are 8 requirements and 2 recommendations. We would like to extend his thanks to the registered manager, Pauline Parchment, for her assistance in helping to facilitate this inspection. What the service does well: Generally, prospective residents are being provided with the information they require, and the opportunity to visit, to enable an informed choice as to whether the home is likely to be suitable in meeting their needs. However, both the Statement of Purpose and the Service User’s Guide need to be reviewed and updated. Residents admitted to the home have been fully assessed and know that their individual needs will be met. Residents are being encouraged and supported to participate fully in the dayto-day life and routines of the home, and to develop an independent and community orientated lifestyle. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 7 Residents are being consulted regarding decisions that affect them, and are having their rights and responsibilities recognised in their daily lives. Residents are being assessed regarding potential risks to their health and safety, and enabled to take responsible risks wherever possible. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements. The health and personal care needs of residents are being met, and their privacy respected. The home has an appropriate complaints policy and procedures in place, which is in a format suitable for the home’s residents. Residents live in a safe, hygienic and well-maintained environment with access to pleasant and appropriate communal facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, being well suited to their individual needs. Residents have sufficient aids and adaptations with which to maximise their independence. The home presents as being clean, pleasant and hygienic. Residents are having their needs well met by an effective, appropriately trained and qualified staff group. Residents are being safeguarded by the home’s recruitment policy and procedures. However, one staff member requires an up-to-date CRB check. Residents are living in a home that is generally being well managed and being run in their best interests. Generally, the home is demonstrating, through the development of its quality assurance processes, that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, a Development Plan needs to be put in place. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 8 Residents’ rights and best interests are being safeguarded by the home’s record keeping. However, policies and procedures need to be more regularly reviewed and kept up-to-date. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, the home’s risk assessments need to be reviewed and updated. What has improved since the last inspection? What they could do better: Both the Statement of Purpose and the Service User’s Guide need to be reviewed and updated. Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. The home does, however, require an up-to-date medication inspection and audit. Generally, residents are being protected by the home’s adult protection policies and procedures, which are in line with local safeguarding procedures. However, policies and procedures for ‘whistle blowing, and for the management of ‘physically aggressive behaviour’, need to be reviewed and updated. A Development Plan needs to be put in place. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 9 Please contact the provider for advice of actions taken in response to this 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. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 10 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 Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 11 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 to 5 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Generally, prospective residents are being provided with the information they require, and the opportunity to visit, to enable an informed choice as to whether the home is likely to be suitable in meeting their needs. However, both the Statement of Purpose and the Service User’s Guide need to be reviewed and updated. Residents admitted to the home have been fully assessed and know that their individual needs will be met. To enable each resident to have an understanding of the terms and conditions of their placement, a new service user agreement, appropriate to the communication needs of residents living at the home, has been put in place. EVIDENCE: Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 12 The home has compiled a detailed Statement of Purpose outlining the aims and objectives of the home, and the facilities and services it provides. This includes all the information required under regulations. The home has developed a Service User Guide that is written in a format/language suitable for the two residents. There are plans to create a service user guide on DVD. To assist in overcoming the communication difficulties that are presented by residents, and potential residents, these documents have been produced in a more accessible format, using pictures and symbols. Time is spent individually with each resident to ensure that there is understanding of the contents. Both the Statement of Purpose (last reviewed in January 2007) and the Service User Guide (last reviewed in June 2007) do, however, need to be reviewed and updated. A requirement applies. There are just two residents living in this small home, no new admissions having taken place within the last 12 months. The home’s admission procedure is for a full assessment of an individual’s personal, social and health needs to be carried out prior to any admission, this being undertaken by the registered manager with additional reports being provided from other professionals. Should the admission proceed, there is a two to three month trial period, prior to an initial review meeting, to decide whether the placement is meeting the person’s needs and is to become permanent. The home has developed thorough assessment processes. The assessment format assesses each aspect of daily need and physical/mental functioning, and includes risk assessments. The manager understands that an up-to-date care management assessment and care plan must be obtained for any referral from health or social services. Prospective residents are able to visit the home, to meet residents and staff, and to experience the feel of the home before a decision on admission is reached. We are satisfied that the home is able meet residents’ needs and aspirations. There is evidence of a high level of commitment by staff in responding to residents’ needs and in helping to facilitate their participation in daily activities. Staff are appropriately qualified, with NVQ qualifications, and are offered a wide range of training opportunities with which to develop their existing knowledge and skills and to competently carry out their duties. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 13 We met with a staff member on duty who has been working in the home for about 9 months. The staff member, who has an NVQ Level 2, has had previous relevant experience in another Choice Support home, and presented as being competent and caring, with a good understanding of the needs of this client group. We spoke with one long-term resident, an older person. She presented as settled and content in her environment, and indicated that she continued to feel happy living in the home. From the CSCI survey feedback, the resident indicated that she likes the staff and feels able to maker choices and decisions regarding her day-to-day routines and activities. Whilst unable to verbally communicate with the other resident (a young adult with severe communication difficulties), the inspector observed that she presented as being settled and well supported in her environment. Feedback from the manager, and in notes of reviews, indicates that the placement has been successful in meeting her needs, and that she is being well supported in her environment. This was supported by the views of a close relative (included in a questionnaire), who expressed a high level of satisfaction with the support and care that is being provided. Following a requirement from the last inspection, a new service user agreement that is appropriate to the communication needs of the two residents at the home, has now been put in place. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 14 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 to 10 People using this service experience excellent quality outcomes in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home has developed person-centred care plans. These reflect the views and preferences of the residents as to how their daily needs and aspirations are to be met. Residents are being encouraged and supported to participate fully in the dayto-day life and routines of the home, and to develop an independent and community orientated lifestyle. Residents are being consulted regarding decisions that affect them, and are having their rights and responsibilities recognised in their daily lives. Residents are being assessed regarding potential risks to their health and safety, and enabled to take responsible risks wherever possible. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 15 EVIDENCE: There has been person-centred planning training for staff within Choice Support. Through the introduction of person centred support, the residents are being provided with more opportunity to express their wishes and preferences and to be more involved in the day to day running of their home Objects of reference are in place for one resident to encourage her to make meaningful choices. Person-centred support plans, which reflect the individual’s preferences, choices and wishes, have been developed for both residents. These include a photograph of the resident on the front cover. We examined the new plans, which are being formally reviewed on a sixmonthly basis or as required to reflect any changing needs. The plans specify how each individual wishes to have their support delivered, and sets out individual requirements in areas relating to their personal care, health and daily living. The plans use pictures and symbols, to assist the understanding of the residents. They detail both those aspects of care and daily living tasks where assistance is required, and those tasks where the resident feels able to manage or can be enabled to do so independently. The Service User Guide makes it clear that residents are assisted to make choices in their day-to-day routines and activities and are consulted regarding decisions that affect them. Residents are being consulted on a one-to-one basis through regular contact with staff, and comments and views are noted in residents’ daily diaries. Staff members have been observed to work with residents in an enabling and client-centred way. The manager has advised that each resident meets on a monthly basis with his or her key worker, and that information is noted in the person centred planning book. There is a process in place for assessing risk. We examined a number of risk assessments on residents’ files, which cover areas of risk such as mobility, eating/drinking, medication and risks associated with daily living and other activities. Appropriate strategies are in place for managing risk, with behavioural guidelines being in place. Professional consultation and advice from a psychologist is available should this be required. The risk assessments Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 16 were evidenced as being reviewed at six-monthly intervals together with the support plans. A statutory 12 monthly care management review is arranged with each resident, at which the suitability of the placement, in meeting the individual’s needs, is reviewed. This is attended by the individual’s key worker, care manager and nearest relative(s). The manager advised that one resident’s review is overdue, last being held in March 2007. This has been followed up with the funding authority (LB Southwark), and a date is to be set shortly for the review. The other resident last had their review on 26 July 2007. The providing organisation (Choice Support) has policies in place for ensuring confidentiality and data protection. Information about residents is held securely in lockable filing cabinets within a small secure office located off the lounge. Issues of confidentiality are reinforced through staff induction, training and supervision. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 17 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): 11 to 17 People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are being enabled to participate fully, and to exercise choice and control, in their daily routines and activities. Residents are being encouraged to maintain contact with their family and friends, and to maintain links with the local community. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Residents are being offered a healthy diet, in pleasant surroundings, and are able to exercise choice and flexibility with meal arrangements. EVIDENCE: Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 18 The philosophy of the home, as indicated in the home’s Statement of Purpose, is to promote independence and enable residents to develop a wide range of social and independent living skills. Both residents are encouraged by the staff team to participate in regular activities of daily living, such as planning menus, meal preparation, tidying their rooms, setting out and clearing the dining table, and shopping for food. Both residents are consulted and supported to create the menu for the coming week, reflecting their likes and choices. The staff rota is created around the individual, with shifts and patterns being flexible so as to promote individual choice and freedom of movement. Both residents have activity programmes that reflect their individual interests and wishes. Both residents have activity programmes that reflect their differing individual interests and wishes. A weekly activity chart has been developed for each resident, using pictures and symbols to assist understanding of the activities scheduled for each day. Support plans are developed to try and ensure that residents achieve their goals and objectives. Talking books has been recently introduced for one resident. The resident, a younger adult, attends a day centre in Peckham, two days a week, where she maintains contact with her friends and peer group. The centre provides a hydro pool and trampolining, with an exercise programme being in place. The inspector observed the resident listening to some rhythmic music on her music centre in her room, which she was clearly enjoying. The manager advised that she has developed a friendship with a resident of a similar age at the day centre, which the home has been endeavouring to assist and encourage, with visits being arranged to each other’s home. The other resident, an older person, goes to occasional concerts at the Fairfield Halls, attends her local church every Sunday, and goes to occasional Church functions and to a lunch club once a month. She also maintains her contact with a long-term friend, visiting her on occasion. Both residents also maintain contact with another resident with whom they lived with in another home for about six weeks in 2007, whilst redecoration and building work was taking place at 166 Selhurst Road. The home provides a pleasant place in which to spend time and relax. There is television, with a video and a DVD player, and there is a pleasant, small garden in which both residents can sit out in nice weather. Both residents are encouraged to go out into the community and access shops and community facilities. One resident, a wheelchair user, has been able to access restaurants that she had not been able to go to previously. Assistance Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 19 to visit pubs and cafes is provided. The home has a motability vehicle, which both residents share. This enables them to visit friends and visit shops, parks and other places in the community. The home has access to its own transport, which has disabled access, and which is used for occasional outings and day trips to places and seaside resorts of their choice. The home actively encourages residents to maintain their family links and friendships. Feedback from questionnaires indicates that relatives and friends are made very welcome when they visit the home. With the support of their key workers, both residents are encouraged and enabled to sustain contact, and to visit friends and relatives. Residents’ logs and the visitors book evidence that there are regular visitors to the home. Residents are able to see visitors in the privacy of their rooms if they wish. Each resident has a day set aside for visiting or receiving family/friends. There are no restrictions on visitors other than they arrange to visit at reasonable times. Both residents are on the electoral roll and are encouraged to exercise their right to vote. The evidence from review notes and service user files indicate that residents are being consulted regarding their rights and responsibilities in their daily lives. With the development of a person-centred approach, this philosophy has been extended to all aspects of the residents’ day-to-day activity and decision-making. Breakfast, lunch and an evening meal are provided. The dining area is pleasantly laid out and provides a relaxed and congenial setting for taking meals. Mealtimes are flexible and take account of individuals’ daily routines and social arrangements. There is regular consultation with residents regarding their choice of meals, with residents being consulted as to which foods they would like purchased. A dietician regularly visits the home to check the menu with full account being taken of dietary needs and individual preferences. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 20 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 to 20 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are being met, and their privacy respected. Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited medication training for all care staff. The home does, however, require an up-to-date medication inspection and audit. EVIDENCE: Both residents are receiving personal care and support according to their assessed needs. Person-centred care plans, which reflect the individual’s preferences, choices and wishes, have been developed for both residents. The plans specify how each individual wishes to have their personal support Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 21 delivered, and sets out individual requirements in areas relating to their personal care, health and daily living. One resident, a wheelchair user with severe communication difficulties, has a relatively high level of support. Due to her high support needs, her room has been adapted specifically to meet her needs and to give her control in a sensitive enviroment. Requiring total assistance with personal care, the home aims to ensure continuity of care from a regular key worker, with care being delivered in a way which is respectful, and which maintains her dignity. Feedback from reviews, and from a relative’s questionnaire, indicates that this quality of support is being sustained. Whilst unable to engage the resident in discussion, she presented as content and well cared for. Information recorded on her file, including her support plan and review notes, indicate that her personal and social care needs are being well monitored and met. We had some discussion with the other resident, an older adult, and was able to ascertain that she felt happy living in the home and that she was receiving good support from staff. From the feedback included in the questionnaire, she indicated that she enjoys good relationships with staff. Her support plan evidences that she has been fully involved in making choices about how her support is delivered. Residents are encouraged to choose which clothes to wear and to express their preferences regarding how their care is provided. In accordance with policy guidelines, staff aim to ensure that privacy and dignity are maintained when assisting with personal care needs. A wheelchair accessible shower and bath seat are provided. A stand-up hoist, to assist in maintaining personal care, is provided for one of the residents. Residents receive regular health reviews, an individual health plan being in place for each resident. The home has worked closely with the local GP practice, and has developed person-centred Health Action Plans (My Health). These are compiled in an accessible format, using pictures and symbols. The HAP details comprehensive information regarding each resident’s health history and health care needs, and involve each resident in the process of identifying these and how they are to be met. These are being reviewed and updated on a regular, six-monthly basis. Each resident receives regular health checks, with any health concerns being followed up through referral to the appropriate health professional. Health checks and treatment are arranged as required. One resident has had contact with a dietician, and has been referred to an audiologist for a hearing test. The other resident has contact with a diabetic nurse, and has been referred for treatment for a cataract. A speech and language therapist has been visiting Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 22 and trying out different techniques for improving communication skills. She has worked with both residents so as to develop object recognition abilities and the use of body language as a means of communication. Both residents are registered with a GP who is based at the local health centre. Other community based health care professionals have regular or occasional contact, and include specialist district nurses, dentists, opticians and chiropodists. Service Managers from Choice Support regularly visit the home to check that assessed needs are being met. Residents are being protected by the home’s medication policy and procedures. There are six monthly medication reviews, which are completed by the GP. Each resident has a medication chart, which is signed and dated for each review by the GP. All staff employed at the home are able to administer medication, neither resident being able to administer this themselves. All staff have undertaken accredited medication training. There is also internal training provided for staff by Choice Support. Staff receive 12 monthly medication training refreshers, and have their competence to administer medication tested annually. The supplying pharmacist no longer visits the home to do inspections and give 3-monthly advice and support. It is recommended that the home review its’ pharmacy arrangements so as to ensure a resumption of inspections and support. The home last received a medication audit from Southwark PCT on 5/2/07, and a pharmacy inspection on 7/2/07. An up-to-date inspection and audit is required. A requirement applies. Medication records are being appropriately maintained. Residents have a written statement detailing their medication needs, and the manager undertakes a medication audit on a weekly basis. There is a separate locked container for the storage of any controlled drugs. This is located in the office within the locked metal medication cupboard. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 23 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 to 23 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has an appropriate complaints policy and procedures in place, which is in a format suitable for the home’s residents. Generally, residents are being protected by the home’s adult protection policies and procedures, which are in line with local safeguarding procedures. However, policies and procedures for ‘whistle blowing, and for the management of ‘physically aggressive behaviour’, need to be reviewed and updated. EVIDENCE: The complaints procedures and information given to residents and their relatives is up to date, and comprehensive, providing details as to how, and to whom they should complain. Residents are assisted to understand the complaints procedure, with access to their care manager being arranged should grounds for making a complaint against the home arise. Independent advocacy, and/or support with communication, can be arranged if this is required. Choice Support has its own internal procedures for monitoring any complaints. These are monitored by the organisation’s quality assurance and protection committees, and during visits from a responsible person, usually a service manager. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 24 There have been no complaints recorded since the last inspection. There is information for residents (in both writing and pictures) regarding how to make a complaint, information that is included in the Service User Guide. Choice Support has developed a Safeguarding Adults policy that is in line with the Governments No secrets legislation and the Local Authority’s Safeguarding Adults policy. All staff are issued with a staff handbook. This includes a summary of these policies, and a code of conduct for staff. Choice Support has a whistle blowing policy, called ‘Challenging bad practices at work’. This outlines the procedures for staff to follow should they have any concerns about bad practices or abuse. According to the home’s records, the policy has not been reviewed since May 2004, and needs to be reviewed and updated. A requirement applies. The home’s has policy and procedures in place for ‘Coping with Physically Aggressive behaviour’. These, however, also need to be reviewed and updated, the last review having been recorded as taking place in February 2004. All staff have attended statutory safeguarding training (POVA), and there is refresher training for managers on a yearly basis. The safeguarding of adults is a fixed agenda item within all team meetings and supervision sessions. According to the home’s AQAA, the organisation has adopted the Reach standards and has delivered relevant training to the home’s manager. Choice Support is currently working with Respond to ascertain whether service users feel safer and better informed about policies and procedures following training delivered by Voice UK. The home has procedures in place for ensuring that residents’ finances are safeguarded. There are weekly finance checks, and finances are monitored monthly on registered person visits. The service manager for Choice Support also audits finances every three months. Properties lists and securities books are maintained for both residents. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 25 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 to 30 People using this service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, hygienic and well-maintained environment with access to pleasant and appropriate communal facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, being well suited to their individual needs. Residents have sufficient aids and adaptations with which to maximise their independence. The home presents as being clean, pleasant and hygienic. EVIDENCE: Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 26 The home is set back off the main road, behind larger buildings. Access is via a narrow alleyway, which is just accessible by car. The home presents as clean, bright and comfortable, with good access to local amenities. The fabric and décor of the premises appears to be in good condition. The home is spacious, with adequate communal space for both residents. It is wheelchair accessible, one of the residents being a wheelchair user. There is a large, through lounge, with a dining area at one end, which provides a pleasant area in which to sit and relax. The home is comfortably furnished throughout, and has a very homely feel. There is a spacious hallway, which can easily accommodate a wheelchair. The communal lounge opens onto a small garden and patio, with patio furniture. This provides a pleasant place to spend time and receive visitors. A sensory garden has been developed, with trellises and sensory plants like honeysuckle. The two bedrooms are individually furnished and are decorated to reflect the wishes of the two residents. Each bedroom is individually furnished so as to reflect the wishes of the individual. Both residents are consulted regarding any changes and improvements that may take place. The home underwent a major programme of redecoration and refurbishment in 2006-07. Both residents’ rooms were redecorated, and the lounge, hall and one bedroom were re-carpeted. One bedroom has been converted so as to have its own self-contained bathroom and toilet. There is also a separate bathroom and toilet. The kitchen has been renovated with accessible fitted units, and redecorated, together with the sleepover room for the overnight care worker. The boiler has been re-housed in a separate closet within the reception area. The manager advised that there had been a problem with damp getting into the lounge, which has been rectified with a repair to the roof. While the lounge presented as pleasantly decorated, there has been some seepage and discolouration, and the lounge is, as a result, scheduled to be redecorated. The home has installed an emergency lighting system so as to safeguard residents in the event of power cuts. The home is well maintained and is kept to a good standard. The home was last assessed by an occupational therapist in 2006, and has sufficient aids and adaptations in place. This includes raised toilet seats and grab rails for use of the shower and toilet, a shower chair and a bath hoist. The home also has a motability vehicle which both residents share, and which enables them to access the local community. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 27 The home presents as being clean, pleasant and hygienic. There is a Health and Safety policy in place and a policy on infection control. The washing machine is situated in a large cupboard in the hallway, while the dryer is in the kitchen. There is a locked COSHH cupboard. Relevant training in food hygiene and infection control is provided for staff. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 28 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): 31 to 36 People using this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are having their needs well met by an effective, appropriately trained and qualified staff group. Generally, residents are being safeguarded by the home’s recruitment policy and procedures. However, one staff member requires an up-to-date CRB check. Residents are benefiting from staff who are well supported. Supervision is now taking place on a regular, two-monthly basis. EVIDENCE: The home has a close-knit staff team who are trained in the specific needs of the home’s two residents. There is clarity of staff roles and responsibilities, with job descriptions outlining the respective duties and responsibilities of Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 29 staff. There are six-weekly staff team meetings when issues relating to staff roles and responsibilities are discussed. The home has a structured induction as part of the probationary period of employment, which is signed and dated on completion. The inspector spoke with a staff member on duty who, following her transfer from another home, has successfully completed her induction and undertaken relevant training. She was able to demonstrate a good understanding of her role and responsibilities. The home has an ongoing training and development programme, with each staff member having their own training and development plan. The manager maintains a record of training undertaken by all staff. The training programme includes training in Adult Protection, Medication, Manual Handling, Health & Safety, First Aid, Food Hygiene and Fire Safety. Staff also receive training in communication skills, and are scheduled to undertake some further training in this area. A speech and language therapist has been visiting and trying out different techniques for improving communication skills. She has worked with both residents so as to develop object recognition abilities and the use of body language as a means of communication. Staff are encouraged to obtain relevant National Vocational Qualifications. 3 staff have achieved an NVQ Level 2, and 2 staff have an NVQ Level 3. Another staff member is working towards an NVQ Level 2. The manager is qualified to NVQ Level 3 and is currently undertaking studies leading to the award of the NVQ Level 4 and RMA (Registered Manager’s Award). We examined staff files and examined supervision and appraisal records. These indicated that staff supervision is now being completed on a regular two monthly basis, an improvement which needs to be sustained. Supervision is recorded in a structured format, which details practice issues, training needs, and goals. Appraisals have been completed with staff on 6/5/08. These evidence that staff’s training and development needs are being addressed. The home has appropriate recruitment policy and practices in place, which, in general, are providing the required level of protection for residents. One new staff member has been appointed since the last inspection. Recruitment records were not available at the home at the time of inspection. In line with an agreement made between the Chief Executive of Choice Support and the CSCI Provider Relationship Manager, all staff recruitment records are located within the Human Resources section of Choice Support’s regional office at Westminster Bridge Road in London. The inspector visited the regional office on 27/6/07 and inspected the relevant staff records for a new staff member transferred from another Choice Support home. Generally, the records were found to be in order, the necessary preSelhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 30 employment checks having been satisfactorily completed. However, an incomplete CRB certificate (bottom half removed), dated 30/1/04, was the only indication of a CRB check. Given that it was not possible to evidence any details on the certificate, and the length of time since the last CRB check (more than 3 years), an up-to-date CRB check needs to be completed. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 31 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 to 43 People using this service experience good quality outcomes in this area This judgement has been made using available evidence including a visit to this service. Residents are living in a home that is generally being well managed and being run in their best interests. Generally, the home is demonstrating, through the development of its quality assurance processes, that it is obtaining widespread feedback regarding the extent to which the home is supporting residents and meeting its aims and objectives. However, a Development Plan needs to be put in place. Residents’ rights and best interests are being safeguarded by the home’s record keeping. However, policies and procedures need to be more regularly reviewed and kept up-to-date. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, the home’s risk assessments need to be reviewed and updated. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 32 EVIDENCE: The registered manager, Paulette Parchment, has been managing the home since 1 March 2005, and has 18 years experience of working with people who have learning difficulties. She has had relevant experience within another Choice Support home prior to transferring to 166a Selhurst Road. The manager holds an NVQ Level 3 and is presently undertaking studies for the NVQ Level 4 and Registered Managers Award. The atmosphere in this small home is a positive and happy one. The inspector met with one resident, an older adult, who presented as settled and happy with the home. The other resident, a younger adult, was unable to communicate with the inspector, but presented as being settled and well supported. Feedback from reviews indicates that both residents are having their needs well met, and that care managers, professionals, residents and their relatives are very satisfied with the support that is being provided. Views expressed by staff members, on this and previous inspections, indicate that the home is being competently managed and that staff feel that they are being appropriately supported. No concerns have been expressed. Service managers from the managing organisation carry out unannounced quality checks on a monthly basis. These visits include discussion with residents and their relatives where possible. The manager carries out weekly checks, which includes seeking residents’ views. Periodically, the manager is expected to write a quality monitoring report. The organisation (Choice Support) has been developing its quality assurance processes. A policy and procedure has been put in place, and a questionnaire has been completed with the two residents at 166a Selhurst Road by a manager from another service within Choice Support. Surveys are also completed with relatives and other parties. The quality assurance evaluation is based on the 11 REACH standards, an independent auditor monitoring and evaluating the otcomes. The home does, however, need to evidence a Development Plan. This is an unmet requirement from the previous inspection. This is detailed in Standard 39.2 and should evidence whether the home is meeting its aims and objectives. The Plan should summarise the findings from surveys and other feedback, and should reflect aims and outcomes for service users. The home has developed a policies and procedures checklist. This indicates that the majority of policies and procedures have not been reviewed within the Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 33 last three years. As detailed in Standard 40.3 staff must be given access to upto-date copies of policies and procedures. The inspector has made it a recommendation for all policies and procedures, whose last review date predates 2006, to be reviewed as a priority. There is a weekly audit of all health and safety checks by the manager, which is documented. The home has completed all the necessary up-to-date maintenance and safety checks, covering electrical installation (11/06), portable electrical appliances (2/08), gas (3/08),), with weekly checks being completed (and logged) for the smoke alarm, water temperature, fire safety and COSHH (Control of Substances Hazardous to Health). A bath hoist, which has been installed, was last serviced on 2/08/07. Fire safety equipment and emergency alarms were last inspected in June 2008, with fire drills being undertaken on a three monthly basis. Health and safety, Fire Risk and COSSH risk assessments were last undertaken on 12/3/07 (Fire Risk), 28/3/08 (H&S) and 20/4/07 (COSSH). These are all out-of-date and must be reviewed and updated as a priority. A requirement applies. Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 34 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 2 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 4 26 4 27 4 28 4 29 4 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 3 3 LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 3 3 4 2 3 3 3 X Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 35 Are there any outstanding requirements from the last inspection? Yes 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. 1 Standard YA1 Regulation 6(a)&(b) Requirement Information. To ensure that information regarding the home is up-todate, both the Statement of Purpose and the Service User Guide must be annually reviewed and updated. 2 YA20 13(2), 13(4)c Medication. To ensure the safety of residents, the home requires an up to date medication inspection and audit. An audit was last completed by the PCT on 5/2/07, and a pharmacist inspection on 7/2/07. See also recommendation (No 1). 3 YA23 12(1)(a), 13(6) Protection of service users. So as to ensure the safety of both service users and staff, the following policies and procedures must be reviewed Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 36 Timescale for action 31/07/08 31/12/08 31/12/08 and updated: Coping with physically aggressive behaviour (last reviewed Feb 2004) Challenging bad practices at work (Whistle blowing) (last reviewed May 2004) 4 YA30 13(4)(a)&(c) Health and safety So as to ensure the health and safety of service users, the policy and procedures for Food Hygiene must be reviewed and updated (last reviewed Feb 2004). 5 YA34 19(1)a & b Schedule 2, No 7 CRB check To ensure the safety of service users, an up-to-date CRB check for a new staff member (NT) must be completed. The inspector must be notified once this has been done. 6 YA37 9(2)(b)(i) Management qualifications. The manager must register and undertake study leading to an NVQ4 qualification in management and care. Partly met and within existing time-scale. Time-scale extended to allow for completion of studies. 01/10/08 31/07/08 31/12/08 7 YA39 24(2) Quality assurance. An annual development plan 31/12/08 Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 37 for 2008 must be put in place. This should be made available to service users, their representatives and other interested parties including the CSCI. 8 YA42 13(4) Health and safety To ensure the safety of service users, the home’s risk assessments (Health and safety, Fire Safety and COSSH) must be reviewed and updated. 31/07/08 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 Refer to Standard YA20 Good Practice Recommendations Medication. The inspector recommends that the home review its’ pharmacy arrangements so as to ensure a resumption of inspections, and support for staff who administer medication. Policies and Procedures All policies and procedures must be kept under review and, where necessary, updated. Those policies and procedures which pre-date 2006 and which have not been reviewed since, should be reviewed as a priority. The date of review should be evidenced on the home’s policies and procedures checklist. 2 YA40 Selhurst Road 166A DS0000028564.V365817.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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