Care Home: Totterdown Street, 21

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What the care home does well The people who live at the home are happy. They are well cared for and are able to be in control of their own lives and decision making. The staff feel well supported and work well as a team and with other professionals involved in the residents` care. Residents lead busy lives and pursue a range of interests. Residents` participation in their community is actively encouraged and promoted by the staff team. The internal environment is comfortable and support is given to residents to personalise the home as they wish. What has improved since the last inspection? This is the first time that Totterdown Street has been inspected by the Commission for Social Care Inspection (CSCI). What the care home could do better: Ensure that the service user guide and care plans are in a format that is more accessible to residents. Ensure that serious incidents under Regulation 26 of the Care Homes Regulations are reported to the CSCI. Fire drills must be carried out when new residents are admitted. CARE HOME ADULTS 18-65 Totterdown Street, 21 Tooting London SW17 8TB Lead Inspector Davina McLaverty Key Unannounced Inspection 24th April 2008 09:00 Totterdown Street, 21 DS0000071399.V362138.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 Totterdown Street, 21 DS0000071399.V362138.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. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Totterdown Street, 21 Address Tooting London SW17 8TB 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) 02086720240 laetuslodge@btconnect.com Mark Anthony Peake Eamonn Dominic Doherty Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code 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 First Inspection Date of last inspection Brief Description of the Service: 21 Totterdown Street is a registered care home for two people, aged 18-65 years with a learning disability. The service is privately owned with staff support provided 24 hours a day. The home is situated in Tooting, convenient for local shops and leisure facilities. Bus, train and tube services are also close by. The standard fee charged is £915 a week, but may be more depending on the assessed needs of the person. Totterdown Street, 21 DS0000071399.V362138.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. The inspection included an announced visit to the service on the 24th April 2008. We met one of the residents, the registered owner, the manager and the team leader. We also looked at a number of records, which included both resident’s files, care plans, resident’s finances and health and safety records as well as the environment. We also contacted people who live at the home, their relatives and staff who worked in the home. We asked them to complete surveys about their experiences. Surveys were received from both residents and four staff, all comments was positive and some are referred to in the main body of the report. We asked the Manager to complete a quality self assessment, which is also referred to in the report and helped us to form some of the judgements made. The resident spoken to during the inspection said that that they liked living there. They felt the staff treated them well and helped them to have control over their own lives. They said that they made decisions about what they wanted to do. The staff member spoken to told us that they worked well as a team and felt supported. They received regular training, meetings and supervision. What the service does well: The people who live at the home are happy. They are well cared for and are able to be in control of their own lives and decision making. The staff feel well supported and work well as a team and with other professionals involved in the residents’ care. Residents lead busy lives and pursue a range of interests. Residents’ participation in their community is actively encouraged and promoted by the staff team. The internal environment is comfortable and support is given to residents to personalise the home as they wish. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 7 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 Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 8 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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Written information about the home is available to residents, although consideration should be given to ensuring that the format is more accessible to residents. Residents needs are effectively assessed to ensure that they can be met. EVIDENCE: There is a statement of purpose and service user guide that describes what new residents can expect from living at 21 Totterdown Street and the aims of the service. There are appropriate procedures to make sure everyone has a proper assessment of their needs before they move in. Residents are able to visit and stay at the home before deciding to move in. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 9 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, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home records residents ‘needs and strengths and works with residents identify goals that are important to them. Residents receive good support to make informed choices about their lives. The home supports residents in taking manageable risks. EVIDENCE: Case files of both residents were examined. The Care plan for one resident was in the process of being developed as they had only lived at the home for three weeks. The information on the other residents’care plan was good, recording Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 10 detailed information about individual strengths, needs and preferences, goals and aspirations. A review had been planned. The resident spoken with said that they were supported to make choices about their daily life and is consulted about decisions that affect them. The home consults significant others, such as family members and health care professionals, about residents care where necessary. From the surveys and from discussion with a residents they confirmed that they are able to choose how they spend their time at the home and that they are consulted about how the home runs. The manager in his AQAA has stated that the home is run around the needs of the resident and that the home intends to encourage residents to have a greater input into policy and procedure decision making. Care plans and risk assessments are signed and dated by the residents and their key workers. Residents are supported to take acceptable risks within a risk assessed framework. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 11 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): 11,12,13,14, 15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities to develop their skills and abilities. Residents participate in activities appropriate to their needs and preferences and are involved in their local community. Resident’s rights and responsibilities are promoted. Residents are supported to stay in contact with friends and families with cultural needs being promoted. Residents enjoy the food provided by the home and are involved in planning and cooking of meals. EVIDENCE: Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 12 The Resident told us that they did lots of different activities and made choices about the things that they wanted to do. Residents living at the home take part in activities and a lifestyle that they chose. One resident attends a local day centre, the other is involved in activities within the community. Residents are also members of social groups such as “Generate” which is a local social club for people with learning disabilities and regularly attend special events organised by the club. Residents actively use the local community including the library, shops and public transport. Both residents have friends outside the home. Both residents are involved in shopping for the house and themselves. They plan menus and help with some household tasks. One person regularly cooks and the other sometimes join in. Residents stay in contact with their families and relatives are encouraged to visit and are welcomed in the home. One resident currently visits his relatives and stays over on occasional nights. The home supports and encourage this arrangement. The staff have a good understanding of how to show respect to people and treating people well. One resident confirmed that staff always knocks on their room door before entering. They also confirmed that they could lock their door if they wanted and use the house phone when they wanted. Interaction between staff and the resident on the day of the inspection was positive. Residents are supported with their cultural needs and interests. One resident spoke of the meals they enjoyed e.g. jerk chicken, curried mutton as well as takeaway meals such as Kentucky Fried chicken and MacDonalds. Fresh fruit was seen in the kitchen. Meals are freshly prepared each day and residents can chose what they want to eat. Healthy eating is encouraged as well as the importance of participating in some form of exercise. A record is kept of meals cooked. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 13 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 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports residents to maintain good health and residents are supported to access specialist health care resources where necessary. The home works co-operatively with other professionals in delivering residents care. Residents’ medication is appropriately stored and recorded. EVIDENCE: The inspection provided evidence that the home liaises well with health care professionals when necessary and responds appropriately to any changes in residents’ needs. One resident currently had a community nurse who works jointly with the home in monitoring resident’s weight and overall health. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 14 Both residents are registered with local GPs and other health care professionals as required. There is a procedure for the safe handling of medication. Staff are trained in this area. Medication is stored, recorded and administered following this procedure. There are medication profiles of residents. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 15 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place for the management of complaints. Residents feel able to raise their concerns and feel these will be acted upon. Training is provided for staff in Safeguarding of Vulnerable Adults. EVIDENCE: An appropriate complaints procedure is in place. Residents confirmed verbally and in their surveys that they have a copy and that they knew how to complain if they needed to. No formal complaints to date had been made. There are suitable policies and procedures in place for the protection of vulnerable adults. Staff are aware of the procedure in the event of abuse being identified. The manager stated that an update in safeguarding of adults had been arranged for the 6h May for all staff. Staff support residents with their finances, with some of their money being held at the home. This is kept safe with receipts being kept. We checked the money of one resident during the inspection, which was found to be accurate. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 16 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): 24,25,27,28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, safe and well maintained. On–going work with residents must continue to ensure personalisation of bedrooms and individual lounges. EVIDENCE: Totterdown Street is a semi detached house, which has been renovated to accommodate the needs of two residents. Residents have their own bedroom and lounge, although the arrangement of the facilities is not very practical, in particular, for one resident who has to go through the dining room to get to his bathroom and lounge. Staff, however, reported that this arrangement seems to work and that each resident respects the others space. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 17 Both bedrooms and staff sleep in room are upstairs, as is the bathroom for one of the resident, which staff also share. We saw the bedroom of one of the residents which they stated they were happy with. The bedroom contained many personal possessions, although the resident stated that the poster, displayed in his room was not of his choosing. In discussion with staff they confirmed that the resident did choose the poster but now had another that they preferred to be put in its place. This would be addressed. Staff also stated that they intended to encourage and support the residents to personalise their own lounges and would be looking at how to make the kitchen/diner more homely. A good size back garden is available, but again, access to it is through one of the resident’s lounge. The lay out of the premises will be kept under review, as it would possible to re-configure how it is currently used, but as stated neither residents or staff saw it as a current issue. The resident spoken to said that they liked their room and living in the home. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 18 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 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are appointed following an appropriate recruitment and selection procedure. Staff have access to training appropriate to their roles. EVIDENCE: Staff records are held at the other home, which is within walking distance and the manager stated that no new staff have started since the inspection of this home. Staff records were inspected at the inspection of the other home and found to meet the standard. These will be looked at again when the inspection of the other service takes place. A copy of the roster was seen, which evidenced that a least one staff is on duty and a staff member also sleeps in. Two staff are rostered when the need arises. The manager in his AQAA stated when the home had one resident “staffing levels meet the needs of the resident and staff are familiar with their roles and responsibilities. Staff have Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 19 pre-knowledge of, or have gained on the job insight into, the resident’s specific, often complex needs. There is a low turnover of staff and low staff sickness rates. Staff are supported to carry out their jobs and develop their skills.” Comments in staff questionnaires were positive and evidenced that staff worked well as a team e.g. “we are usually briefed about the residents before they come in and also get updates during our staff meetings and handovers about the things we need to watch out for or pay more attention to”, “things are discussed daily, if needs be they are also discussed during supervision sessions”, and “staff will be put on duty depending on what activities or appointments residents need to attend”. The roster evidenced this to be the case. As staff actively support one resident access activities in the community, staff on duty will carry a mobile phone so that messages can be taken straight away. The second resident attends more structured day care at a day centre where both the staff and resident are aware to contact the home if the person would be returning early or are ill to ensure that someone is home. Staffing levels must be kept under review to ensure that they can meet the needs of the two residents. Staff stated that training is on –going and refresher courses were due to take place in Food Hygiene, Health and Safety, First Aid and Safeguarding of Vulnerable Adults. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 20 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 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is experienced and has a clear understanding of the service aims. Staff supports residents to contribute their ideas to the running of the home. The health and safety of residents is maintained. EVIDENCE: The manager of this service also has responsibility for another registered care home, which is not far from Totterdown Street. Day to day management of Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 21 this home has been designated to a Team Leader who is mainly based in the home. There is also a core group of staff who work at this service, although all staff employed could work in either service depending on need. Staff in their surveys were positive about the manager and his management style. Neither resident in their survey raised concerns regarding how the home is run. The manager is experienced, but does not hold the Registered Managers award. Consideration must be given to undertaking this award, particularly as he has responsibility for two registered care homes. In the interim the manager must ensure that he undertakes such training as is appropriate to ensure that they have the experience and skills necessary for managing the care home. Observation on the day and feedback from individuals confirmed that their views are taken into account, however, a quality assurance system, which seeks the views of the people living there, their relatives, advocates, professionals and stakeholders should be developed. Notifications under Regulation 37 must be submitted to CSCI. The inspector noted that one of the residents had returned to hospital following an incident in the home, which under regulations, the CSCI should have been informed about. Following the inspection the Regulation 37 notice was received. There are good systems in place for making sure health and safety checks are up to date. Gas safety and electrical installation certificates are up to date. Hot water temperatures are also recorded weekly. Fridge and freezer temperatures are taken daily. The fire alarm system is tested weekly. Staff must ensure that when a new person moves in that a fire drill is carried out to ensure that the person is clear what to do in the eventuality of a fire. Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 22 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 3 2 3 3 X 4 3 5 X 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 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 23 N/A 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. 1 Standard YA39 Regulation 24(1) Requirement A Quality Assurance scheme must be developed which includes the views of residents, relatives/advocates and stakeholders. Timescale for action 30/09/08 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 YA1 Good Practice Recommendations The organisation should look at how they can make documents such as the service user guide and care plans more accessible for the people for whom it is intended e.g. appropriate languages, pictures/symbols. The manager should take steps to undertake the NVQ manager’s award. A fire drill should be carried out when new people move into the home to ensure that the person will know what to do in the eventuality of a fire starting. 2 3 YA37 YA42 Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Totterdown Street, 21 DS0000071399.V362138.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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