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Inspection on 19/11/08 for Cambstone Close 1

Also see our care home review for Cambstone Close 1 for more information

This is the latest available inspection report for this service, carried out on 19th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Cambstone Close 1 Cambstone Close 1 New Southgate London N11 1JQ two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh Date: 1 9 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Cambstone Close 1 Cambstone Close 1 New Southgate London N11 1JQ 02083685169 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): amansell@pentahact.org.uk PentaHact Limited trading as Adepta Name of registered manager (if applicable) Mr Adam Paul Mansell Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 4 0 care home 4 learning disability Additional conditions: Date of last inspection 1 8 1 2 2 0 0 6 A bit about the care home 1 Cambstone Close is a care home registered to provide care for four adults who have learning and physical difficulties. The home is a large bungalow with off street parking for one vehicle to the front. The home is situated on a relatively new housing estate in New Southgate near local shops, a library, Barnet College campus and Brunswick Park. All service users have their own single furnished bedrooms, which are decorated and furnished to the service users personal preferences reflecting their hobbies and interests and with pictures of their family and various activities. There is a large nicely decorated lounge, which has sensory equipment at one corner for service users. There is a large kitchen/diner. There are two male and two female service users living in the home. All have learning, physical and sensory disabilities. Sanctuary Housing Association own the building and the home is operated by PentaHact, a company limited by guarantee, which provide a number of registered and care services in London and the South East of England. The staff team aims to provide care which meets individual needs of the people who use the service, ensuring that they adhere to the principles of choice, respect, dignity, community presence and community participation. The fee for residents living in the home is £1,600 per week. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This was a surprise inspection, which means that the home had not been informed of the visit. Two members of the staff and a deputy manager, who was working as an acting manager and was in charge of the home, were present during most part of the inspection. A regional director of the company which owns the home also came during the inspection. The inspection process included observation of the staff and the residents. We also talked to the residents, care staff, the deputy manager and the regional manager. The home completed and sent to us a self assessment document, also known as the annual quality assurance assessment (AQAA). This document tells us how the home meets the needs of the people and the actions it takes to improve the service. We looked at this document as part of the inspection. We also examined the residents files, health and safety records, and other documents such as the menu, staff rota, policies, procedures and the staff files. The communal areas and the bedrooms were also seen during a guided tour of the premises. What the care home does well What has got better from the last inspection At the last inspection the home was asked to provide training for all the staff. From the AQAA, staff records, and discussion with the deputy manager it is confirmed that the staff have had training. The home has also planned further training and development programme for the staff. What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Teferi Degeneh Caledonia House 223 Pentonville Road London N1 9NG 0207 239 0330 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . New residents are confident that their admission to the home is based on the ability of the home meeting their assessed needs. Evidence: There have been no new admissions for a number of years. The four residents have lived at the home since it opened in 1997. The acting manager confirmed that no new residents would be admitted before their needs are checked. She said that people are admitted only if the home believes that their needs can be met. The files of the four residents, which were checked, showed that the home regularly checks and updates the record of their needs. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The care planning system has enabled the people who use the service to identify their needs and receive good care. The risk assessment has also enabled the residents to live in an environment where the risks to their wellbeing are identified and managed. Evidence: We looked at the residents files. These contained the details of the residents needs and care plans. From discussions with the person in charge and care staff it was clear that named members of staff (also called key workers) sit with the residents and complete the care plans for them. The home is introducing a new care plan which looks at the needs, aspirations and wishes of each person. This system is called a person centred care plan. From discussions with the person in charge we understand that a person from outside the home comes to assist the staff and the residents to complete the person centred plans. All the four residents were at the home during this visit. We saw them walking freely around and accessing communal areas. We observed staff talking to and helping the residents in a good way. All the residents looked comfortable. One resident spoken to confirmed that they are happy with the care they receive. From records, observation and discussion with the deputy manager it was clear that bedroom paints and furnishings were selected to reflect individual choices. We noted in the records that in some cases the residents have spent their own money to buy some furniture for their personal use. We discussed that while the residents can spend their money on items they wish to have, there should be a clear system which shows that the decisions are made by the residents or people who represent them. Evidence: The risk assessments were detailed and up-to-date. They contained information which the staff use to reduce the risks to the residents. All the incidents and accidents are recorded and kept in the home. Also arrangements are made to prevent risks, for example, by providing equipment for the residents or by getting advice from other professionals. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The people who use the service are satisfied with the support provided for them to access community based facilities. The meals provided at the home are good. However, there is a room for improvement of the quality of the meals. This can be achieved by providing a variety of meals freshly prepared at the home. Evidence: The person in charge said that staff help residents to go to shops, cinemas, restaurants, post office and banks. During this visit a resident was supported by a member of staff to go shopping to buy cloth. The staff also help residents to do various activities in the home. One resident was observed doing their preferred routine with a support of a care worker. The residents are also supported to visit their family and to attend places of worship. From the records and discussions with the person in charge it was clear that the residents rights are respected. For example, it was repeatedly mentioned by the staff during conversations that the reason why one resident was not up in the morning around 10 am, during the early part of this visit, was that the resident wanted not to be disturbed until late in the morning. We saw residents being provided with breakfast and lunch. From discussions with two members of staff we confirmed that the staff had training in basic food hygiene, a training programme that gives knowledge and skills of handling, preparing and presenting food. We also checked the menu. The menu gives details of food for each day and mealtime of the week. We noticed that food items provided from one week to another do not change very much and that the home uses occasionally prepared food Evidence: from the cans. The person in charge explained that the staff ask and offer the residents choice. When asked, one resident confirmed that they are happy with the food. Records in the residents files showed that the residents dietary needs are identified. The person in charge said the home will look at ways of improving the meals provided. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The health needs of the people who use the service are met by the arrangements put in place for them to have appropriate medical care. The medication administration system is good but there is a room for improvement to eliminate a mistake from occurring and to ensure a safe medication administration. Evidence: The residents files showed that the residents are supported to make appointments and to see health professionals. The residents health care needs are recorded in the files. From the records it was clear that the residents have regular dental, eye and foot checks. The residents also see their psychiatrist regularly and it is evident in the files that different health professionals know what the others do in respect of the health care of a resident. On the day of the visit the residents looked comfortable and relaxed. There was good communication and understanding between the residents and the care staff. The staff who were observed and spoken to had a good knowledge of treating the people who use the service with respect and dignity. Medication is kept in a locked cabinet. The home has a guidance for medication. Staff who administer medication had training in administration and handling of medication. There were occasions when medication was given in error. This were quickly found out and dealt with by the home by seeking advice from a general practitioner and by recording in the accident and incident books. The medication administration record sheets and the medicines were checked and found to be in order on the day of the inspection. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home are confident that they are protected by the availability in the home of trained staff and satisfactory complaints and adult safeguarding policies. Evidence: One complaint has been recorded since the last inspection. This was investigated and dealt with by the home following the homes complaints procedure. We were not able to ask at this visit if the people who use the service know how and who to tell if they have a concern. The residents have limited verbal communication. However, we have seen how they express their wishes by using different ways of communication. We also observed that the staff have good skills in understanding and communicating with the residents. In the AQAA the home stated that they use an advocate (a person not employed by the home) who comes regularly and provides support for the residents. From our discussions with the staff it was evident that they know how to make sure that the residents needs are met, or recorded if not met. The home has an adult safeguarding policy. The home has also obtained the local authoritys policy on adult protection. During a one to one conversation with the staff we asked them if the staff know what safeguarding means and how they can put it into practice. The staff were able to give full explanation of adult safeguarding and the correct ways of dealing with an allegation or real case of abuse. The staff also confirmed that they had attended training on safeguarding as part of their national vocational qualification (NVQ) course. The person in charge also confirmed that training on safeguarding is being organised for all staff. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The facilities, cleanliness and maintenance arrangements make the home a safe place to live in for the residents. The home can be more comfortable for the residents and visitors when it becomes free from bad smells. Evidence: The communal areas are spacious with comfortable seats. All parts of the home were bright and clean even though there was a slight bad smell in the entrance hall. The person in charge gave reasons for this slight smell and said a professional cleaning company was due to come and clean the carpets. Records and certificates checked showed that the facilities and equipment are maintained. A domestic assistant comes to the home to do cleaning tasks. From observation and AQAA it was clear that bedrooms were decorated reflecting individual wishes. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has experienced and trained staff team to meet the needs of the people who use the service. Evidence: We spoke to and observed two members of staff. Both staff members have worked at the home for many years. They were seen to be communicating with the residents with respect by giving them enough time to listen to them and by not rushing them. They also encouraged the residents to do things for themselves wherever possible. For example, when a resident asked to get something from the garden, a member of staff encouraged the resident to obtain the material by themselves. This is part of enabling people to be as independent as possible and to gain more confidence. From discussions, the files and AQAA it was clear that some staff have completed a national vocational qualification training in care and some have started undertaking the same course. The staff files also contained job descriptions, application forms, written references, terms and conditions of employment and evidence of criminal record bureau checks. The AQAA says that the home has a good staff recruitment procedure. From a discussion with the regional director and the AQAA it was evident that the people who use the service are involved in the selection of the staff. For example, the AQAA describes: The recruitment and selection procedure is very robust and actively includes the people we support in assessing candidates and making decisions about their suitability. The staff spoken to said they work as a team and solve any issues they may have through discussions. They said they attend staff meetings every month. The person in charge has developed a training programme for each member of staff. She said she would send the programme to the head office so that they could arrange training for the staff. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The introduction of good systems of quality assurance have enabled the people who use the service to share their views and influence the quality of the service. The efforts made by the home to bring an advocate to help the residents to express their wishes are commendable. The health and safety arrangements are good to ensure the safety of the residents and the staff. Evidence: The registered manager has left since the last inspection. The regional director, who came while the inspection was taking place, confirmed that a new manager has been recruited but was waiting for some checks before starting work. Presently the home is managed by a deputy manager who is supported by a service manager and the regional director. From conversations and records it was clear that the service manager visits the home every month to undertake quality checks. The two members of staff spoken to said they are well supported by the management team. The deputy manager said the home consults with the people who use the service about the quality of the service. It was noted above that an advocate comes to the home to support the residents to express their wishes. Records and conversations with the deputy manager indicated that the residents are consulted about the colour of paints and quality of furnishings. As indicated above, the service manager visits the home every month to check all aspects of the service by looking at the documents, talking to staff and residents and by observing the premises. The AQAA states that the home has s system of quality assurance which allows the relevant people to give their views about the service. For example, the AQAA says: This review [quality assurance] invites input and feedback from all stakeholders involved with the service. Evidence: The homes incident and accident books were looked at. These showed that there have been 14 recorded incidents/accidents since the last inspection. It was also noted the home has appropriately dealt with the incidents and accidents. We learned from the AQAA that the home uses a health and safety consultant to advise it about the health and safety practices in the home. The inspection of the records confirmed that the gas boiler was checked on 20/08/08 and portable electrical appliances were tested on 15/08/08. The fire alarms and fire the risk assessment were carried out on 31/07/08. Fire drills are carried out once every three months. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 13 The medication 31/12/2008 administration and recording systems must be reviewed. To prevent errors and to ensure safe administration of medicines. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 There should be a clear system which shows how decisions about financial transactions of the residents are made. This is to ensure that the residents money is spent wisely and for the benefit of the residents. The use of pre-prepared food should be controlled and the home should, after consultation with the residents, provide the residents with fresh food items. The registered person should ensure that all parts of the home are free from bad smells at all times. This will make the home a more comfortable place to live in for the residents and to visit for the relatives. 2 17 3 30 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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