Inspection on 14/11/08 for DRS (Annex) Care Home

This is the latest available inspection report for this service, carried out on 14th 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: DRS (Annex) Care Home 3 New Villas Baronet Road Tottenham London N17 0LT     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Robert Bond     Date: 1 4 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. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 28 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. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: DRS (Annex) Care Home 3 New Villas Baronet Road Tottenham London N17 0LT 02088850758 02082030430 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: DRS Care Homes Limited care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: 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: Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 Date of last inspection Brief description of the care home The Annexe is a care home for six people that is operated by DRS Limited at 3 New Villas, Baronet Road, Tottenham. The company also operates care homes on either side of this home and certain aspects such as management and the provision of a minibus are shared. At the present time all the residents are male and have mental health needs. Each resident has a single bedroom with ensuite toilet and bathing facilities. The rooms and communal facilities are furnished and equipped to a high standard. There is parking at the front, and a secure patio and outside smoking area to Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 0 6 6 Brief description of the care home the rear. Shops and other local services including public transport are within walking distance. The fees range from 750 to 950 Pounds per week. Care Homes for Adults (18-65 years) Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was a key inspection that considered mainly the key National Minimum Standards (NMS) for care homes for younger adults as published by the Department of Health. The previous key inspection took place on 20th January 2006 but we also undertook an Annual Service Review on 19th March 2008 which involved obtaining survey responses from residents, staff and care managers who place people at the home. On the day of this current inspection, we spent 5 hours at the home, interviewed the Registered Manager, met the Responsible Individual and some staff members, talked to three residents, toured the property, and examined a range of documents. An Annual Quality Assurance Assessment (AQAA) had been sent to us by the Manager in Care Homes for Adults (18-65 years) Page 6 of 28 advance. Equality and diversity were considered at all times and no adverse issues came to light, indeed the home is commended for the cultural and religious facilitation and support given to residents, who come from a wide range of ethnic groups. What the care home does well: What has improved since the last inspection? What they could do better: Minor corrections to the homes Statement of Purpose will improve the quality of information provided to prospective residents and their representatives. Changes to the homes written Protection of Vulnerable Adults procedure should bring it in line with the Government publication No Secrets. The provision of a table within each residents own room will enable any resident who chooses to, to eat there, to have a computer there, or more easily pursue a hobby there. This will enhance the concept of having a personal room that is a sanctuary away from the pressures of communal life. It is recommended that the temperature of hot water is monitored, recorded and adjusted as necessary on a regular basis. Care Homes for Adults (18-65 years) Page 8 of 28 It is also recommended that the contents of first aid boxes are regularly audited. 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. Care Homes for Adults (18-65 years) Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and health care support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 28 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. Minor discrepancies were seen to be present in the Statement of Purpose. Comprehensive assessments of need are undertaken before a prospective resident moves on to the home. Evidence: We examined the homes Statement of Purpose and their Service Users Guide. The Statement of Purpose on page 11 refers to 4 residents being accommodated as opposed to the actual 6, and it says the home is operated by a private individual as opposed to a limited company, hence these changes will have to be made. The Service Users Guide however was accurate, detailed and up to date. We case tracked the care files of two residents and found that both contained comprehensive assessments by the hospitals making the referrals, admission documentation, and assessments by the Manager of the home. The latter formed the basis for an initial care plan, and included cultural and religious needs. In one case the hospital had provided an occupational therapy assessment. Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: One file also contained details of 5 pre-admission visits and 2 weekend stays prior to the resident moving in. Care Homes for Adults (18-65 years) Page 12 of 28 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. Care plans are good, and residents sign their agreement to the contents of care plans. Consultation with residents takes place in several ways. Independence is fully promoted and residents are facilitated to move into independent or supported living schemes. Evidence: Both of the care files we examined contained detail care plans based on the initial assessment of need, with the initial care plan being dated on the date of admission. The care plans assessed needs and weaknesses and strengths and identified action taken or the plan/goal for each identified need. These included leisure/hobbies and religious and cultural needs. We noted that although one resident had been in the home for 4 months, the local authority had not yet undertaken an initial review of the placement. The home however had completed a review report form ready for the placement review, and the contents were detailed and signed by the Manager, key worker and resident. Notes of monthly key working sessions are also signed. All the Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: residents come under the Care Programme Approach protocol. We examined minutes of residents meetings that are held monthly. We also read through the responses given by residents during the last annual survey of their satisfaction levels. The care files examined contained a comprehensive risk management and risk-taking plan that was signed by the Manager, key worker and resident. All the residents leave the premises to pursue leisure or work activities. In the last year, one resident has moved into supported living, and a second resident is waiting to follow suit. Residents are encouraged to assist in the running of the home. Care Homes for Adults (18-65 years) Page 14 of 28 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. Residents are enabled to partake in a large range of leisure activities. Residents social, recreational, religious and cultural needs are all identified and strong efforts are made to meet them. The provision of a holiday is commended. Education, employment and independence are promoted. The meals system offers substantial choices so that ethnic options are always available. Evidence: During the course of our inspection, all the residents left the premises at some point. The Manager explained that one has employment, another has done a course in use of computers, one goes to the MIND drop in centre, and three attend a day centre. The home has the use of a 9 seater minibus and driver, shared with other homes run by the same company. Last summer a holiday to Brighton was organised and we saw the holiday photos. Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: Links with relatives and friends are maintained and religious observance facilitated. The Manager said one resident goes to church, one to his mosque, and another prays in his room. The care files examined contained individual activity charts signed by the key worker and the resident. The home also publicises an outside activity list which contains something almost every day, and an indoor activity timetable. Residents are provided with a bedroom door key if they want it. The Manager said that residents are encouraged to clear up after themselves, to take their dirty clothes to the laundry room, to wash up dishes, and to undertake basic shopping. We examined several menus, a general one for the home as a whole, and specific ones for individual residents who have specific cultural likes and dislikes. Thus if the general menu contains an item that a resident does not want to eat, he can chose an alternative from his personal menu. This system is commended. Care Homes for Adults (18-65 years) Page 16 of 28 Personal and health care 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. Residents receive the personal care support and the health care they need. Residents are enabled to self-administer their medication where possible and are well protected by the homes medication procedures. Evidence: The Manager reported that 4 of the residents are fully self-caring, whereas 2 require to be prompted over certain personal care matters. This is documented in their care plans, which they have agreed to. The key working system is in place, with monthly key working sessions. Advocacy is available via the Mental Health Community Team. All the residents are under CPAs. The care files we examined contained a My health booklet, and notes of multidisciplinary team visits or meetings, and CPA review notes. All the residents are registered with one GP practice. The care files contained details of hospital appointments, and eye tests. One resident is self-administering his medication. Another resident was escorted by a member of staff to have a depot injection on the day of our inspection. We checked the administration records of five residents and found them to be in order. We also Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: checked the record of medication returned to the pharmacist. Medication is stored in a filing cabinet in the office. No controlled medication is kept on the premises. Care Homes for Adults (18-65 years) Page 18 of 28 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. The home has good complaints procedures in place but the POVA policy and procedure is in need of review. Evidence: We examined the homes complaints record and found that one complaint had been recorded since the last CSCI inspection. The complaint, which was from a resident, concerned an aspect of the building. It had been appropriately recorded, together with action taken, evaluation and resolution. We noted that a Safeguarding Adults referral had been made by the home concerning a resident but it did not refer to alleged abuse within the care home. As a result, a strategy meeting had been held by the local authority. We noted records of staff training in the Protection of Vulnerable Adults and we examined the homes policy and procedure for making POVA referrals. The procedure referred to the home undertaking an investigation of any allegation of abuse but the correct procedure is to alert the local authority and they will decide who undertakes the investigation. The Manager explained that he was in the process of reviewing this policy (and others) and he recognised that it should be extended and revised. Care Homes for Adults (18-65 years) Page 19 of 28 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. Residents live in a homely, comfortable and safe environment that is clean, hygienic and well furnished and equipped but residents do not have a table they may sit at within their personal rooms. Evidence: We toured all areas of the care home, including all six bedrooms, with the residents permission. The personal rooms had been recently redecorated with the involvement of residents in choosing colours. Double beds had been purchased and some rooms contained televisions but none of the rooms contained a table you could sit at to eat a meal or undertake an interest or hobby. Otherwise the furniture was of a very high standard. Communal areas were seen to be also very well furnished and equipped, and everywhere was spotlessly clean and tidy. The laundry is in an out-house. The back garden contains a covered patio area where new garden furniture has been provided and where smoking is allowed. Care Homes for Adults (18-65 years) Page 20 of 28 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. Residents are well supported by sufficient staff who are properly recruited and supervised , and very well trained. Evidence: We noted that the home has job descriptions for all posts and we examined a staff rota. The Deputy Manager covers two homes and neither he not the Manager normally work at weekends but a senior care worker is on duty at these times. A waking care worker is on duty at night. This home has 9 permanent care staff, 5 of whom have obtained NVQ awards, and the remaining 4 are undertaking the awards. Other recent training we noted from records included COSHH, epilepsy, first aid, health and safety, fire safety, food safety, manual handling, medication, and the Mental Capacity Act. The Manager explained that a preferred provider for London Borough of Haringey, the home were able to access the local authoritys training programme. We also examined a thorough induction programme that had been undertaken by a new member of staff. We noted individual training plans and a collective plan for the year ahead. Two new recruits had been taken on in the last year and we examined their recruitment files that demonstrated that all proper checks had been undertaken. We also saw two supervision records that demonstrated that formal supervision of a high Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: standard was taking place sufficiently frequently. We saw minutes of staff team meetings which are held every 2 to 3 months. Care Homes for Adults (18-65 years) Page 22 of 28 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. Residents benefit from living in a home that is well managed. Residents views are carefully obtained as part of a good quality assurance system. The health, safety and welfare of residents is promoted but some minor improvements are indicated. Evidence: The Manager is a Registered Mental Health Nurse and has a BSc in Nursing Studies and a diploma in management. He manages a 4 bedded care home next door as well as this home. We examined the quality assurance surveys that had been completed by residents land care managers last year, and the summary that had been complied by the Manager. Typical comments from care managers were, generally very happy with the care provided to our clients and This is an excellent resource . Most residents comments were also very positive. We spoke to one resident in depth who said, I am happy here. Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: We also read the AQAA completed by the Manager that was very detailed and comprehensive. We checked the temperatures that were being recorded for the fridge and the freezer, and we ascertained that the hot water was at the correct temperature but no records are being kept of this. We examined the records of fire drills, fire equipment and emergency lighting checks. We examined the contents of the first aid box in the office and found that it did not contain a list of its contents to aid auditing and refilling the box. Care Homes for Adults (18-65 years) Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The Statement of Purpose must be amended to show the correct registration details for the home. Otherwise prospective residents and their representatives may be misled. 01/01/2009 2 23 13 The homes Protection of Vulnerable Adults policy and procedure must be revised. At present it does not accord with the Governments No Secrets protocol. 01/01/2009 3 26 16 Residents must be offered the opportunity to have a table that they may sit at within their personal rooms. Thus residents may eat a meal in their room whilst sitting at the table, or they can place a computer on the table, or use the table when pursuing a hobby. 01/02/2009 Care Homes for Adults (18-65 years) Page 26 of 28 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 42 The hot water temperature should be measured and recorded at various outlets where residents have access to it. Any deviation of more that 2 degrees from 42 degrees Centigrade should lead to adjustments being made in order to maintain infection control but avoid the danger of scalding. All first aid boxes in the care home should contain an approved list of their contents. The contents should be audited at least monthly and any missing items replaced. 2 42 Care Homes for Adults (18-65 years) Page 27 of 28 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. 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. Care Homes for Adults (18-65 years) Page 28 of 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!