Inspection on 04/06/08 for Faircross Avenue

This is the latest available inspection report for this service, carried out on 4th June 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

Other inspections for this house

Faircross Avenue 13/06/06

Faircross Avenue 10/11/05

Faircross Avenue 14/06/05

Faircross Avenue 20/01/05

Faircross Avenue 28/09/04

Faircross Avenue 27/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Faircross Avenue 100 Faircross Avenue Barking IG11 8QZ Lead Inspector Mr Roger Farrell Unannounced Inspection 4th June 2008 11:00 Faircross Avenue DS0000027898.V365270.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 Faircross Avenue DS0000027898.V365270.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. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Faircross Avenue Address 100 Faircross Avenue Barking IG11 8QZ 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) 0208 591 5655 0208 591 5655 marie.harris33@ntlworld.com Nasser Kassouri Marie Jose Noelle Harris Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only:Care home only - Code PC to service users of the following gender: Either - whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is: 3. 5th June 2007 2. Date of last inspection Brief Description of the Service: 100 Faircross Avenue is a registered care home providing accommodation and support to three people who have learning disabilities. All three residents have lived at this house for over ten years and are well settled. In Spring 2008 this compact mid-terrace property was expanded by combining it with the nextdoor house. This has greatly improved the general living areas. Three additional bedrooms have been added, and an application is due to increase the overall number of places to six. At the same time an application will be made to change the ownership details, as the registered manager is now a partner in the business. The home is a short walk from shops and transport links of Barking town centre. The current range of fees are between £2,827.56 and £4,735.45 per month. Faircross Avenue DS0000027898.V365270.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 now 2 Stars. This means that the people using this service experience good quality outcomes. This inspection took place between 11am and 6pm on Tuesday 4 June 2008. Marie Harris, the registered manager was on duty. This was the first inspection since the building was expanded by combining the original property at 100 Faircross Ave, with the adjoining house at No.102. The major works were carried out in March 2008, the three residents and staff staying in a holiday apartment in Southend for three weeks during the conversion. When Faircross Avenue was originally registered it was classed as a ‘small home’. Care homes with less than four residents did not have to meet the stricter rules, such as having bedrooms of a certain size; separate staff facilities like an office and sleep-in room; and a linked-up fire alarm system. Soon after the law was changed six years ago, the owner said he intended to upgrade and expand the home by incorporating the house next-door. Our earlier reports have covered the set-backs that caused such a lengthy delay in carrying out this work. The plans for the new facilities changed a number of times. The last version shown to us involved adding two places, but the redevelopment has created six bedrooms. In January 2006 Marie Harris started as the new manager, though she was not confirmed as the registered manager until March 2007. Following this she formed a business partnership with the owner, Nasser Kassouri who had been the registered manager since he bought the home in 2002. At this recent visit Marie Harris said they were about to send in an application to increase the number of places, and to register the new owner partnership, called ‘Faircross Care Home.’ The last ‘key inspection’ had been a year earlier on 5 June 2007. The report of that visit talked about considerable improvements having been achieved. Prior to that our reports had raised a long list of concerns about the quality of dayto-day support being provided to the three residents. This had included issuing ‘legal notices’ about failures in basic care and safety standards. At the visit a year ago the inspector gave the manager an overview of the changes in the way care homes are assessed. This includes introducing a new self-assessment form called an ‘AQAA’; managers providing ‘improvement plans’ saying how they are tackling the necessary changes; making sure the Commission is kept informed of changes and difficulties; and making public the home’s quality ‘star rating’. The challenge facing the manager was to demonstrate that areas scored as ‘adequate’ were raised to the more acceptable score of ‘good’. She was also aware that particular attention must Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 6 be paid to those requirements that had been carried forward in reports beyond the original target date. The reduced list of requirements set one year ago was followed up at a ‘random unannounced inspection’ on 18 January 2008. Also, at last year’s visit we stressed the need for Nasser Kassouri and Marie Harris - as the registered owner and registered manager - to make sure they are keeping each other informed as there had been some important gaps in their communication, and delays in the Commission getting information it had requested. In addition to talking to the manager about the change of registration applications and looking at paperwork to do with the ‘key standards’, our checks at this visit also included: • • • • Reading the detailed ‘Annual Quality Assurance Assessment‘ (‘AQAA’) completed by the manager just prior to this visit; Checking through all the notifications and ‘monthly reports’ sent to us over the past year; Speaking with the three residents, and the staff on duty during the visit; Updating our contacts list, and phoning around relatives who are in touch with their family member, and talking to staff at the home; we also looked at the two questionnaires returned when we did a mail-out to relatives last year. We also looked at comments made by relatives in the last survey carried out by the manager. Contacting the main social worker and community nurse who have contact with the home; Asking the manager to send on more details about items discussed at the visit. • • The inspector would like to thank the residents and staff at the home for the warm welcome he receives and taking time to answer his questions. He also appreciates residents showing him their bedrooms. He would also like to thank the relatives who returned comments or returned calls. What the service does well: Over the past eighteen months this service has been made considerably better. A measure of what has been achieved in the support provided to the three residents, and the quality of the house is that the number of requirements listed in inspection reports has reduced considerably. The number of legal notices that were served a couple of years ago also showed our concern about the deterioration in basic care and safety. Once the current manager took over she set about making sure the day-to-day care provided to the residents was to an acceptable standard in fundamental areas such as meals, personal care and clothing, and household cleanliness. She has continued to build on this, tackling other issues like having worthwhile care plans and medical records. This success is reflected in comments made by relatives such as – • “The service overall has improved since Marie Harris has taken charge of Faircross.” DS0000027898.V365270.R01.S.doc Version 5.2 Page 7 Faircross Avenue • • • • “Improved since Marie and regular staff took charge.” “We know the manager makes the right choices, and so far they have been okay.” “In the last 2 years or so the home has shown great improvement.” “It does seem evident that Faircross has come a long way which has only improved my brother’s life. For him, to be able to go out on his own and be responsible enough to make his own way back is something of a milestone. I’m sure this is down to the system and workers at Faircross.” This report describes how the residents’ lives have been improved considerably, what we call ‘positive outcomes’. Indeed the key word in the quotes above, and found under all headings is ‘improvement’. One social worker who has been visiting the home over a number of years said – ”The residents are more relaxed. Marie has stabilised the home. The changes are very pleasing….it is much more open and bright. I visited recently on (one resident’s) birthday. The place was much more alive…the place has had quite a lift.” What has improved since the last inspection? What they could do better: At the time of this visit the two rear gardens had been combined and levelled – but were still awaiting landscaping. Also, exterior decoration still needs to be carried out to match-in both houses. The inspector said that the priority was to speak with the fire inspectors and get their approval for the safety measures. A requirement has been set on this matter. The manager was also reminded that the application to increase the number of places must have the necessary building approvals from the planning department and building control where these are applicable. Once registration is achieved, the next challenge will be to make sure those joining this household group are compatible. The application to our registration team must include details of the current ownership arrangement. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 8 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. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 9 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 Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 10 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 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home understands the importance of having sufficient information when choosing a care home. Before agreeing admission the manager is committed to carefully considering the needs assessment for each individual prospective person and the capacity of the home to meet their needs. Prospective residents will be given the opportunity to spend time in the home. Our judgement is that people who are thinking of using this service in the future will have sufficient information and attention to help them to feel comfortable in their surroundings and enable them to ask any questions about life in the home. EVIDENCE: Ahead of the three new places being registered, the manager has developed a new format for assessing prospective residents. She has also written a new policy setting out the steps covering new residents, such as arranging initial visits and having the chance to ask questions in private. She understands the importance of having sufficient information when choosing a care home. She is also doing an information pack that will help prospective individuals to choose if this is the home that will meet their needs and preferences. The three existing residents have lived together as a group for more than fifteen years, moving to this house with a former owner. The recent expansion Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 11 means that this will be the first time new residents will have to be assessed to join this well-established household group. Last year the inspector stressed the need to prepare a procedure covering the assessment and move-in arrangements for prospective new residents – making sure these cover all areas set out in Standard 2.3 of the ‘National Minimum Standards’. At this visit the manager showed the inspector the latest version of her ‘Service User Assessment.’ This form’s main headings include personal details and contacts; medication; physical health; mental health; daily living skills; social contacts and interests - and has a log of initial visits and move-in details. Each section can be expanded to include all the necessary details. The manager has a clear idea about the additional information she would want from social workers, family and so on. She has also prepared a basic policy setting out the principles covering selection and move-ins, saying that this group of national minimum standards will be followed full. This will be included in the new ‘statement of purpose’ she is drawing up. She repeated the commitment to make sure the selection of new residents will place a major emphasis on making sure they will fit in with the existing household group. As part of applications to increase the number of residents, we look at how assessments are carried out. Also, at subsequent visits an inspector will look closely at how the undertakings have been followed in practice to confirm the ‘good’ rating given to ‘Standard 2’. It is important that care homes have an accurate document that describes the type of resident they are registered to care for, and how they will support their needs. This is called a ‘statement of purpose’. The manager showed how she is working on updating their version as part of their new registration application. The inspector looked at some of the new revised sections. His main advice was – • In addition to the broad statements on values and principles, there is a need to be more specific about the actual resources and facilities provided. For instance, statements like – “Faircross is committed to providing quality services for Service Users by caring, competent, welltrained staff in a homely atmosphere” – needs to be backed-up giving details of the staff complement (the number and type of posts); the level of shift cover (the number of staff on each shift); and saying what training and qualifications staff have completed. Making sure the final version is factually correct. For instance, one of the revised sections refers to ‘nursing care’, and another section carries forward out-of-date owners’ details. When commercially available policy and procedure examples are used, these must be adapted so that they match what is provided at Faircross Ave. • Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 12 • There was some confusion over which was the most recent version of some sections of the ‘statement of purpose’ and other policies. The inspector said it is a good idea to include in each document when it was last updated, such as putting the date in at the bottom of the page. A requirement has been set saying the ‘statement of purpose’ needs to be updated, making sure it is factually correct. The same advice applies to the other main legal document covered under this section. This is called the ‘service users’ guide.’ Existing versions have been accepted as satisfactory given the length of time the three residents have lived at this home. The manager is revising the ‘service users’ guide’ and talked about putting together a new information pack that will help prospective residents make choices. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 13 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 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service involves individuals in the planning of care that affects their lifestyle and quality of life. Staff understand the importance of residents being supported to take control of their own lives. Individuals are being encouraged to make their own decisions and choices. Each care plan includes a range of risk assessments, which are reviewed regularly to ensure the protection of people who use the service. The management of risk is positive in addressing safety issues while aiming for improved outcomes for people. Where there are limitations, such as going out alone, the decisions have been made with the agreement of the person and their representative and are accurately recorded. People who use this service are receiving the type of care and support expected under these important standards. EVIDENCE: As previously stated, there is evidence of a satisfactory format for assessing the needs of prospective users of the service. Marie Harris’ priority to restore satisfactory daily care routines is now clearly evident. All three residents have reasonably good day-to-day living skills. There are now ideas being considered Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 14 to help residents develop new skills, such as one person learning how to make himself a cup of tea and snacks. This home had struggled over a number of years to set up and operate a worthwhile record of support planning and monitoring. Various initiatives were started, such as the ‘Statement of Support and Action Plans’ with bullet point entries under twenty-one or more headings, with some good practical advice on assisting residents with day-to-day living needs. The intention to develop ‘person centred planning’ sheets never happened. The various styles of care plans were not kept up-to-date, and it was difficult to see how service users were being helped beyond basic assistance with daily domestic routines. When Marie Harris took over as the acting manager she explained how she intended to introduce a new style of practice records. However, progress was slow, and the owners were therefore served with an ‘Immediate Requirement Notice’ for a failure to comply with Regulation 15 of “The Care Homes Regulations 2001”. There is now good evidence that she has succeeded in setting up and running a worthwhile care planning and monitoring system. This is much better at setting out how residents will be helped with day-to-day needs, as well as wider matters such as learning new skills. The information is also generally being kept up-to-date. An example of how this is benefiting people is one resident’s progress with making hot drinks and he has now moved on to preparing snacks with help from staff. This person is also much more relaxed, such as when there are visitors in the house. He is also talking more, saying what he wants such as choice of meals. He is also having much more interaction with his family. Another positive finding is that the manager has made sure that all service users have had the necessary reviews over the past six months – this includes meetings with the social workers; medication reviews; and CPAs. The riskassessment sheets seen at this visit had also been up-dated within the last three months. These include the important area of monitoring two residents who have agreements about going out alone. Residents know that their changing needs and personal choices are being taken into account. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is increasingly enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. People who use the service have the opportunity to develop and maintain important family relationships. The staff practices now promote individual rights and choice, but also consider the protection of individuals in supporting them to make informed choices about planning their lifestyle. There is better attention paid to education and leisure opportunities, which are now being actively encouraged, supported and promoted. EVIDENCE: The manager can show that significant improvements have been made under the five key standards covered in this section. This is very welcome as our previous reports have been critical of the lack of help given to residents to be involved in social and leisure activities, saying – “The ‘weekly programme’ on display, and the ‘activity plans’ in the care plan files were considerably out of date, and there was little evidence that the programmed ‘in-house’ activities Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 16 were taking place according to these plans. Other than going to local shops and parks, there was little evidence of other supported day activities.” The revised schedule seen last year was largely made up of domestic chores and personal care, such as - ‘wash and shave’, ‘tidy bedroom’, ‘empty bins’, ‘set table’, and such like. However, the manager was actively searching for appropriate opportunities, and initial success included each resident attending at least one weekly educational session. This includes a computer course; pottery class; and a literacy lesson. The main fixed outside social events remained a couple evening clubs that residents have attended over a number of years. Whilst the new ‘Activity Schedule’ still slots-in fixed times for help with personal care and household chores, the scope of activities outside the home are much wider. Equally, it is much easier to confirm that listed events have taken place, such as going swimming, having lunch out, and being helped to go to shops to buy clothes. When pressed at the last key inspection, only two group trips could be evidenced over the past year – one to central London and one to Southend. To show how residents are being supported to have much better opportunities, here are some examples of social events that have taken place over the last six months, some which have included staff from the evening social clubs - Moby Dick restaurant; Christmas party at the Catholic Club; Whetherspoon pub lunch; Aladdin Pantomime at Goodmayes Church Hall; Goldilocks Pantomime; Christmas Party at Thomas Moore Centre; Meal at Nando’s Restaurant; Disco at Thomas Moore Centre; Three week holiday in Southend (went to various pubs, restaurants, funfair etc.); Lunch in MacDonald’s then Bowling; Funfair in Barking Park; Day trip to Hastings; as well as regular lunches in a local café. The manager is still looking at what educational options are available, and discussing these with residents. She has taken all residents along to local colleges to look at the courses on offer. All three residents had prospectuses and application forms for further courses at the Fanshaw College, and were due to attend interviews the following week. One person uses the local library regularly. One resident needs staff with him for all outside activities. The manager was able to show that there are thirteen hours of pre-planned ‘oneto-one’ staff support time each week. The two other residents have agreements decided in reviews about going out to local shops and facilities on their own – and there are risk assessments covering these arrangements. One visiting professional said – “The guys are integrating better than I have seen before. I have found the manager very patient. Before there was a lack of motivation, or (residents) dropped out of things that were set up. (One resident) has stuck with his college course, and that would not have happened a couple of years ago. There is much more outreach work.” Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 17 Earlier reports have described a slapdash and negligent approach to providing meals. Menu planning was not taking place, there was no day-to-day coordination of meals, with staff improvising with what food was in the cupboards, or falling back on getting take-away from the fish and chip shop. Before this manager started the owners were served with ‘Immediate Requirement Notices’ for a failure to maintain accurate food records and for lapses in standards of food hygiene. We had asked environmental health food inspectors to carry out spot checks. This was symptomatic of how the service was failing to meet even basic needs at that time. From soon after the current manager took over she made it her priority to improve the standard of everyday care and household arrangements, such as making sure there are varied and wholesome meals. This has included - having a planned menu that is followed, or recording where a resident requests an alternative on the day; using fresh vegetables and having fruit available; and carrying out regular checks to make sure food hygiene standards are being followed. At unannounced visits we have found that the meals being prepared were according to the menu, and included fresh vegetables. The new kitchen is much better and brighter – the old kitchen was small and dingy as it had very little natural light. Again, at this visit there was a wellstocked fruit bowl, and a good stock of fresh vegetables and other products. The fridge was clean, as were other parts of the kitchen. Two residents are able to confirm to us that there has been a big improvement in meals, and that they get asked about their choices and help with the food shopping. The manager showed us the current menu, and the meals served on the day was according to that day’s options, with the stocks available for the next couple of days meals. Staff said how much better they found the new kitchen facilities. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 18 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 and checking support and medical records. People receive good personal and healthcare support using a person centred approach - taking account of dignity, autonomy and respect. People are supported and helped to be independent, and where possible take responsibility for their personal care. Staff listen and take account of what is important to residents. People who use the service are receiving good help with personal and health care, and support to promote their physical and psychological well-being. EVIDENCE: Residents have regular medical appointments and are helped to visit local health care services. The arrangements for helping residents with their medication are satisfactory. At all our visits since this manager took over including unannounced inspections – we have found considerable improvement in how residents are supported with their day-to-day living needs. This can be seen how residents’ personal appearance has improved as a result of better encouragement with personal care and help with having appropriate clothing. Prior to this we were very concerned about the deterioration in care standards. We had received complaints covering basic areas like the poor condition of Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 19 residents’ clothing, such as shoes with holes. Since Marie Harris took over dayto-day responsibility the quality of support has been much better. Last year one anonymous complainant wrote again saying things had improved. Following that, a resident said – “These shoes are fine, and I have two other new pairs upstairs. When you go (shopping) with Marie she makes sure you make up your mind.” Another resident who uses few words is now making choices, for instance showing that he likes sports wear. These positive signs were reflected in the comments made by relatives. One resident has good self-care skills, another needs guidance, whilst the third person needs supervision with areas such as getting dressed and using the bathroom. The increased space and improved bath and shower facilities has made life better for the residents in how they can be helped with personal care. The improved care plans and day-to-day notes show how personal support is being monitored in a much more consistent way. It is now much easier to gain a picture of how residents’ health care is monitored, and how they are helped with medical appointments. The files give a good overview of health needs and show that action is taken and followed through regarding psychological and physical changes. This includes clear medical tracking sheets, and details of health reviews. These cover contacts with the GP, dentists, optician and chiropodist. They also show the continuing involvement of a community psychiatric nurse who has worked with the residents over many years. Last year he had worked with the three residents and manager drawing up some Functional Assessments’. He still visits the home every six weeks, and attends reviews. No resident has needed a hospital admission, or suffered a serious illness over the past year. One resident is prone to chest infections. At this visit we discussed how matters were followed through when this person started loosing weight, appeared to be having minor seizures, and then had a fall. The manager was able to give a good account of the monitoring, medical appointments, and medication reviews that had taken place – including referring to the medical tracking sheets, and weight and seizure charts. Stability was restored when he was put back on some medication that had been phased out. This example shows that residents are being helped to look after their well-being. The manager again spoke about the good working relationship with GP with whom all residents have been registered since they moved to this house. It has been very helpful to have one key health care worker like the CPN who has provided continuity over many years. The arrangements for helping residents with their medication were another key area where safeguards had dropped below the required levels of safety. Legal action had been taken for failures, with the registered persons being served with three ‘Immediate Requirement Notices’ relating to Regulations 13(1);13(2); and 18(1)(c)(i) of “The Care Homes Regulations 2001”. At a follow-up visit the manager was able to show how she had carried out the Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 20 improvements, and all the recommendations listed in subsequent pharmacist reports. This had included making sure all staff who give out medication had received training. At this recent visit the manager is able to show how the system is much better organised. The home uses the Boots ‘monitored dose system’, supplied with printed instruction and recording sheets. The supplying pharmacist visits to carry out checks from time to time and leaves a report of her findings. A new metal medication cabinet is now being used, and was due to be screwed to the wall in the dining room in line with the one recommendation made by the pharmacist at her last visit. All other areas were ticked as satisfactory. The inspector looked at how the pre-packed containers and other preparations are arranged. He also looked through the medication recording sheets for each resident, and these were satisfactory. The manager confirmed that there had been no known serious errors over the past year, and described the action taken when there had been minor mistakes, such as not recording on an occasion when a skin cream was used. There is a file that has the policies and procedures covering the ordering, storage and administration of medication. Staff training logs showed that all current staff have attended medication training in recent months. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 21 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. The policies and procedures for safeguarding adults are available and give clear specific guidance to those using them. The manager knows when incidents need to be reported to external agencies. Also staff have had training in safeguarding responsibilities, including ‘whistle blowing’. This means that those who use this service and their representatives can be confident that the right protections are in place. EVIDENCE: The manager can demonstrate compliance with these standards, and has the correct information available covering complaints and safeguarding procedures. There are copies available of the main guidance called ‘No secrets’, and the local safeguarding guidelines. All staff have signed to say that they have been given a copy of the General Social Care Council’s ‘code of practice’, and are aware of the phased programme of enrolment. Complaints and protection have been added as topics on the induction list. The notice board has information on display on how to make complaints, along with the local council’s guidelines on safeguarding procedures. Information on these topics are included in the ‘service users’ guide’, including contact numbers. A pack called ‘Say No to Abuse’ is also on display. The complaints’ log is available, the last entry being in April 2006, saying how a minor altercation between two residents was sorted out. There have been no safeguarding issues over the past year. Prior to this manager starting a range of issues had been raised with the local adult protection team and with the Commission. This included the previous manager being served with an ‘Immediate Requirement Notice’ for failing have Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 22 available up-to-date accounts of service users personal monies handled by staff and the owners, covering Regulation 17(1)(a) and Schedule 4, para 9 of “The Care Homes Regulations 2001”. Placing authorities were advised to read inspection reports, and discuss issues at subsequent reviews. This included asking for accounts covering residents’ personal monies. The manager is able to give an account of all personal spends and balances since she took over responsibility. She can give a description of how residents’ personal money is tracked. Fees are paid into the new partnership’s business account. The manager has helped each resident open a bank account. The manager goes with each resident to their bank once a week to transfer their rent contribution and withdraw their personal money. Personal cash is kept in individual cash tins with accounting sheets. The resident signs for each transaction, and receipts and withdrawal slips are stapled to the account sheets. She does weekly checks of the cash tins, and says there have been no discrepancies since she took over responsibility for helping the residents with their own money. She has followed up with one resident’s social worker about access to a legacy held under a guardianship arrangement by a relative. She has also drawn up ‘Financial Guidelines’. She confirmed that she is still following all advice given in earlier reports under this heading, including - arranging for periodic audits of each person’s bank account and cash accounts; provide each resident’s care manager with a summary report on the management of accounts at the main annual review; making sure there is double signing for each transaction; and including checks on the handling of money as part of the owners’ ‘monthly visit reports’. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has now ensured that the physical environment provides for the individual requirements of the residents. The living environment is now more appropriate for the particular lifestyle and needs of the residents. It is homely, clean, and comfortable - and reflects the choices and individuality of the people using the service. Residents are encouraged to see the home as their own, and have personalised their bedrooms. The shared areas are now much better, and provide opportunities to meet relatives in private. The manager is talking to a fire safety inspector about making sure there are all the required safety arrangements. This is important to make sure those using the building have the necessary protection against fires spreading. EVIDENCE: The much-needed and long delayed improvements to this home are nearly finished. Since becoming a partner in the business Marie Harris has taken a lead in seeing through the expansion by integrating the two neighbouring properties. The major phase of work started on 17 March 2008, and was Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 24 completed by the time the three residents moved back on 5 April. All building rubble and waste had been taken off-site. Many of the shortfalls judged against the ‘National Minimum Standards’ have been addressed. This includes bigger bedrooms; improved bath, shower and toilet facilities; a much brighter lounge, and large kitchen/diner; and separate staff facilities including an office and small sleep-in room. Two of the residents have moved to larger bedrooms, and told us how much they liked their new rooms. One said – “Do have a look, it’s much better. It’s a bit of alright. Yes, I like it more”. Another said the best thing was he had more room to store his cd collection. The third resident was also offered one of the new larger bedrooms, but has made it clear by his actions that he wants to stay in his original smaller room. The manager is congratulated for seeing through this project, which represents a major improvement in the facilities provided for the people who use this service. However, the layout does vary from the plans shown to inspectors last year. The conversion added three bedrooms rather than the additional two shown on the previous drawings. The main issue we raised at this visit was gaining the approval of the fire authority. The connection between the two houses at first floor level are open, including the head of both staircases. Further, an integrated fire detection and alarm system had not yet been fitted. The manager said that she was confident that sufficient early-stage consultation had taken place with the fire authority. A fire safety inspector from the LF&EPDA was due to visit soon after this inspection. The manager was told to make sure there was no reference to guidelines that previously applied to “small homes”; to be clear about the standard of fire detection and emergency lighting required; and to have any opinion on the separation of the two joined buildings confirmed in writing. Equally, our reports and advice have stressed the need to make sure that all works fully conform to building regulations and any applicable planning permissions. The manager said that the planning department had confirmed their approval through the ‘certificate of lawfulness’ that had been issued for both houses, additional permissions not being necessary as the premises have not been extended beyond their original footprint. Further, she said documentation provided by the contractors covered building control checks. The manager was told that the application to the Commission regarding the alterations must have the correct reports and certificates from these three agencies. This is covered in the requirement set on this matter. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 25 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. People have confidence in the staff that care for them. People who use the service tell us that staff working with them are very helpful and kind. The manager encourages and enables training and recognise the benefits of a skilled, trained team. Staff files have sheets that show the correct vetting has taken place so residents can feel safe and confident in the support team. EVIDENCE: Legal action has previously been taken against the owners for a failure to present staff records, and for not showing that they were carrying out the necessary checks. This responsibility is now being taken seriously. It is now much easier for inspectors to check on details covering the key standards under this heading. The manager keeps up-to-date ‘at a glance’ sheets, such as having a vetting checklist and training log at the front of each staff member’s file. A page has been added to the ‘statement of purpose’ giving shift cover details. This is normally one support worker on duty between 10am and 6pm; followed by a support worker on from 6pm to 10pm, who then does a sleep-in, and is on duty between 8am and 10am the following day. The acting manager’s hours Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 26 are normally 9am to 4pm Monday to Friday, and she provides on-call back up. Rotas now show more regular shift patterns, with two days off each week. Gaps in the rota are usually covered by one part-time established worker doing extra – but there is no evidence of the lengthy stretches seen previously, with only one ‘long-day’ shift shown on recent rotas. The rotas also showed staff on a shorted day-shift or overlaps to support activities like going swimming or attending a keep-fit class. The current rota also showed a training day with all staff on duty. The rotas are now accepted as authentic, taking into account the increased support to some residents. There is now a core of three main support workers who have all worked at the home for over a year. They told the inspector how pleased they are with the new facilities, and the better day-to-day routines – a couple saying that they felt it was now a much ‘happier’ place to work, and how they have seen the residents become more relaxed. The staff tracking sheets record the steps taken to vet all staff, such as getting a CRB certificate; receiving references; checks that prove identity and permission to work; and employment contracts – as well as covering the induction checklist, and when they attended courses on core topics. Staff members undertake the main external qualification. For the past year the manager has been using a well-established training company that cover short training sessions on essential areas such as first aid; food hygiene; moving and handling; general health and safety and abuse and neglect whistle blowing. That organisation also operates NVQ schemes. Two of the three main support workers have now completed their NVQ level 2, with one now doing level 3. The third core staff member has started his NVQ at level 2. The conclusion under this section is that the manager can now prove a responsible approach to staff selection, vetting and core skills training. Earlier requirements set under this group of standards have been met. Comments from relatives included – • • “‘The staff always make you feel welcome when I visit and always polite on the telephone” “Always helpful and made welcome”. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 27 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 has the required qualifications and experience, and residents can be confident that she is competent to run the home. They have seen how she has a clear understanding of the key principles of good care, and has followed through improvement priorities regarding previous failures, so that residents are benefiting from how she and her small team have greatly improved this service. People who use this service have an increased quality of life. There is also a focus on person centred thinking, with residents’ needs shaping service delivery. EVIDENCE: We now have greater confidence in the day-to-day running of this service. Central to our previous concerns was the evidence we found that when Mr Kassouri was the manager, he was spending a lot less time at the home than was listed on the rota. Although it has taken time, since becoming manager and later a business partner – Marie Harris is able to show that the home is Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 28 being operated much more in line with the national minimum standards. This includes tackling the areas previously raised as concerns by issuing legal Notices and setting out requirements in our reports. Marie Harris gives details of her experience and qualifications in the ‘statement of purpose’. This includes having achieved the NVQ L4 Registered Managers Award. She leads and supports a strong staff team who have been recruited and trained to a reasonable standard. Two residents are able to voice their opinion on their preferences. The way the third resident was presented with the chance to move to one of the new larger bedrooms - but demonstrated that he wanted to remain in his familiar bedroom - shows that genuine and sensitive steps are being taken to establish choices and act on these preferences. It is also much easier to show how contact with families is being maintained and promoted. The manager did a resume of visits and contacts with families. In one case this shows a considerable increase in positive contact, including the resident meeting younger members of that family. We also saw copies of the minutes from the occasional relatives meetings, the last being the first where a relative of each resident attended. The manager said that there is now better communication between her and Mr Kassouri. Previously we had raised concerns about poor communication, such as not passing on documents sent by us that the manager had not seen. However, there is still a problem with the owner and manager being slow to submit applications when there have been variations. The Commission is still awaiting an application to confirm the new ownership arrangement between Mr Kassouri and Ms Harris, trading as “Faircross Care Home.” This change will result in an application and fee being submitted to the Commission as a new registration since the change will be from a sole trader to a partnership. Failure to do this will result in the service operating illegally as an unregistered service. Equally, the new facilities have been brought into use without submitting an application to have the expansion approved. These applications must be submitted without delay. They must have the attached paperwork referred to earlier, such as an updated ‘statement of purpose’, and the certificates and reports referred to on page 25 under the ‘Environment’ heading. As with each section of this report, the manager can show improvements in important areas such as having the right household safety certificates and accounts for the handling of residents’ money. There has been a helpful response to our requirement that Mr Kassouri must show that he is staying in touch with the operation of the home. We are now sent copies of the ‘monthly reports’ that he is obliged to do whilst he remains the sole registered owner. Checks of paperwork at this visit included safety documents, including – gas and electricity certificates, and tests on electrical appliances; smoke detector Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 29 weekly checks; testing and installation of new extinguishers as part of the fire risk assessment; drills involving all staff; and the last visit by food hygiene inspector. All these were satisfactory. The policies and procedures are generally commercially available versions that have been adapted to this service by inserting the name of the home. The manager is gradually revising these to be more specific about the service and facilities provided to the service users, and is gradually working her way through the list. At this visit the inspector gave further pointers, such as how to adapt the ‘statement of purpose’ into a draft that will be sent to the Commission’s registration team as part of an application to increase numbers. He also gave advice on how to set out better evidence in the next ‘AQAA’, by giving more specific information rather than just broad statements. Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 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 X 26 X 27 X 28 X 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 X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 2 Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 31 No 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 YA1 Regulation 4(1) Requirement Timescale for action 11/08/08 2. YA42 23(4) 3. YA43 39 The registered persons must revise the ‘statement of purpose’, making sure it accurately covers all areas specified in “Reg. 4(1)(c)/Schedule 1”. This must be specific about the services and facilities, and be factually correct. A copy of this document must be included in the application referred to in Requirement 3 below. 11/08/08 The registered persons must consult with the fire authority and gain their approval for the safety arrangements in the expanded building. This must include the fire detection system, emergency lights, and suitable compartmentalisation required to prevent fire spread. Provide the Commission with copies of reports provided by the Fire Authority (LF&EPA). Changes to the registration 31/10/08 status of the current provider must be notified to the Commission, together with a new registration application and fee for the registration as a DS0000027898.V365270.R01.S.doc Version 5.2 Faircross Avenue Page 32 partnership. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 33 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 Faircross Avenue DS0000027898.V365270.R01.S.doc Version 5.2 Page 34 - 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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