Inspection on 11/06/09 for Greenfield Road 9

This is the latest available inspection report for this service, carried out on 11th June 2009.

CQC 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.

Other inspections for this house

Greenfield Road 9 11/05/07

Greenfield Road 9 24/04/06

Greenfield Road 9 31/10/05

Greenfield Road 9 25/04/05

Greenfield Road 9 25/10/04

Greenfield Road 9 14/07/04

Greenfield Road 9 04/03/04

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 25/11/2009.

Key inspection report CARE HOME ADULTS 18-65 Greenfield Road 9 London N15 5EP Lead Inspector Susan Shamash Unannounced Inspection 11th May – 11th June 2009 4:45 Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenfield Road 9 Address London N15 5EP 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) 020 8809 7044 020 8809 7044 companionincare@hotmail.com Companion in Care Ltd. Mr John Ajumobi Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 3 people of either gender who have a mental disorder (MD) or who have a learning disability (LD) Date of last inspection 4th November 2008 Brief Description of the Service: Greenfield Road is registered as a care home for a maximum of three adults between the ages of 18 and 65 who may have mental health problems or learning difficulties. The home’s registered provider, Companion in Care Ltd, owns two other homes in Brent and Newham. The home consists of a large three-storey town house situated in South Tottenham in the borough of Haringey. There are good public transport links to the area and a good variety of shops and other amenities are close by. On the ground floor, there is a kitchen/ lounge/diner, a toilet and bathroom, with access through the lounge to the garden and a laundry area. Two bedrooms and an office are situated on the first floor. A toilet and bathroom and two more bedrooms are located on the second floor. None of the bedrooms are en-suite. There is a small garden at the front of the property and a large paved garden at the rear. The home is not suitable for people with mobility problems. The stated aims of the home are to provide care, support and attention to people living at the home to enable them to lead as normal a life as possible. Inspection reports are available upon request from the registered manager/provider. The current scales of charges are from: - £500 to £550 per week. There are no other additional charges. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection visit lasted approximately four and a half hours, over two days. The manager was not available at the home at the time of the first visit to the home, and therefore a follow up visit was arranged in order to gain access to staff files and other relevant documentation. I was assisted by a staff member during the first visit, and had the opportunity to meet with all three residents who live at the home. On the second visit I met another staff member, and the manager, alongside two of the three residents living at the home. The home remains fully occupied by people who have lived there for a number of years. I also conducted a brief tour of the building, and examined residents’ care plans, staff records, health and safety records, and other records relevant to the running of the home. Information provided in surveys distributed to three people living at the home, and returned to the Care Quality Commission, was also taken into account as part of this inspection. What the service does well: The home supports three people with mental health disorders. They have all lived in the home comfortably for a number of years. Each person living at the home has their own bedroom, which is decorated appropriately meeting their individual needs and choices. Clearly recorded care plans and risk assessments are available for people living at the home, and the standard of documentation and organisation of records within the home is high. People living at the home are able to go out independently and if support is needed this is available from the home. The care staff team are generally experienced, understanding and positive in their work practices and support of the people living at the home. Clear records are available of one-to-one key working support provided to residents, enabling them to work towards their agreed goals. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 6 Residents are very satisfied with the food provided to them within the home, alongside staff support with cleaning, laundry and occasional activities. One resident noted ‘The home feeds us and does our washing, good TV and cleans our rooms.’ What has improved since the last inspection? What they could do better: Some improvements are needed to the home environment, particularly the rear garden area and the window in two bedrooms. It is recommended that guidelines be kept for ‘as and when’ medicines prescribed for people living at the home, that quality assurance procedures be upgraded and that fire drills be held at more varied times, for the further protection of people living at the home. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 7 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 8 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 Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents’ needs are assessed prior to their admission to ensure that these can be addressed appropriately. EVIDENCE: Detailed assessments were available in the files of the three people living at the home, indicating that appropriate information was obtained prior to their being admitted. This was confirmed by staff and residents spoken to. The Statement of Purpose, Service User’s Guide and contracts for each person living at the home had been checked at previous inspections. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the 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 monitored and reviewed regularly to ensure that the changing needs of people living at the home are met appropriately. People living at the home are supported to make decisions about their lives and to take informed risks to develop their independence skills. EVIDENCE: Care plans and risk assessments continue to be in place for people living at the home taking account of people’s cultural needs and lifestyle choices. All people living at the home have a care plan in place and all three care plans were examined. Each care plan had been updated within the last six months as appropriate and discussion with staff and people living at the home confirmed that they reflected individuals’ current day-to-day goals and Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 11 aspirations. These included mental health needs, budgeting, activities, personal hygiene and daily activities. Care plans were signed and dated by people living at the home and residents spoken to advised that they were consulted about their care and support needs. There were also records of key working meetings with each person, during which further support was provided for people to work on their individual goals. Two staff members had undertaken training in Person-Centred planning, and one staff member spoken to advised that they were using this training to encourage greater participation by residents in their own care plans, and a more holistic approach. Risk assessments were updated regarding all three people. Residents advised that they were not being left alone at the home at any time, and this was confirmed by the staff member on duty. The manager is aware that written agreement of placing authorities and relevant medical professionals is needed if it is felt that particular individuals would benefit from time alone within the home. Risk assessments were also available regarding smoking for all people living at the home indicating that they had been consulted and agreed to the safeguards recorded. One of the people living at the home manages their own finances. One person’s money is managed by the home and the placing authority manages the other person’s money. Monies stored on behalf of people living at the home were clearly recorded, as were details of monies withdrawn from bank accounts and how these had been spent. Residents confirmed that their monies were available to them whenever needed, as appropriate, and I was able to witness one resident requesting and being given their money as appropriate. People living at the home are offered opportunities to participate in the day-today running of the home, through monthly resident meetings and annual questionnaires. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 12 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): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17. People using the 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 living at the home know that their rights are respected and their independence is supported. They are encouraged to maintain contact with family and friends, utilise facilities in the local community and their cultural needs are met. People living at the home are satisfied with the choice and variety of meals served to them, and these meet their nutritional needs. EVIDENCE: People living at the home told me that they continued to go out independently, visiting local shops, markets, family members and friends. The staff member on duty on the first day of the inspection, confirmed that one person living at the home continues to undertake voluntary work at a local Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 13 day centre. The others go out to support group drop-in sessions, local cafés or shops and Holloway Road market. I observed staff interaction with people living at the home and this was appropriate. During the course of the inspection, residents came in and out of the home independently, all having their own key to the door. Timetables of each person’s daily activity programmes were displayed in the office, and these indicated that each person had a full day’s activities planned. Activities recorded in daily records included shopping, household chores, cooking, bus rides, a support group drop-in, visiting friends, us of an exercise bike, resident meetings, going to the market, post office, betting shop and other local facilities. Following a requirement made at the previous inspection, I noted an increase in activities planned for evenings and weekends, particularly for an individual identified as wishing to have more choices available to them. This resident advised that they would still like to have more opportunities to go to the cinema with staff support, and this was relayed to the home’s manager. Two other people continued to advise that they generally preferred to do their own thing rather than have activities organised for them. Two residents had been on a holiday to Butlins in Bognor Regis last year, and both told me that they had enjoyed the trip a great deal, and were looking forward to going there again for a longer period of time over the summer this year. One resident chose not to participate in the holiday, preferring to stay at home. Photographs from the holiday and other celebrations in the home were displayed around the home It was evident on individuals’ files that family contact continues to be supported by the home. Most of the residents’ families live close by. One person’s family lives abroad and they are supported to keep in contact by phone and letter. There had been an increase in activities offered to people within the last six months included trips to the coast, cinema, art galleries, shopping, and other places of interest. One person mostly chooses not to attend these activities, another is keen to take these up, and the third residents attends occasional trips. The staff member and the manager advised that further activities including days out, cinema trips, and barbeques were being planned for the summer, in addition to the two holidays. This was confirmed in the minutes of recent residents meetings. Records of food served indicated that the home continues to provide at least one hot meal during the day, in the evening, with breakfast and a light lunch also provided. I observed residents making cups of tea at their leisure during the inspection. The kitchen was well stocked with fresh fruit, dried, tinned and Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 14 frozen produce, and a selection of fresh, canned and frozen vegetables. People living at the home advised that they continue to enjoy the food provided. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the 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 living at the home are supported in the way they prefer with their health and social care needs met appropriately. They are safeguarded by the policies and procedures for dealing with medicines, promoting good health. EVIDENCE: All people living at the home are independent with regards to personal care, but the staff advised that at times they might need prompting to ensure good personal hygiene is maintained. Some changes in one person’s need for support in this area were discussed, and their care plan had been updated accordingly. One staff member had undertaken training in supporting people with diverse needs, including sexuality, ethnicity, race and lifestyle choices. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 16 Healthcare records were detailed indicating appointments attended by people living at the home, including those refused by residents. One person living at the home is working to control their weight, with support from staff to use their exercise bike which they prefer to attending the gym. Medication was checked and was in good order with no gaps in the medication administration records and appropriate storage arrangements in place. Prescribed medicines received at the home and those returned to the pharmacy were recorded as appropriate. I observed staff administering medication to one resident and people living at the home confirmed that they are given their medication regularly by staff. No residents are currently self medicating. It is recommended that written guidance should be obtained from people’s GPs regarding the administration of and PRN (as and when) medicines prescribed to individuals living at the home, to ensure that these are administered safely. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the 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 living at the home feel that their concerns are listened to and addressed. Staff have a good knowledge and understanding of adult protection issues which protects people living at the home from abuse. EVIDENCE: People spoken to during the inspection visit, advised that they would feel able to speak up about issues of concern to them within the home. The home has in place complaints and abuse policies and procedures including the local authority’s Safeguarding Adults Policy and Procedure. Concerns recorded since the previous inspection had been addressed appropriately, indicating that people views were being taken into account. Compliments from residents were also recorded, particularly with regard to a new television purchased for the lounge, a day trip to the seaside, and food served at the home. Staff records showed that all except the most newly recruited staff member had undertaken training in Safeguarding Vulnerable Adults. Both staff members spoken to were aware of action to be taken in the event of an allegation or disclosure of abuse against a service user. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally furnished and decorated appropriately, and kept clean and hygienic, however some improvement are needed to the garden, and within people’s bedrooms, to ensure that people live in a comfortable environment. EVIDENCE: At this inspection and the previous random visits, people living at the home stated that they are generally happy in the home, and their bedrooms are comfortable to meet their individual needs. Over the years the manager has improved a number of areas of maintenance within the home. As required previously, the communal areas of the home had been redecorated and the bathroom and toilet on the top floor had been Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 19 refurbished. An ongoing problem of a leak in the shower room on the first floor had also been repaired as appropriate. Residents’ bedrooms were generally decorated appropriately, and they advised that they had chosen the colours for their bedroom walls, and were happy with the outcome. However the rug in one person’s room was covered in cigarette holes, and the chest of drawers in one bedroom was also in poor repair, and in need of replacement. The ceiling in an identified bedroom (following an incident of flooding) must be repainted, and a schedule should be provided for replacing the windows in two identified residents’ bedrooms (which are cloudy due to condensation between the two layers of double glazing). The carpet on the staircase within the home, was also quite worn and should be replaced for the comfort of people living at the home. The laundry facilities are accessed by the rear garden and included soap and towels for hand washing. An exercise bike purchased by one resident is also housed in this area. The brickwork around plants in the rear garden had been crumbling, and this should be repaired. There were also a number of worn chairs in the garden area, which did not give the garden a pleasant appearance. More durable new garden chairs should be provided in this area, and worn furniture should be discarded, the rear garden fences must also be repaired. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A competent and effective staff team supports people living at the home. Residents are protected from potential abuse by appropriate recruitment procedures. Staff are generally well trained and supervised to ensure that they work in line with best practice and ensure the safety of people living at the home. EVIDENCE: The rota was displayed on the staff notice board. Discussion with staff members and inspection of the rota showed that there are now primarily three staff members working at the home, with two in particular working on most days. Both staff members spoken to advised that they were happy with the rota and could request time off at anytime if needed. Residents generally spoke highly of the support provided to them by the staff team, and I observed supportive interactions between staff and residents during the inspection visit. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 21 I examined three staff files during the inspection, including files for the most recently recruited staff members. Evidence was available of satisfactory enhanced Criminal Records Bureau (CRB) disclosures for each staff member, alongside two written references, application forms, evidence of identity checks etc. as appropriate for the protection of people living at the home. I saw evidence of staff training booked for the coming months, alongside certificates confirming training undertaken in fire safety, manual handling, mood disorders, food hygiene, health and safety, self harm, care planning, infection control, person centred care and diversity. Two staff members have gained National Vocational Qualification (NVQ) level 2 in Care, and one was working towards NVQ level 3. As required at the previous inspection, the registered manager and staff members identified had undertaken up to date training in first aid. Support workers spoken to advised that they receive regular supervision and support from the manager. Records showed that regular supervision was being carried out at the moment, although there had been some gaps last year. One staff member and the manager had undertaken training in the implications of the Mental Capacity Act 2005 as recommended previously, and the implications had been discussed at a staff meeting. Records of staff meetings indicated that these were being used effectively to discuss relevant issues regarding the way the home is run including training, activities, cleaning and medication administration. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People using the 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 living at the home benefit from a well organised home and can be confident that their views are sought and taken into account. They are generally well protected from harm by the home’s health and safety procedures. EVIDENCE: The manager is qualified and sufficiently experienced to run the home and meet its aims and objectives. He has a Diploma in Social Work and has extensive experience of working with people who have mental health problems. As required previously, the manager provided evidence that he has commenced working towards the registered manager’s award at NVQ level 4. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 23 As required at the previous inspection, a rudimentary annual quality assurance audit had been undertaken for the home including feedback from residents. This was generally positive regarding the food, care, cleaning, laundry and cinema trips. However it is recommended that feedback also be obtained from staff, relatives, health care professionals and social workers, and that a more rigorous system of auditing all areas of the home’s activities at least annually, be put in place. Regular residents meetings and staff meetings had been arranged for the home, and this was confirmed by staff and residents alongside records of the meeting minutes. As required previously the Regulation 26 visits (unannounced visits by the provider organisation) were being undertaken monthly, and addressed areas for improvement alongside the strengths of the home, on each occasion. Clear records were maintained of incidents and accidents occurring at the home and the general standard of record keeping was found to be high. Current gas and electrical installation certificates, portable appliances testing and fire equipment records were available as appropriate. There was evidence that the home had complied with requirements made during the most recent London Fire Emergency Planning Authority (LFEPA) fire officer visit. Environmental and fire risk assessments were in place and regular alarm tests and fire drills were being organised. I noted a tendency for fire drills to be undertaken at the same time of day, and it is therefore recommended that the times when fire drills are carried out should be varied, to ensure that staff and residents are well prepared in the event of a real fire at the home. . Records were available of hot water temperature from various outlets in the home, evidencing that these are maintained at 43°C or below, to avoid the risk of scalding. Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 24 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 X 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 2 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 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Version 5.2 Page 25 Greenfield Road 9 DS0000010810.V375554.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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 YA24 Regulation 23(4) Requirement The registered persons must ensure that the following issues are addressed with regard to the home environment: The brickwork around plants in the rear garden must be repaired, more durable new garden chairs should be provided in this area, and worn furniture should be discarded, the rear garden fences must also be repaired. A new rug and chest of drawers should be provided for the identified residents. The ceiling in an identified bedroom must be repainted, and a schedule should be provided for replacing the windows in two identified residents’ bedrooms, and replacing the carpet on the staircase within the home, for the comfort of people living at the home. Timescale for action 14/08/09 Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA14 Good Practice Recommendations It is recommended that the home continue to provide an increased selection of activities to an identified person living at the home, on a regular basis, particularly at weekends, to ensure that they are supported to live a stimulating life. It is recommended that written guidance be made readily available for the administration of ‘as and when’ medicines prescribed to individual people living at the home, to ensure that these are administered safely. It is recommended that the quality assurance audit procedures for the home should be further developed, including at least an annual audit of all areas, and feedback from stakeholders, to ensure that the care and support provided by the home meets a high measurable standard. It is recommended that the times when fire drills are carried out should be varied, to ensure that staff and residents are well prepared in the event of a real fire at the home. 2. YA20 3. YA39 4. YA42 Greenfield Road 9 DS0000010810.V375554.R01.S.doc Version 5.2 Page 27 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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