Inspection on 11/08/09 for Stoke Newington Common, 6

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

CQC found this care home to be providing an Excellent 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

Stoke Newington Common, 6 05/01/07

Stoke Newington Common, 6 31/07/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stoke Newington Common, 6 6 Stoke Newington Common London N16 7ET     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Peter Illes     Date: 1 1 0 8 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Stoke Newington Common, 6 6 Stoke Newington Common London N16 7ET 02088060303 02088060303 6stokenewington@hillgreen.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Hillgreen Care Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following categories of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home 6, Stoke Newington Common is a privately operated care home that is registered to accommodate six younger adults with a learning disability. The home currently accommodates people with complex needs and behaviour that can challenge services. The premises is a large three storey terraced house opposite to Stoke Newington Common in the London Borough of Hackney. Accommodation is provided on three floors and the basement. The building was substantially renovated when it was registered in 2005 and all residents bedrooms have en-suite facilities including a shower, wash hand basin and toilet. Bus and rail links are very good and the home is Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 6 Brief description of the care home near to a range of local amenities. The stated aim of the service is to support and guide people to live a normal life by enabling them to settle and integrate within the community, to become accepted and valued as individuals and to enjoy all the facilities and amenities available to all people within that community. At the time of the inspection, fees were charged at a weekly rate of £1400 - £1700, dependent upon the persons need. Information about the service, including inspection reports, are made available to interested parties on request. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 28th August 2007. This key inspection took approximately six and a quarter hours and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken on behalf of the Commission. The registered manager was available to assist throughout this inspection; six residents were living in the home on the day and there were no vacancies. The inspection activity included: meeting and speaking to all the residents although conversation was limited due to their communication needs; detailed discussion with the registered manager; independent discussion with the senior support worker and two other support workers and an independent telephone conversation with a team Care Homes for Adults (18-65 years) Page 6 of 32 manager from L.B. of Hackneys learning disability service. Further information was obtained from a tour of the building, documentation kept in the home and from survey forms. These included survey forms from residents, some of whom had been completed with the help of relatives, and a survey form from a GP. The registered manager sent us an Annual Quality Assurance Assessment (AQAA) when we asked for it. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of up to date information to assist people and their representatives make a decision about whether the home can meet the persons needs and wishes. Each persons needs and wishes are properly assessed by the home when they are referred, to make sure that the home has the resources and skills to meet these. Once admitted residents needs and wishes are regularly reviewed to help the home make sure it is aware of any changes to these. Evidence: The home has an up to date statement of purpose and an easy to read (pictorial) service user guide; we were given a copy of both documents. These were seen to be up to date and provide a range of information to help prospective residents, and those involved with them, to decide whether the home can meet their needs and preferences. The homes annual quality assurance assessment, (AQAA), states; Before service users move into our home we ensure that they test drive the home before they move in. We undertake a good transition over a couple of weeks so that both parties Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: are sure we will suit each other. One new resident had been admitted to the home since the last inspection and we looked at this persons file. This showed evidence that the home had received a range of specialist assessment information about the person before they were admitted. This included information from a psychiatrist, a learning disability nurse, an art therapist, a speech and language therapist an occupational therapist and a psychologist. The file also showed that the home had undertaken its own assessment of the persons needs and wishes prior to admission to help make sure that the home was likely to be able to meet these. Following admission there were two reviews undertaken with the placing authority within the first six weeks which led to the placement becoming permanent. We spoke to a team manager from the L.B. of Hackneys learning disability service who told us that the authority were satisfied with the service they were receiving from the home. The files of two other residents were inspected and these two residents have lived at the home since 2006. These files showed evidence that once admitted to the home peoples needs and preferences about how they are supported are reviewed on a regular basis to ensure that the home was aware of any changes relating to these. The home operates a key worker system and three staff who act as key workers were spoken to independently during the inspection. These staff were knowledgeable about the different residents needs and their individual preferences regarding their support. Key workers were able to describe how they worked with their nominated residents to promote these. We particularly noted that staff presented as being committed to promoting each individuals wishes regarding equality and diversity; including their religion, culture, ethnic background and sexuality. Key workers confirmed that they undertook monthly reviews with each resident and the notes seen of these monthly reviews were detailed and took a holistic approach to the person and their wishes. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from their needs and wishes being well documented in their care plans to assist staff in addressing these effectively. Residents appreciate being supported to make as many decisions for themselves as they can to give them greater control over their day to day lives. They are also supported to take appropriate risks to help them safely achieve their aspirations. Evidence: The homes annual quality assurance assessment, (AQAA), states; We have very good and user friendly care plans and person centred plans for our service users. Three residents files were inspected and each contained an up to date and comprehensive care plan. The care plans showed the persons individual needs and how they would like these addressed. Areas covered by the care plans included: physical health needs, mental health needs, social networks, travel in the community and a range of individual issues relating to keeping the person safe in different environments. We were pleased to see that the home was in the process of writing Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: care plans in a pictorial format so that these would have more meaning for residents and to assist them in meaningful involvement in the care planning process. In addition the home has also developed person centred plans, (PCPs), that are developed with residents and that are much more focused on the individuals personal aspirations rather than their assessed needs. Both care plans and PCPs had been signed or marked by residents to evidence their involvement with the process. At the last inspection a good practice recommendation was made that the home should write a record on care plans of any review and who was involved in it, to further evidence a review has taken place and to confirm to staff that the document is current. This recommendation had been acted upon and we saw a separate record of monthly reviews that are undertaken by key workers. The plans were informed by a social history that identified the persons likes and dislikes including how the person likes to be supported with their religious and cultural needs and preferences. The plans were also informed by a range of detailed risk assessments that were detailed and up to date. In addition each person has a Positive Behaviour Support Plan that includes guidance for staff on how to provide a calm atmosphere for residents to minimise incidents where the person felt the need to inappropriately challenge or confront others. The guidance for staff also includes the most effective ways to react if the person does become frustrated or angry. Although Positive Behaviour Support Plans were in place at the last inspection a requirement was made at that time that where a risk assessment identifies the possible need for physical intervention the guidance for staff should be more specific. This was to include that only approved methods of restraint are to be used and only by staff that are trained and competent to do this. This requirement was being complied with and the files seen contained detailed guidance to staff regarding the use of physical restraint where this was the only way to deal with behaviour that challenges the service. We also saw evidence in the homes documentation that there is a clear and detailed physical restraint policy and also that staff are properly trained to use physical restraint; staff spoken to confirmed this. The registered manager was keen to point out that the use of physical restraint is the last option for staff to consider and that the whole ethos of the home is to prevent challenging behaviour occurring in the first place. He went on to say that if a situation does escalate then staff are trained to try to diffuse this using a range of non physical interventions in the first instance. From sampling the records of incidents that had occurred since the last inspection we were impressed to see that the number of serious issues of physical challenging behaviour has significantly decreased over the past two years. It is our judgement from the Care Homes for Adults (18-65 years) Page 13 of 32 Evidence: evidence seen that staff intervention to reduce challenging behaviour is becoming increasingly effective. We observed staff interacting with residents throughout the inspection and this was seen to be undertaken in an appropriately friendly manner and in ways that were respectful of residents wishes. Care Homes for Adults (18-65 years) Page 14 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents enjoy a range of appropriate activities, both within the home and within the wider community. However, more effective planning for holiday trips may reduce residents becoming upset if such a trip has to be postponed. Residents are encouraged to enjoy contact with family and friends to the extent that they wish. Residents benefit from a staff group who are knowledgeable about their needs and treat them with proper respect. Residents are also supported to eat a healthy and balanced diet of their choice. Evidence: The homes annual quality assurance assessment, (AQAA), states; We provide a service for a varied group of service users in terms of ethnicity and religion. This includes people who are Jewish, Muslim, Christian and Black of African and Caribbean origin. We do local dishes for all of them and take whoever is interested to their respective festivals in the wider community. Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: The home has a weekly programme of activities for residents that is developed in consultation with them. This included such activities as bowling; the use of a local sports centre, including trampoline sessions; swimming; visiting local community resources, including the pub and going to the cinema. We were told that the activities can be varied on the day, depending on what residents would like to do at the time. On the morning of the inspection the majority of residents decided they would like to go to the cinema that afternoon and this was arranged. Residents have cinema cards to assist with this activity, which we were told residents very much enjoy. The homes daily notes showed evidence of activities that residents took part in and a separate daily activities record is also completed for each resident, to further evidence activities undertaken by each person each day. The home has the use of a mini-bus although although staff are working hard to support residents use public transport where possible; each resident has a travel pass to assist with this. Residents indicated in various ways that they like using public transport and we were generally impressed that the use of this has increased over the last year or so, given their individual needs. At the last inspection a good practice recommendation was made that the home should explore how additional drivers could be identified to drive the homes mini-bus to give more flexibility in its use. The registered manager stated that the home was working hard to action this although most staff currently did not hold a driving licence. We were informed that some residents went on a short break holiday to Blackpool in 2008 and that this was very successful as most of the residents had not been on a holiday for many years. We were disappointed therefore to learn that the home had planned another break to Blackpool for residents this year but this had been postponed by the provider organisation just days before the residents were due to leave. We were told that this was because the provider organisation decided that the the risk was too great, partly because the plan was for residents to travel to Blackpool by train this year. Feedback from staff, and residents records seen, showed that some residents were upset by the very short notice of the cancellation of this trip and that episodes of challenging behaviour had increased at the time. However, we were told that another holiday is currently being planned for this year to take the place of the cancelled one. While we appreciate that providers must ensure that identified risks to residents and others is assessed and minimised wherever possible these should be identified in a planned and timely manner so that residents do not get let down at the last minute. A good practice recommendation is made regarding this. Residents are supported by the home to maintain contact with relatives and friends Care Homes for Adults (18-65 years) Page 16 of 32 Evidence: and comment cards, staff and other records all assisted to evidence this. As stated above, residents come from a range of different ethnic communities and evidence was seen that individuals are supported by the home and by relatives to meet their needs and preferences, including relating to their culture. This includes by being supported to attend their chosen place of worship; with their personal care and appearance and with their diet. Residents are also supported to maintain their sexual identity in a sensitive manner, including which behaviour is suitable in public and which behaviour is more appropriately engaged in in private. Evidence of this was seen in peoples care plans and also in minutes of a recent residents meeting. Throughout the inspection staff were seen to interact with residents in an appropriately respectful and friendly manner. Staff were seen to communicate with residents using a variety of means, including sign language and range of other appropriate non-verbal communication. From their reactions residents were relaxed and obviously comfortable during the interactions observed. The home has a four weekly menu that was seen although we were told that this could be flexible with residents choosing alternatives on the day. The menu contained a range of dishes to meet the preferences of residents, this included dishes such as plantain and yam with tomato stew and fish; it also contained other dishes appropriate to residents from a range of other cultures. Where appropriate the home is working with relatives to ensure that the meals supplied are appropriate to the persons religion, e.g. Kosher food. Residents are also supported to attend restaurants catering for people from different ethnic communities, e.g. Turkish restaurants. Evidence was seen that the home receives ongoing input and has good working relationships with the Community dietitian service and that staff are working hard to ensure that residents eat healthily as well as enjoying meals of their choice. The home keeps a record of meals eaten by all the residents as part of this process. Food was seen to be properly stored as was a range of satisfactory health and safety records relating to food storage and preparation. Care Homes for Adults (18-65 years) Page 17 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is working hard to meet peoples personal care needs in ways that they prefer. People also benefit from the homes good working relationships with healthcare professionals in order to promote their healthcare. The homes medication policies and procedures help protect people living in the home. Evidence: All the residents living at the home need a range of support with their personal care. Their needs and preferences in this area are well recorded in their care plans and person centred plans with clear guidance to staff on meeting these. Records seen were especially clear regarding peoples preferences including their cultural needs and preferences, in relation to their personal care e.g. skin and hair care. The home works hard to have both male and female staff on duty to enable gender specific personal care to be offered to residents. Staff spoken to were knowledgeable about different peoples preferences and were aware that meeting these sensitively has contributed to reducing residents displaying behaviour that challenges. Records should that the home has developed increasingly positive relationships with the local learning disability team, including the healthcare professionals within that Care Homes for Adults (18-65 years) Page 18 of 32 Evidence: team. Evidence was seen of ongoing input from professionals including from a dietitian, psychiatrist, psychologist and community nurses. (We were told that the provider organisation also employs a psychologist whose input is valuable to staff). In addition residents also have access to other community health resources including GP, dentist and optician. We received a comment card from the GP that the majority of the residents are registered with. This stated; Excellent communication with our GP practice. Kind, supportive staff always accompany clients here and are very respectful toward them. Peoples files inspected all contained an overall record of healthcare appointments they attended as well as a record of each appointment, the outcome of the appointment and any guidance to staff resulting from the appointment. At the last inspection a good practice recommendation was made that the home should write to the consultant psychiatrist to request written feedback from appointments so that the home has a record of this. This had been acted upon and we saw reports from the consultant psychiatrists appointments with residents on the files inspected. The homes medication systems were inspected and indicated that residents were being supported to receive their prescribed medication safely. Medication was properly stored, both in a proper medication cabinet and in a separate medication fridge. The medication and medication administration record (MAR) charts for two residents were inspected and were found to be accurate and up to date. These showed clear guidance on peoples medication needs, including any allergies, and also clear individual guidance for those people who may need to be given medication as the need arises (PRN medication). The separate record of a resident who has diabetes and is given insulin injections by a community nurse were inspected and were also up to date. Records showing medication entering the home and medication no longer needed by the home were up to date. We were informed that a recently appointed senior support worker was now taking a delegated overview of medication procedures in the home and that this was proving useful. Staff spoken to and records seen indicated that staff that administer medication have been properly trained to do so. Care Homes for Adults (18-65 years) Page 19 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are protected by the homes complaints policy and procedures and also the homes safeguarding policies and procedures, both of which staff are familiar with. Evidence: The homes annual quality assurance assessment, (AQAA), states; We keep our complaints book and procedure simplified for all to access, and in the service users meetings this forms part of the agenda. We inform them that they have a right to complain and that we will help them with the process if they wish to. The home has an easy to read(pictorial) complaints procedure and a summary of this was displayed in the home. Both of these were seen to be current and satisfactory. The homes complaints log was inspected and showed that the home had received two complaints since the last inspection. Both showed evidence that they had been properly investigated and responded to. A response letter inspected informed the complainant that if they were unhappy with the response to the complaint they could take their complaint to the next stage of the provider organisations complaints policy and also how to do that. We also noted that Complaints was a recurring theme in residents meetings, i.e. that residents should tell staff if they are not happy with anything. No complaints or concerns about the service have been received by the Commission since the last inspection. The home had a satisfactory safeguarding adults (adult abuse) procedure and a copy Care Homes for Adults (18-65 years) Page 20 of 32 Evidence: of the L.B. of Hackneys safeguarding adults procedure, the London Borough in which the home is situated. No safeguarding disclosures or allegations had been reported to the home since the last inspection and none have been reported to the Commission in that time either. At the last inspection a requirement was made that the home must formally write to L.B. of Hackney to request a copy of a protection plan for an identified resident. In our judgement the action the home was taking at the time regarding this resident, agreed at a formal safeguarding adults strategy meeting, was clearly in the persons best interests. However, it was our judgement the home also needed written confirmation that the local authority had agreed this as part of the protection plan in case the home was challenged about the action by a third party. This requirement had been complied. The registered manager and staff spoken to were clear about both the actions they should take individually and the actions the home should take if an allegation or disclosure of abuse be made to them. Staff spoken to confirmed that they have received up to date training on safeguarding and how to respond. Care Homes for Adults (18-65 years) Page 21 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that meets their basic needs but may benefit from more robust fittings and furniture, including more robust flooring in bedrooms, to further promote their comfort feeling of well being. The home was appropriately clean and tidy for the benefit of all. Evidence: The homes annual quality assurance assessment, (AQAA), states; We keep our home as comfortable, homely, safe and as clean as we possibly can. Our service users rooms are constantly redecorated to suit their individual tastes and preferences. The Company now has a full time handy person who we can call on within three to four hours and get the repairs done if we have any major breakdowns. Accommodation is provided on three floors and the basement. This is arranged as follows: on the second floor there are two residents bedroom and the managers/ staff office; on the first floor there are two residents bedrooms and a quiet/ multi-purpose room; on the ground floor there is one residents bedroom, kitchen, the main lounge/ dining room, laundry, a communal bathroom/ toilet and main entrance hall to the home. One further residents bedroom is situated in the basement. All residents bedrooms have en-suite facilities including a shower, wash hand basin and toilet. Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: At the last inspection seven requirements were made to assist improve the environment that residents live in. One of these was ensure that the laminate flooring in residents bedrooms was repaired or replaced. This had been acted upon with evidence that the laminate flooring in rooms had been repaired or replaced, some of it quite recently. However, we were disappointed to see that the new flooring in most residents rooms was also now damaged, particularly by water between the laminate strips, through constant washing to maximise infection control. This was the main cause of the damage identified at the last inspection and the registered manager told us that it was an ongoing problem. We do understand that the home is subject to very hard wear and tear because of the residents particular needs. However the state of the floors significantly detracts from the homeliness of the environment and may well have a bearing on how some residents may feel about the environment they live in. The state of the flooring was also a major factor that staff identified when asked if there were things the home could do better. Given that this issue was identified at the last inspection it is a major factor in our judgement that outcomes for residents in this section of the report is considered only adequate. A good practice recommendation is made that the provider organisation explores more specialist and robust floor coverings for the areas of the home that residents have access to. The other requirements made at the last inspection regarding the environment were in the following areas: ensuring that furniture in peoples bedrooms was kept in good repair and be strong enough to meet their needs; that the communal toilet was kept in good repair; to replace a shower hose in the communal bathroom; to ensure that the home complied with the latest legislation regarding smoking; to ensure that the light in the kitchen was kept in good working order and to ensure that adequate arrangements were put in place to keep people safe in the homes rear garden. Most of these requirements had been met e.g. new fencing and rails to help keep people safe in the garden, with staff working hard to keep compliance with others e.g. bedroom furniture and facilities such as the communal toilet receive very hard use and need ongoing attention. We did meet the provider organisations new handy person who was dealing with an emergency repair in the shared bathroom on the day. The registered manager stated that having swift access to the handy person had made maintenance much easier since he had been in post and no new requirements are made about the environment at this inspection. Given the needs of the residents living in the home we judged the home to be appropriately clean and tidy during the inspection. The home has appropriate laundry facilities and infection control procedures that staff had undertaken training in Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: recently. Care Homes for Adults (18-65 years) Page 24 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a staff team that are competent and are deployed in sufficient numbers to meet residents needs. Residents are also protected by the homes robust recruitment procedures. Staff receive proper training and management support to assist them in effectively meeting residents needs and preferences. Evidence: The homes annual quality assurance assessment,(AQAA), states; All our staff members except one have got a minimum of (national vocational qualification) NVQ level 2, the only one who has not is working toward NVQ level 3 (in care). The company has got a centralised recruitment system which requires all prospective staff members to go through a recruitment process and vetting, all conducted by the human resources department at our head office. At this inspection we saw documentary evidence that staff had achieved the NVQs outlined above and staff spoken to confirmed this. At the last inspection a requirement was made that the home must ensure that staff are able to effectively operate the fire evacuation procedures at night to make sure that people are fully protected in this area. We say evidence that this had been complied with and noted that the home now deploys a sleeping in member of staff at Care Homes for Adults (18-65 years) Page 25 of 32 Evidence: night as well as a waking member of staff, to strengthen the night cover available. We saw a copy of the staff rota that showed in addition to the night staff the home deploys a minimum of three staff during the day time and the rota accurately recorded the staff on duty during this inspection. The registered manager is in addition to the rota and were were told that there is management on call cover available for when the registered manager and the senior support worker were not on duty. Support staff spoken to confirmed that this worked effectively. It was our judgement that the staff deployment was sufficient to meet the current needs of the residents living at the home. The home had employed two new staff since the last inspection and these two staff members files were inspected. Both of these files contained: a criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check obtained by the provider organisation prior to the staff member starting work, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work where appropriate. From the evidence seen it is our judgement that the home operates a robust recruitment procedure that helps protect residents. Staff training records were sampled and showed evidence that staff receive regular and relevant training. Evidence seen of recent training undertaken by staff included in infection control, supporting people with challenging behaviour and person centred planning. Evidence was also seen of the current training programme programme for staff run by the provider organisation and this was also satisfactory. It was noted that staff training records are kept in each individual staff members file which, in our judgement, made it somewhat difficult for the registered manager to quickly monitor which training staff had undertaken and when refresher training was due. A good practice recommendation is made that the home develops a training matrix to make this easier to monitor. Evidence was seen that staff receive supervision at least every two months and also receive an annual appraisal. Staff spoken told us that they felt well supported by management and confirmed they received regular supervision and an annual appraisal. Care Homes for Adults (18-65 years) Page 26 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and staff continue to benefit from the home being effectively managed. People living in the home also benefit from appropriate ways of involving them and other stakeholders in quality assurance monitoring that contributes to identifying how the service can continue to improve. However, more evidence of monitoring the quality of care in the home by the provider organisation would maximise he the homes quality assurance mechanisms.The home has effective health and safety procedures in place to protect people living there as well as others that work in or visit the home. Evidence: The registered manager presented as being competent and very knowledgeable about the needs of people with a learning disability, particularly those whose behaviour may challenge services. He has achieved his registered managers award and holds a masters degree (mental health) and a bachelors degree (social sciences). In addition he informed us that he is now a member of the L.B. of Hackneys Person Centred Planning Champions Forum and L.B. of Hackneys Quality Network Review system. Feedback from staff spoken to, including the senior support worker, was that he is Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: approachable and supportive to staff. The homes annual quality assurance assessment, (AQAA), states; We have a range of excellent monitoring tools for the proper review and development of the home. Evidence was seen that the home has a range of appropriate ways that it monitors the quality of the service it provides to residents given that most residents are non verbal and have complex needs. The home holds Quality Assurance - Evaluation of Positive Goals meetings, these are separate meetings from formal reviews and include a range of stakeholders including relatives, social work staff and any other person who is significant in the residents life. The meetings help promote how the person can meet their personal aspirations and is linked to the person centred planning process. The home also operates a robust key worker system which allows key workers to evaluate and monitor the persons progress and who contribute to the regular review of the persons care plan. In addition the home holds regular residents meetings with topics seen in the minutes including activities, meals, health and safety, how to complain and sexual well being. The registered provider organisation also undertakes monthly monitoring visits to the home and copies of the reports of these were sampled. The reports seen were satisfactory although at the time of the inspection there were only reports available for four months out of the last six months. A requirement is made regarding this. However, the registered manager stated that he felt well supported by the provider organisation and its managers. At the last inspection a requirement was made that the home must review its fire precaution arrangements including its fire risk assessment and fire plan. We were pleased to have received confirmation that this had been complied with soon after the last inspection. We also noted at this inspection that the home had increased its night staff (see the Staffing section of this report) which strengthens the homes ability to deal with a fire should one occur at night. At this inspection the homes fire log had a clear record to evidence that the homes fire fighting equipment is serviced regularly and that regular fire drills take place. A range of satisfactory health and safety documentation was seen. This included; a gas safety certificate, portable appliance test certificate and an electrical installation certificate. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 26 The registered persons must 30/09/2009 ensure that an unannounced monitoring visit by the provider organisation takes place each month and that a report of the findings of each visit must be made available to the registered manager in a timely manner. This requirement is made to maximise the health, safety and well being of residents. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 14 When planning holidays for residents the provider organisation should assess known risks and make appropriate plans to minimise these in a timely manner . This is to minimise disruption and disappointment to residents at the home if arrangements need to be changed, especially given their complex needs. The provider organisation should explore more specialist Page 30 of 32 2 24 Care Homes for Adults (18-65 years) Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations and robust floor coverings for the areas of the home that residents have access to, this is in order to maximise residents safety and comfort. 3 35 The home should develop a staff training matrix to allow managers to more quickly monitor what training each staff member has undertaken and when refresher training is due. This is to assist in monitoring that staff skills and knowledge are up to date. Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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