Inspection on 17/05/07 for 100 Whitehall Street

This inspection was carried out on 17th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

100 Whitehall Street 30/06/08

100 Whitehall Street 05/11/07

100 Whitehall Street 02/11/06

100 Whitehall Street 17/05/05

100 Whitehall Street 07/10/04

100 Whitehall Street 07/06/04

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 08/07/2008.

CARE HOME ADULTS 18-65 100 Whitehall Street Tottenham London N17 8BP Lead Inspector Susan Shamash Key Unannounced Inspection 17th May 2007 01:45 100 Whitehall Street DS0000010755.V336450.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 100 Whitehall Street DS0000010755.V336450.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. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 100 Whitehall Street Address Tottenham London N17 8BP 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 8801 2930 020 8365 0097 London Borough of Haringey Vacant Care Home 18 Category(ies) of Learning disability (18) registration, with number of places 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home may provide accommodation and personal care for up to 18 persons of either gender who are between the ages of 18-65, who have learning disabilities. The provider must undertake a programme of measures that will achieve full compliance with National Minimum Standards for Younger Adults. Standards 24-30 - Environment or those equivalent Standard that may be published at the time, as required by Regulation 23 (1)(a); 23(2)(ap); 23(4)(c) and Regulation 16(2)(c)(g)(j)(k) - by April 1st 2005. In order to promote health and safety needs of service users living in Whitehall Street, the provider must ensure that the home complies with all requirements contained in relevant Health and Safety legislation on an ongoing basis and further must undertake a programme of measures that will achieve full compliance with National Minimum Standards for Younger AdultsStandard 42 - Safe Working Practices, or those equivalent Standards that may be published at the time, as required by Regulation 23(1)(a); 23(2)(a to p); 23(4)(c) and Regulation 16(2)(c)(g)(j)(k) - by April 1st 2005. Two specific service users, who are over 65 years of age, may remain accommodated in the home. This condition must be reviewed at such time as either service user is discharged and the Commission for Social Care Inspection notified. 2nd November 2006 3. 4. Date of last inspection Brief Description of the Service: 100 Whitehall Street is situated in an area just off of White Hart Lane. The home provides residential care for up to eighteen people with learning disabilities. The provider is Haringey Local Authority. The home is large and purpose built over three floors that are accessed by two staircases and a lift. There are a number of shared lounges, dining areas and kitchens and a rear garden with various patio areas. There are eighteen single bedrooms. There are no en-suite facilities but there are a generous number of bathrooms and toilets. The home was closed for major refurbishments for approximately one year in 2006. The statement of purpose states that the homes service is based on ordinary life principles and people living at the home are encouraged to access activities in the community. The home provides support with all aspects of personal care 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 5 and daily living. The home provides three main meals per day and people living at the home have facilities to make themselves drinks and light snacks whenever required. Home fees are from £618 per week as from May 2007. Copies of the most recent CSCI inspection report can be obtained from the office at the home or the CSCI website www.csci.org.uk 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as a routine visit to check on the welfare of people living at the home, which reopened at the end of 2006, having been closed for refurbishments for almost a year. The visit lasted approximately eight hours, during which the inspector was assisted by the interim manager, deputy managers and support workers on the ground and first floors. The second floor is not yet in use, however it is proposed that it will be used as a respite service. The inspector also had the opportunity to meet and speak to all of the people living at the home and spoke to four staff members in all. All staff cooperated fully with the inspection. When the inspector arrived at the home, the majority of residents were out at day activities, however all returned during the afternoon of the inspection. Four support workers were on duty at the home, two on each floor. There were five people living on the ground floor and five on the first floor. The residents on the ground floor have higher dependency needs to those on the first floor and the home is staffed accordingly. People living on the first floor had previously lived at the home and moved out to temporary accommodation whilst the home was being refurbished. The inspector conducting a tour of the building and sampled staff and resident individual records as well as records regarding the general running of the home. What the service does well: There is a generally welcoming and cheerful atmosphere at the home, and people living at the home are very positive about the support provided to them. Bedrooms are personalised reflecting the choices of the individual people living at the home. Those living at the home are satisfied with the quality and variety of food served including cultural alternatives. There is a high level of satisfaction in respect of the staff support provided to individual people living at the home. A range of activities are provided for people living at the home according to their choices. People living at the home are encouraged to be independent and to make their own choices. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 7 Residents are consulted about their care plans as far as possible. The home successfully provides sensitive individual support to people with a range of different needs, characters and interests. Staff members are knowledgeable about their role and responsibilities within the home. What has improved since the last inspection? What they could do better: It remains required that the statement of purpose must be updated to include information regarding fire precautions and emergency procedures, and the dimensions of rooms in the home. The service users guide must be made available to all people who are moving or who have moved into the home, and it is strongly recommended that this be made available in a format suitable for people living on the ground floor of the home. All people living in the home must be provided with completed and signed statements of terms and conditions, and at least annual social services reviews 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 8 must be sought for all residents. Records of these meetings must be kept by the home in the interim period before the formal minutes are received. All residents must have six-monthly reviews with the home and further information must be recorded in care plans regarding peoples’ cultural needs and lifestyle choices. It is strongly recommended that an alternative format for recording care plans on the first floor be considered, as none of the people living on the first floor are able to understand Widget symbol formats. It is also recommended that more evening activities outside of the home be made available to residents living at the home. It remains required that appropriate equipment must be made available so that people living at the home can be weighed regularly, and that weights are recorded and monitored, and that medicines received into the home or returned to the pharmacy are recorded. It remains required that there be a system in place for recording complaints on the ground floor including clear details of how each complaint is dealt with and timescales for action. It remains required that action be taken to address poor television reception in the lounge area on the ground floor. The furniture of all people living on the first floor should be inspected and replacements should be provided for damaged items. It remains required that the assisted bath on the first floor is safely accessible to all people living on that floor and that sufficient handrails be provided in the toilet facilities on this floor, so that all residents can use these safely. Failure to comply with this requirement may result in enforcement action being undertaken by the CSCI. The garden must be maintained regularly to ensure the comfort and safety of people living at the home. It remains recommended that multi sensory equipment be obtained for the home particularly for the use of people living on the ground floor. Copies of all relevant recruitment documents must be maintained on staff files and further staff must undertake training in managing challenging behaviour, learning disability, fire safety and manual handling. It remains required that an experienced manager must be appointed for the home and apply for registration with the CSCI without delay. Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. Clear records must be maintained of support provided to people living at the home who need help managing their finances and any valuables. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 9 It remains required that reports of unannounced visits to the home by the responsible individual must be sent to the local CSCI area office every month. Copies of emergency lighting, gas safety and electrical installation certificates must be provided and the fire risk assessment for the home must be reviewed at least six-monthly. 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. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 10 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 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 11 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, 2, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate assessment procedures are in place to ensure that the needs and goals of people living at the home can be effectively met. People thinking about living at the home have the opportunity to visit the home on a number of occasions prior to moving in, although the information given to them prior to moving in could be improved. Their rights could also be further protected through improved contractual arrangements with the home. EVIDENCE: At the time of the inspection five people were accommodated on the ground floor and five were living on the first floor. The people living on the first floor of the home told me at the last inspection that they had had the opportunity to visit the home prior to moving back in from their temporary accommodation in Edwards Drive, Bounds Green. They said that they remained happy to be back home, and had enjoyed picnics at the site over the summer whilst it had been closed for refurbishments. Staff confirmed that these visits had been arranged in order to keep them in touch with the home whilst it was closed. Assessments were in place for all the people living on the first floor, continued 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 12 from their previous address and appeared to be appropriate including new risk assessments for all residents following their move into the home. My communication with people living on the ground floor was more limited, due to the need for more varied communication methods. However I spent time with each person living on this floor, and saw recorded evidence that each had had the opportunity to try out the home prior to moving in. This included meal visits as well as overnight and weekend stays. Detailed assessments were also in place for all those living on the ground floor, as appropriate. At the previous inspection draft versions were available of the statement of purpose and service users guide for the home. However the statement of purpose still needed to be updated to include all the information required under Schedule 1 of the Care Homes Regulations 2001, including information about fire precautions and emergency procedures, and the dimensions of all rooms. There was no evidence that this had been completed, and this requirement is therefore restated. A copy of the updated statement of purpose for each floor must be sent to the local CSCI area office. The service users guide included some pictorial information as appropriate, however there was no evidence that each resident had received a copy of this document. A requirement was made accordingly. It is strongly recommended that the service users guide for the home be made available in a format that is accessible to all people living at the home. The interim manager advised that work was underway to make the service users guide more accessible to people living on the ground floor of the home. Once this is complete this must be made available to all people who are moving or who have moved into the home. Contracts were available for people living at the home, between social services and the home, however there were no agreements in place between residents and/or their advocates and the home. It is therefore required that all people living in the home are provided with completed and signed statements of terms and conditions, to further protect their rights within the home. 100 Whitehall Street DS0000010755.V336450.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 adequate. This judgement has been made using available evidence including a visit to this service. The needs and goals of people living at the home are assessed and responded to, in consultation with them, to ensure that these are met effectively. However insufficiently regular in-house or social work reviews mean that they may not receive sufficiently reactive support to changes in their needs. Risks are recorded appropriately with strategies in place to ensure that people living at the home are protected, whilst being encouraged to develop independence skills. EVIDENCE: I examined three care plans for people living on the ground floor. A high quality care planning system had been put in place, and as required at the previous inspection, due to the newness of the home, all care plans had been completed, although the interim manager advised that work was underway to bring them in line with Haringey formats. Not all of these care plans had been reviewed within the last six months and this is required. Information was 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 14 available regarding residents’ cultural needs and lifestyle choices, however this was insufficiently detailed to ensure that these needs are adequately met. A requirement is made accordingly. Detailed risk assessments had been produced for the people living on the ground floor as appropriate, including a risk assessment for a resident whose taps needed to be removed from their bedroom. Care plans and risk assessments for people living on the first floor are still recorded in the Widget symbol format. There was recorded evidence that these were up to date and being reviewed regularly as appropriate. However it remains strongly recommended, that an alternative format for recording care plans be considered, as none of the residents are able to understand Widget symbol formats. Clearly this may also entail some staff training in using a new format. Signatures indicated that people living at the home are consulted regarding the care plans and risk assessments as appropriate. The residents that I spoke to indicated that they were given opportunities to be involved in choosing their own activities and helping out in the running of the home. Observation of staff and resident interactions on the ground floor also indicated that the people living on this floor are encouraged to make choices about their activities and that these are respected. Minutes of resident meetings for the first floor indicated that these are held regularly and are used to disseminate information and provide people with an opportunity to make choices about home life. One such meeting had also been held on the ground floor, which had been very successful considering the differing communication needs of people living on this floor. As required risk assessments had been undertaken for people on the first floor using the assisted bath, due to space limitations. Records indicated that not all people living on the first floor of the home had had at least annual social services reviews, or reviews since they had moved back into the home. For some people living on both floors of the home, although staff advised that they had been reviewed by a social worker, no records were available of these meetings. It is required that social work reviews must be sought for all people living at the home and that records of these meetings be kept by the home in the interim period before the formal minutes are received. 100 Whitehall Street DS0000010755.V336450.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, 14, 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. People living at the service have fulfilling lifestyles with access to meaningful activities both in the community and in the home. They are supported to maintain links with their friends and families, encouraged to be involved in the running of the home according to their abilities and to develop independent living skills as far as possible. A balanced and varied selection of food meets their nutritional needs. EVIDENCE: 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 16 Inspection of peoples’ care plans on the ground floor, discussion with staff and discussion and observation of residents indicated that they have varied day activities including attendance at college and day centres. There is room for improvement in leisure activities in the evenings, but staff advised that this is largely due to residents being tired following day activities. It is recommended that this area be further explored. All those living on this floor had day activities available to them outside of the home, including day centres, college and structured activities within the local community. As required there had also been an increase in the variety of leisure activities available to those living on the ground floor of the home. These included pub lunches, music therapy, shopping trips, horse riding and a trip to Tate Modern. The Deputy manager advised that holidays were being planned for people on this floor, in addition to barbeques and day trips over the summer period. It remains recommended that multi sensory equipment be obtained for the home particularly for the use of person living on the ground floor. Care plans and discussion with staff and people living on the first floor indicated that they have varied lifestyles according to their choices, with access to a range of social, cultural, educational and leisure activities both in the community and in the home. Two people are supported to attend church on Sundays. People attend day centres, college or supported employment according to their choices, and also have a variety of leisure activities available to them. One had recently been on holiday to visit a relative by the coast (with staff support) and all were going on a day trip to Brighton at the weekend. They had enjoyed a holiday in Linconshire last summer, and were considering destinations for a holiday this year. A musician entertainer visited them on the evening of the inspection, and those spoken to indicated that they enjoyed singing these sessions on a weekly basis. Other activities undertaken regularly include gentle exercise, beauty therapy, music, puzzles, karaoke, a regular Mass service held at the home, and trips out to the cinema, shopping, swimming and to a local pub. Records for people living on both floors, alongside the visitors book, discussion staff and residents confirmed that staff support people to maintain links with friends and families. Residents on the first floor are involved in helping to lay the table for meals and clear up, as well as undertaking their own laundry and keeping their rooms clean. Observation of residents on the ground floor during a mealtime indicated that they enjoyed the food served. Menus for both floors included a variety of choices and were nutritionally balanced as appropriate. People spoken to 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 17 indicated that they were satisfied with the food served at the home. Cultural alternatives were available to a Caribbean resident, and they had been supported to go out for a Caribbean meal. Staff spoken to were aware of the food preferences, and allergies of each person living on the ground floor, where people’s communication needs are more complex. 100 Whitehall Street DS0000010755.V336450.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 adequate. This judgement has been made using available evidence including a visit to this service. The physical and emotional needs of people living at the home are generally met appropriately, however inadequate equipment and insufficient monitoring of routine health care appointments may place them at risk. People’s medication needs are met appropriately, although there is room for improvement in the recording of this support to fully protect them from harm. EVIDENCE: All of the people living on the ground floor and the majority of people living on the first floor need some physical support with personal care and their care plans outline their support needs accordingly. Arrangements were detailed in care plans ensuring that the broad range of their health and personal care needs are addressed. However due to the communication difficulties of people living on the ground floor it is important that they are weighed regularly, and a requirement was made accordingly at the previous inspection. However no suitable equipment is available for weighing the people living on this floor, and this is therefore still not possible. The interim manager advised that the necessary equipment is 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 19 very expensive and there has therefore been a delay in purchasing it. Appropriate equipment is however available at a local day centre. It remains required that people living on the ground floor of the home be weighed at least fortnightly and that appropriate equipment be available. This can be undertaken at another site e.g. a day centre if necessary. Records on the first floor indicated that people attend regular health care appointments and discussion with staff and residents confirmed this. People advised that they were satisfied with the support provided to them by staff at the home. As required a system had been put in place for monitoring routine health care appointments of people living on the ground floor. Due to all these residents being still newly admitted to the home, not all had seen a dentist or optician yet. Inspection of medication storage facilities and records of medicines brought into the home, administered and disposed of, indicated that satisfactory procedures are in place to protect people living on the first floor. No residents are currently self-medicating. Inspection of medication systems on the ground floor indicated that there had been an improvement in procedures with no gaps found in the Medication Administration Records. A monitored dosage system was now being used so that the risk of staff error was significantly reduced. However medicines were still not being signed in and out of the home, so that a clear audit trail regarding all medicines was not available. This remains required. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The home has an adequate complaints procedure, however the recording of complaints must be improved to ensure that the concerns of people living at the home are acted upon effectively. Procedures and training are in place to ensure the protection of people living at the home from abuse. EVIDENCE: The home has a very clear and accessible complaints procedure, an adult protection procedure and guidance for staff regarding whistle blowing. A suitable complaints record was available on the first floor and people spoken to indicated that they would feel able to speak up about issues that concerned them. However, although it was required at the previous inspection, no complaints record was available on the ground floor. The interim manager advised that a complaint had been received, made directly to the provider’s head office (Social Services). I discussed the complaint with him, and saw evidence that the areas raised in the complaint (regarding the support to a particular person living at the home) were being addressed. It remains required that a complaints record must be available for this part of the home including clear details of how each complaint is dealt with and timescales for action. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 21 Records indicated that almost all staff members at the home had undertaken training in the protection of vulnerable adults. Appropriate policies and procedures are available regarding action to be taken in the event of an allegation, disclosure or suspicion of abuse, including a whistle blowing policy. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 22 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, 27 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home had been refurbished resulting in a number of improvements for people living at the home, however it still does not meet national minimum standards regarding space available to residents. Bedrooms are sufficiently comfortable to meet people’s needs, however inadequate bathroom facilities on the first floor do not meet people’s needs placing them at risk of injury. The standard of cleanliness is satisfactory to ensure a hygienic environment for people living at the home. EVIDENCE: As required at the previous inspection a new doorbell was in place at the front door of the home and for access to the first floor. During the time that the home was closed for refurbishments, improvements were made to the physical structure. These included a lift being installed, domestic style kitchens being available on each floor and improved communal areas and furnishings within the home. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 23 The segmentation of the home into three separate units is also better for residents who now live in smaller groups rather than a large less personal setting. People living on the first floor, advised that they were generally satisfied with the facilities available to them at the home. Bedrooms had been personalised and were adequately furnished and decorated and the chest of drawers in one person’s room had been repaired. Staff advised that despite a requirement made at the previous inspection, the assisted bath facility on the first floor is not appropriate for the needs of the people accommodated, due to the lack of space available for its use. There are also insufficient handrails for people to hold onto when using toilet facilities. The interim manager advised that the bathroom facilities on the top floor would be refurbished shortly, following which the first floor facilities would be updated, so that the top floor facilities can be used whilst work is underway on the first floor facilities. However it is unacceptable that these facilities have been left for so long without action taken to address the problems for people living at the home. Whilst it is understood that refurbishment of bath facilities is costly, the failure to fit handrails on the walls of the toilet facilities for people who need this support continues to place people at risk of harm. On the day of the inspection, one person on the first floor told me that they had had a bath that evening and that they were now in discomfort because of the bath facilities. Staff also continue to be placed at risk of injury from supporting people in these facilities. Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. As required soap and towel dispensers had been fitted in the bathrooms and toilets. A solution had been found to the problem of insufficient storage space on the first floor for hoists and wheelchairs, with space on the ground floor identified for this purpose. Bedrooms on the ground floor had been personalised as required, one included a number of multi-sensory decorations and all bedrooms contained lampshades and mirrors as required, so that people can check their appearance when getting ready. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 24 The inspector was concerned to note that there remains poor television reception in the residents’ lounge on the ground floor although residents are now using the allocated lounge room. Staff advised that this is because there is no aerial point available in this lounge. At the previous inspection it was required that action be taken to address this problem. This requirement is restated. Communal areas were adequately decorated and the home was clean, tidy and free from unpleasant odours. Inspection of the garden area indicated that regular garden maintenance is required to ensure that it is accessible to people living at the home. Action should also be taken to address the problem of a lack of privacy for residents when using the rear garden area, As required at the previous inspection. The chest of drawers in an identified residents’ room on the first floor must be repaired/replaced. The furniture of several people living on the first floor appeared to be worn and insufficiently strong (possibly related to it having been moved into temporary accommodation and back to the home). It is required that replacements should be provided for those items affected, following consultation with residents. It remains recommended that multi sensory equipment be obtained for the home particularly for the use of people living on the ground floor. It is also recommended that an operational intercom system be available for access to first and second floors of the home. 100 Whitehall Street DS0000010755.V336450.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, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed to meet peoples’ needs, and appropriate recruitment practices and staff supervision promote people’s safety. However staff members require further training to meet the needs of people living at the home. EVIDENCE: I looked at five staff files comprising four from the ground floor, and one from the first floor. These generally contained evidence that appropriate recruitment checks had been undertaken including two written references, CRB disclosures, identity documents, contracts etc. However for staff on the ground floor, references were not available for all staff, application forms were not available for two staff members and an enhanced CRB disclosure was not available for the deputy manager. These documents had been seen by CSCI inspectors at the other homes from which they had been transferred, so the inspector could be sure that these documents had been obtained by the registered provider. A requirement is therefore made that all of these documents must be maintained on all staff files in the house. Staff spoken to and the rota for the home indicated that at least two staff 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 26 members are scheduled to work on each floor at all times with more staff being available at busier times of the day on the ground floor. Observation of practices in the home indicated that people receive sufficient staff support to meet their needs at the home effectively. Staff advised that several members of staff working at the home are employed by an employment agency, however they are scheduled to work regularly so as to provide continuity of care for people living at the home. As required at the previous inspection records were available to evidence that staff had received appropriate induction training. Staff spoken to advised that they had received a corporate induction, and a detailed induction specific to the home is now in place. Adequate numbers of staff members working on both floors, are undertaking or have completed NVQ level 2 or 3 in care as appropriate. Records of staff training for the first floor of the home indicated that staff training needs are assessed regularly and a wide range of training courses are provided to staff. However staff training records for the ground floor, varied between some staff who had taken a variety of relevant courses, and others who still needed further relevant training courses in order to meet the needs of residents. The majority of staff whose files were checked had undertaken training in communication and protection of vulnerable adults, and these courses were due to be taken by remaining staff members. At the previous inspection it was required that all staff undertake training in addressing challenging behaviour, learning disability and computer training (where this is necessary for the completion of care plans). The interim manager advised that in-house computer training is being provided as and when needed. However specific learning disability training has not yet been sourced and some staff have yet to undertake training in addressing challenging behaviour. Staff training in manual handling is to be arranged shortly. It is also required that fire safety training be arranged for all staff without delay. A matrix of staff training undertaken and required must be completed for the ground floor to ensure that all staff are appropriately trained. Records indicated that staff supervision sessions for the ground floor was being held regularly, although there had been some gaps due to two managers having left at short notice. The interim manager advised that appraisals would be held for all staff once the appropriate period of time of service within the home elapsed. 100 Whitehall Street DS0000010755.V336450.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, 41 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is managed appropriately with the needs of residents in mind, however the absence of a registered manager for the home may place residents at risk. Monitoring visits by the provider organisation ensure consistency of standards. There is room for improvement in financial records maintained for residents, health and safety checks carried out within the home to ensure the protection of people living at the home. EVIDENCE: 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 28 The two floors of the home were being managed by the deputy managers and senior support workers, and had an open, positive and inclusive atmosphere. Staff and people living at the home appeared to have adapted well to the new setting, and appeared settled there. The interim manager advised that the Registered Manager position for the home remains vacant, although a requirement was made about this at the previous inspection. Two managers were recruited to the home but left after short periods of time following the last inspection. The previous manager is currently working as deputy manager on the first floor of the home. The vacant Registered Manager position must be filled without delay. Following the inspection, the CSCI was formally notified regarding the status of the previous Registered Manager so that the registration certificate for the home can be amended. However it remains required that the Registered Manager position be filled without delay. Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. Records indicated that there are regular resident meetings held on the first floor and regular staff meetings held on both floors of the home and that these cover a wide range of topics relevant to the home. Staff advised that where possible residents had chosen the colours of paintwork, carpets, duvets and curtains for their rooms. Recently a resident meeting was held on the ground floor of the home, and this was successful, despite some residents’ communication difficulties. Records in the home indicated that unannounced monitoring visits were being undertaken to the home by the provider organisation. However reports of these visits were not being received at the local CSCI area office, nor were copies of the relevant reports available on the first floor of the home as required to ensure compliance with any requirements made. This remains required. All residents living at the home require support to manage their finances, although family members take on the bulk of this responsibility for some people living at the home. Clear records are maintained of support provided to people living at the home who need help managing their finances. Clear systems were in place for recording financial transactions of residents on the first floor, however there is room for improvement in the financial records for people living on the ground floor. Detailed records must be maintained of all transactions, including receipts maintained in date order, and a record must be maintained of all valuables kept on behalf of people living at the home (including building society books, passports etc.) 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 29 Satisfactory portable appliances testing and fire extinguisher and fire alarm servicing certificates were available. The emergency lighting test certificate that was available indicated that further work needed to be undertaken. Discussion with staff and observation of financial records indicated that this work had been carried out, however no new certificate was available to evidence this. This must be addressed without delay. Although gas safety and electrical wiring certificates were available at the previous inspection, and should still be current, these could be located at the current visit. Copies must be sent to the local CSCI area office without delay. As required fire alarm testing was being undertaken on a weekly basis, and fire drills were also being arranged regularly. This involves coordination between staff and residents on the two floors of the home so that these can be undertaken together. A fire risk assessment was available for the home, and the interim manager advised that they continued to liaise with the local fire prevention authority to ensure the safety of residents. He was hoping to purchase a safety exit chair to be used to evacuate the home in the event of a fire affecting the home’s lift. The fire risk assessment must be reviewed sixmonthly and at least one fire drill must be carried out for the home annually at night (this may be silent if necessary) to ensure that staff are fully aware of their responsibilities at this time. 100 Whitehall Street DS0000010755.V336450.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 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 1 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 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 2 2 X 2 X 3 X 2 2 X 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES 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 Requirement Timescale for action 13/07/07 4(1c) Sched 1, 5(2) The registered person must ensure that the statement of purpose is updated to include information regarding fire precautions and emergency procedures, and the dimensions of rooms in the home. A copy of the updated statement of purpose for each floor must be sent to the local CSCI area office. The service users guide must be made available to all people who are moving or who have moved into the home, to ensure they are given adequate information about the home. (Previous timescale of 12/01/07 not met). The registered person must ensure that all people living in the home are provided with completed and signed statements of terms and DS0000010755.V336450.R01.S.doc 2. YA5 5(1b) 10/08/07 100 Whitehall Street Version 5.2 Page 32 3. YA6 15(2) 4. YA6 14 15 5. YA19 12 6. YA20 13(2) 7. YA22 22 conditions to ensure that their rights are protected. The registered person must ensure that at least annual social services reviews are sought for all people living at the home and that records of these meetings are kept by the home in the interim period before the formal minutes are received. All residents must have six-monthly reviews with the home and these must be recorded, to ensure responsive support for their changing needs. The registered person must ensure that further information is recorded in care plans regarding residents’ cultural needs and lifestyle choices to ensure that these areas are addressed adequately. The registered person must ensure that appropriate equipment is available so that people living at the home can be weighed regularly, and that weights are recorded and monitored. (Previous timescale of 25/01/07 not met). The registered person must ensure that medicines received into the home or returned to the pharmacy are recorded for people living on the ground floor of the home, to safeguard residents from harm. (Previous timescale of 08/12/06 not met). The registered persons DS0000010755.V336450.R01.S.doc 27/07/07 27/07/07 27/07/07 29/06/07 22/06/07 Page 33 100 Whitehall Street Version 5.2 17(2) Sched 4(11) 8. YA24 23(2c) 9. YA25 16(2cd) 23(2cd) 10. YA27 13(4a) 16(2j) 23(2n) must ensure that there is a system for recording complaints on the ground floor including clear details of how each complaint is dealt with and timescales for action, so that people can be sure that there concerns will be addressed. (Previous timescale of 08/12/06 not met). The registered person 13/07/07 must ensure that action is taken to address poor television reception in the lounge area on the ground floor for the comfort of people living at the home. (Previous timescale of 08/12/06 not met). 10/08/07 The registered person must ensure that the chest of drawers in an identified residents’ room on the first floor is repaired/replaced. The furniture of all people living on the first floor should be inspected and replacements should be provided for worn items following consultation with residents to ensure their comfort. The registered person 13/07/07 must ensure that the assisted bath on the first floor is safely accessible to all people living on that floor. Action must also be taken to address insufficient handrails in the toilet facilities on the first floor, so that all residents can use these safely. 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 34 (Previous timescale of 29/12/06 not met). Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. The registered person 13/07/07 must ensure that arrangements are made to ensure the privacy of people living at the home using the rear garden area and send a schedule of proposed action to be taken to the local CSCI area office. The garden must be maintained regularly to ensure the comfort and safety of people living at the home. 22/06/07 The registered person must ensure that verified references, enhanced Criminal Records Bureau (CRB) disclosures and application forms are available in the staff files of all people working at the home to ensure the adequate protection of residents. 07/09/07 The registered person must ensure that all staff in the home have undertaken training in managing challenging behaviour, learning disability and fire safety. A training matrix must be available for all staff in the home indicating courses completed and dates for undertaking proposed DS0000010755.V336450.R01.S.doc Version 5.2 Page 35 11. YA28 23(2a) 12. YA34 17(2) Schd 4 19 Schd 2 13. YA35 18(1ci) 100 Whitehall Street 14. YA37 8 training to meet the needs of people living at the home . (Previous timescale of 23/02/07 not met). The registered person must ensure that an appropriately trained and experienced manager is appointed for the home and applies for registration with the CSCI without delay, to ensure that the home operates with the needs of residents in mind. (Previous timescale of 12/01/07 not met). 27/07/07 15. YA41 17(2) Schd 4(9) 16. YA41 26 Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. 22/06/07 The registered person must ensure that clear records are maintained of support provided to people living at the home who need help managing their finances. A record must also be maintained of all valuables maintained on behalf of residents (including building society books, passports etc) to ensure their protection from financial abuse. The registered person 06/07/07 must ensure that the reports of unannounced visits to the home by the responsible individual are sent to the local CSCI area office and the appropriate areas of the home, every month to Version 5.2 Page 36 100 Whitehall Street DS0000010755.V336450.R01.S.doc 17. YA42 23(4cv) 13(4) 18. YA42 13(4) 19. YA42 13(4) 23(4) ensure that the quality of care for residents is monitored. The registered person must ensure that a current emergency lighting safety certificate is available for the home. All works specified on the previous testing certificate must be undertaken to ensure the protection of staff and residents at the home. A copy of this certificate should be sent to the local CSCI area office. (Previous timescale of 22/12/06 not met). The registered person must ensure that current gas safety and electrical installation certificates are available for the home to ensure the safety of staff and residents in the home. Copies of these certificates must be sent to the local CSCI area office. The registered person must ensure that the fire risk assessment for the home is reviewed sixmonthly and that at least one fire drill is carried out for the home annually at night (this may be silent if necessary) to ensure that staff are fully aware of their responsibilities at this time. 22/06/07 29/06/07 27/07/07 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 37 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. 2. Refer to Standard YA1 YA6 Good Practice Recommendations It is strongly recommended that the service users guide for the home be made in a format that is accessible to all people living at the home. It is strongly recommended that an alternative format for recording care plans on the first floor be considered, as none of the people living on the first floor of the home are able to understand Widget symbol formats. It is recommended that more evening activities outside of the home be made available to residents living at the home. It remains recommended that multi sensory equipment be obtained for the home particularly for the use of people living on the ground floor. It is recommended that an intercom system be provided for entry to the first and second floors of the home. 3. 4. 5. YA14 YA14 YA29 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 100 Whitehall Street DS0000010755.V336450.R01.S.doc Version 5.2 Page 39 - 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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