Inspection on 02/11/06 for 100 Whitehall Street

This inspection was carried out on 2nd November 2006.

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 no outstanding requirements from the previous inspection report, but made 23 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 17/05/07

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 2nd November 2006 12:00 100 Whitehall Street DS0000010755.V298918.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.V298918.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.V298918.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 Mrs Christine Avis Hamelo-Gentles Care Home 18 Category(ies) of Learning disability (18) registration, with number of places 100 Whitehall Street DS0000010755.V298918.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. 17th May 2005 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 service users are encouraged to access activities in the community. The home provides support with all aspects of personal care and 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 5 daily living. The home provides three main meals per day and service users have facilities to make themselves drinks and light snacks whenever required. Home fees are from £618 per week as of 26 September 2006. 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.V298918.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 the home to check on the welfare of residents following the reopening of the home after almost a year being closed for refurbishments. The visit lasted approximately seven and a half hours, during which the inspector was assisted by senior support workers on the ground floor and the deputy manager on the first floor. The inspector also had the opportunity to meet and speak to all of the residents in the home, and spoke to five staff members in all. All staff cooperated fully with the inspection. When the inspector arrived at the home, all residents apart from one on the ground floor were out at day activities, however all returned during the afternoon of the inspection. Four staff members were on duty at the home, two on each floor. There were five residents 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. Whilst residents on the ground floor are new to the home, those 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 residents are very positive about the support provided to them. Residents are satisfied with the quality and variety of food served in the home. There is a high level of satisfaction in respect of the staff support provided to individual residents. The home provides a wide range of activities for residents on the first floor. Evidence was available that residents are encouraged to be independent and to make their own choices. Residents have detailed care plans that are reviewed regularly. They are consulted about these as far as possible. The home successfully provides sensitive individual support to residents with a range of different needs, characters and interests. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 7 Staff members are knowledgeable about their role and responsibilities within the home. What has improved since the last inspection? What they could do better: Whilst there are a large number of requirements made in this report, this is a result of the inspection taking place while the home had only recently reopened, and was therefore still in the process of setting up new systems. An improved statement of purpose is needed for the home and the home’s brochure must be distributed to all residents. Care plans need to be completed for all residents in the home including further exploration of cultural needs and lifestyle choices. Risk assessments are needed for the use of the first floor bath and toilet facilities, and these facilities need to be improved so that all residents can use them safely. More structured activities must be available to residents on the ground floor. Weighing scales need to be available so that staff can monitor the weights of residents in the home. Health care appointments must also be recorded and monitored. Improvements are needed in the medication procedures and the recording of complaints for residents on the ground floor. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 8 A number of minor improvements are needed to complete furnishings within the home and personalise rooms. More storage space is needed for residents on the first floor, and the privacy for residents in the garden must be improved. Door bell and intercom systems in the home must be available. Staff need improved induction training and supervision records, and training in addressing challenging behaviour and working with residents who have learning disabilities as well as further NVQ training. A registered manager needs to be appointed for the home. Weekly fire alarm testing and regular drills are needed as well as a fire risk assessment and emergency plan to ensure the safety of residents. It remains recommended, that an alternative format be used for recording care plans on the first floor as none of the residents understand Widget symbols. Photographic material should be used with residents on the ground floor and it is recommended that multi-sensory equipment be provided at the home. 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. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Adequate assessment procedures are in place to ensure that residents’ needs and goals can be effectively met. Residents 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. EVIDENCE: At the time of the inspection five residents were accommodated on the ground floor and a further five residents had recently moved in on the first floor. The residents on the first floor told the inspector that they had had the opportunity to visit the home prior to moving back in frrom their temporary accommodation in Edwards Drive, Bounds Green. They said that they were 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 residents in touch with the home whilst it was closed. Assessments were in place for all the residents on the first floor, continued from their previous address and appeared to be appropriate. New risk assessments had also been undertaken for all residents following their move 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 11 into the home, and copies were sent to the inspector shortly after the inspection. Communication with residents on the ground floor was more limited, due to the need for more varied communication methods. However the inspector spent time with each resident, 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 in place for all residents on the ground floor, as appropriate. Draft versions were available of the statement of purpose and service users guide for the home. However the statement of purpose needs 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. The service users guide had been updated and includes some pictoral information as appropriate, however there was no evidence that each resident had received a copy of this document. A requirement is made accordingly. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. Residents’ needs and goals are assessed and responded to in consultation with them, to ensure that these are met effectively. However due to the newness of the service, care plans do not always evidence that cultural and lifestyle choices are being met. Risks are recorded appropriately with strategies in place to ensure that they are protected, whilst being encouraged to develop independence skills. EVIDENCE: The inspector examined three care plans for residents on the ground floor. A high quality care planning system has been put in place, however due to the newness of the home, and short length of time that residents have been living there, not all care plans are complete, and most are currently only dealing with personal care and health issues so far. Formats were available for the assessment of lifestyle needs and future plans but were not yet completed. Whilst it is acknowledged that this will take some time as staff get to know residents better, this is required to ensure that residents needs are fully met. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 13 A requirement is made accordingly. Detailed risk assessments had been produced for the residents on the ground floor as appropriate including a risk assessment for the resident whose taps needed to be removed from their bedroom. Care plans and risk assessments for the residents on the first floor are still recorded in the Widget symbol format. There was evidence that these were up to date and being reviewed regularly as appropriate. Signatures indicated that residents are consulted regarding the care plans and risk assessments as appropriate. Residents were spoken to briefly during the inspection, and all indicated that they were given opportunities to be involved in choosing their own activities and helping out in the running of the home. Minutes of resident meetings for the first floor indicated that these are held regularly and are used to disseminate information and provide residents with an opportunity to make choices about home life. These meetings are not in place on the ground floor, and an alternative method of consulting with residents may be needed on this floor due to the communication needs of the residents accommodated. It remains recommended, however, that an alternative format for recording service user plans be considered for the first floor, 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. A requirement is made under Standard 26 that risk assessments be undertaken regarding the residents on the first floor using the assisted bath, due to space limitations. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Most residents have fulfilling lifestyles with access to meaningful activities both in the community and in the home. However some of the residents on the ground floor do not have access to sufficiently varied activities. Residents are supported to maintain links with their friends and families. They are encouraged to be involved in the running of the home according to their abilities and to develop independent living skills as far as possible. Dietary needs of residents are catered for with a balanced and varied selection of food available that meets their nutritional needs. EVIDENCE: Inspection of residents’ care plans on the ground floor, discussion with staff and discussion and observation of residents indicated that some residents on the ground floor have varied day activities including attendance at college and 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 15 day centres. Leisure activities at other times of the day or at weekends are more limited, although staff are investigating facilities available within the local community. One resident did not have any day activities available to them outside of the home, and although staff were attempting to keep the resident stimulated, options were limited and usually involved going out for a walk and watching television or listening to music. The staff member in charge advised that day activities were being sought for this resident. However it is required that structured day activites be available for this resident until such time as an external agency is able to provide activities for them. It is also required that there be an increase in the variety of leisure activities available to the residents on the ground floor. It is recommended that multi sensory equipment be obtained for the home particularly for the use of service users on the ground floor. Care plans and discussion with staff and residents 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. Residents attend day centres, college or supported employment according to their choices, and also have a variety of leisure activities available to them. They enjoyed a trip to Linconshire over the summer, and were looking forward to a musician entertainer arriving on the evening of the inspection. 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. Residents on both floors confirmed that staff at the home support them 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 meal time indicated that they enjoyed the food served. Menus for both floors included a variety of choices and were nutritionally balanced as appropriate. Residents spoken to indicated that they were satisfied with the food served at the home. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. The physical and emotional support that residents receive is compromised by inadequate equipment and insufficient monitoring of routine health care appointments. The support residents received in order to take their prescribed medicines appropriately is also insufficiently rigorous to ensure that they are fully protected from harm. EVIDENCE: All of the residents on the ground floor and the majority of residents 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 health and personal care needs of service users are addressed. Due to the communication difficulties of residents on the ground floor it is important that residents are weighed regularly. However no suitable equipment is available for weighing residents and this is therefore not possible. A requirement is made accordingly. Records on the first floor indicated that residents attend regular health care appointments and discussion with staff and residents confirmed this. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 17 Residents advised that they were satisfied with the support provided to them by staff at the home. However there was no system in place for monitoring routine health care appointments of residents including dentists, opticians etc. this is required. 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 residents on the first floor. No residents are currently self-medicating. However inspection of medication systems on the ground floor indicated that there were some gaps in the Medication Administration Records, so that it could not be verified that medicines had been administered appropriately. Nor were medicines being signed in and out of the home, so that a clear audit trail regarding all medicines was not available. Finally a medicine was prescribed for one resident in tablet form, which required halving on each occasion that it was administered. Because this tablet was not scored, staff advised that it was extremely difficult to calculate half of the tablet especially when using the tablet cutter. Clearly there was a potential risk to the resident in having differing amount of the tablet on each occasion. It is therefore required that this matter be addressed with the resident’s GP and the local pharmacist so that a more suitable solution can be found. It is recommended that the policy regarding no use of homely remedies for service users on the ground floor, be reviewed to ensure that service users’ rights are respected. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. 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 from evidence gathered both during and before the 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 residents are acted upon effectively. Procedures and training are in place to ensure the protection of residents from abuse. EVIDENCE: The home has a very clear and accessible complaints procedure, an adult protection procedure and guidance for staff regarding whistle blowing. However no complaints record was available on the ground floor, although the staff member in charge advised that one was to be produced shortly. Staff advised that no complaints had been received since the home had reopened. A suitable complaints record was available on the first floor and residents spoken to indicated that they would feel able to speak up about issues that concerned them. 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.V298918.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home had been refurbished resulting in a number of improvements for residents, however it still does not meet national minimum standards regarding space available to residents. Residents’ rooms on the first floor are sufficiently comfortable to meet their needs, however insufficient facilities and personalisation means that the needs of residents on the ground floor are not fully met. Bathroom facilities on the first floor do not fully meet the needs of residents. A small number of repairs are required to fully ensure residents’ comfort and safety is met in the remainder of the home. The standard of cleanliness in the home is satisfactory to ensure a hygienic environment for residents. EVIDENCE: 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 20 On arrival at the home the inspector had to wait for some time to gain access to the home as the doorbell was not working. Likewise the intercom for the door leading directly to the stairway to the first floor was not yet operational. It is required that these areas be addressed so that residents can receive visitors without delay and to ensure the security of the home. A large number of improvements had been made to the physical structure of the home since the previous inspection. These include a lift having been installed to all floors at the home, larger bedrooms are available on the first and second floors, and a domestic style kitchen being available on each floor. There also improved communal areas and furnishings and general decoration within the home. 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. Residents spoken to, on the first floor, advised that they were generally satisfied with the facilities available to them at the home, particularly the increased space within their new bedrooms. First floor bedrooms had been personalised and were adequately furnished and decorated. The chest of drawers in one resident’s room require repair. Staff advised that the assisted bath facility on the first floor is not appropriate for the needs of the residents accommodated due to the lack of space available for its use. There are also insufficient handles for residents to hold onto when using toilet facilities. This must be addressed without delay and risk assessments must be completed regarding the use of bath and toilet facilities until these problems are rectified. Soap and towel dispensers must also be fitted in the bathroom and toilets. There is also insufficient storage space on the first floor for storage of hoists and wheelchairs, and a need for shelving to be fitted in various areas of the home. Requirements are made accordingly. Bedrooms on the ground floor still need to be personalised and do not contain mirrors so that residents cannot check their appearance when getting ready. This is required. All bedrooms in the home still require lampshades to be fitted. The inspector was concerned to note that there is poor television reception in the residents’ lounge on the ground floor. Residents on the ground floor are currently using a temporary lounge area whilst work is undertaken to complete the main lounge. However staff advised that there is no aerial point available in the permanent lounge also. A requirement is made accordingly. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 21 Communal areas were adequately decorated and the home was clean, tidy and free from unpleasant odours. Changes to the exterior of the home mean that there is less privacy available to residents when using the rear garden area, and this issue must be addressed. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. 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 from evidence gathered both during and before the visit to this service. The home is adequately staffed to meet residents’ needs, and appropriate recruitment practices ensure the safety of residents. However staff members require further training and supervision to meet the needs of residents on the ground floor of the home. EVIDENCE: 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 23 The inspector looked at five staff files for the ground floor, and these contained evidence that appropriate recruitment checks had been undertaken including two written references, CRB disclosures, identity documents, contracts etc. Staff spoken to and the rota for the home indicated that at least two staff members are scheduled to work on each floor at all times with more staff being available at busier times of the day. Observation of practices in the home indicated that residents 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 residents at the home. No records were available to evidence that staff had received appropriate induction training prior to working unsupervised on the ground floor of the home. Staff spoken to advised that they had received a corporate induction, however they had not received a detailed induction specific to the new home. 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. An adequate number of staff members working on the first floor, are undertaking or have completed NVQ level 2 in care as appropriate. 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 the person in charge advised that these courses were due to be taken by remaining staff members. It is also 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). Sufficient staff on the ground floor must undertake appropriate NVQ training to ensure that at least fifty percent of staff are qualified as required under the national minimum standards. Records indicated that staff supervision sessions for the ground floor are not always held six times annually as required under the national minimum standards. It is required that this situation be addressed. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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 health and safety checks carried out within the home to ensure the protection of residents. EVIDENCE: The two floors of the home appeared to be adequately managed by the deputy managers and senior support workers, and had an open, positive and inclusive atmosphere. Staff and residents appeared to have adapted well to the new setting, and appeared settled at the home. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 25 Staff advised that the registered manager position for the home is currently vacant. 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 and the CSCI must be formally notified regarding the status of the currently registered manager so that the registration certificate for the home can be amended. Records indicated that there are regular service user 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. No unannounced monitoring visits had been undertaken to the home by the provider organisation prior to the inspection, however one was undertaken shortly after the inspection visit with a copy of the report sent to the local CSCI area office as required. Satisfactory gas safety, portable appliances testing and electrical wiring certificates, fire extinguisher and fire alarm servicing certificates were available. An emergency lighting test certificate was also available but indicated that further work needed to be undertaken. This must be addressed. Records also indicated that fire alarm testing was not taking place weekly as required, nor had their been any recent fire drills. Staff indicated that this was due to a need for coordination between the two floors of the home so that these can be undertaken together. Requirements are made accordingly. A fire risk assessment and emergency plan must also be available for the home. 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 26 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 X 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 2 26 X 27 1 28 2 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 3 X X 2 X 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4(1c) Sched 1, 5(2) Requirement The registered person must ensure that the statement of purpose is updated to include information regarding fire precautions and emergency procedures, 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 are office. The service users guide must be made available to all new service users who are moving or who have moved into the home. The registered person must ensure that care plans are completed for all service users on the ground floor in the home including further exploration of cultural needs and lifestyle choices. The registered person must ensure that more structured activities are available for service users on the ground floor. DS0000010755.V298918.R01.S.doc Timescale for action 12/01/07 2. YA7 15 26/01/07 3. YA12 YA14 16(m,n) 29/12/06 100 Whitehall Street Version 5.2 Page 28 4. YA18 12 5. YA19 12 6. YA20 13(2) 7. YA22 22 17(2) Sched 4(11) 8. YA24 23(2c) 9. YA25 16(2cd) 23(2cd) The registered person must ensure that appropriate equipment is available so that service users can be weighed regularly, and that weights are recorded and monitored. The registered person must ensure that attendance of health care appointments for service users on the ground floor is monitored, and that the outcomes are recorded in an appropriate format so that they can be tracked easily. The registered person must ensure that medication administration on the ground floor is monitored to ensure that there are no gaps in the medication administration records. Medicines received into the home or returned to the pharmacy must be recorded and advice must be obtained from the GP and/or pharmacist regarding the tablet that needs to be halved on each occasion. The registered persons 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. The registered person must ensure that action is taken to address poor television reception in the lounge area on the ground floor. The registered person must ensure that lampshades and mirrors are provided within all service user bedrooms DS0000010755.V298918.R01.S.doc 25/01/07 28/12/06 08/12/06 08/12/06 08/12/06 29/12/06 100 Whitehall Street Version 5.2 Page 29 and that the bedrooms on the ground floor are personalised. The chest of drawers in the identified service user’s room on the first floor must be repaired/replaced. The registered person must ensure that the assisted bath on the first floor is safely accessible to all service users. Action must also be taken to address insufficient handrails in the toilet facilities on the first floor, so that all service users can use these safely. Until these facilities are rectified, risk assessments must be undertaken regarding the service users on the first floor using these bath and toilet facilities. Soap and towel dispensers must also be fitted in all bathrooms and toilets. The registered person must ensure that arrangements are made so that there is sufficient storage space for staff and service users on the first floor of the home. The registered person must ensure that arrangements are made to ensure the privacy of service users using the rear garden area. The registered person must ensure that functioning door bell and intercom systems are available for the home. The registered person must ensure that sufficient staff undertake appropriate NVQ training to meet the national DS0000010755.V298918.R01.S.doc 10. YA42 YA27 23(2n) 13(4a) 16(2j) 29/12/06 11. YA28 23(2m) 26/01/07 12. YA28 23(2a) 30/03/07 13. YA29 23(2c) 08/12/06 14. YA32 18(1a) 26/01/07 100 Whitehall Street Version 5.2 Page 30 15. YA35 18(1ci) 16. YA35 18(1ci) 17. YA36 18(2) 18. YA37 8 19. YA42 23(4cv) minimum standard of at least fifty percent trained staff working in the home. The registered person must ensure that induction training is provided to all new staff working in the home and that this is recorded. The registered person must ensure that all staff in the home have undertaken training in managing challenging behaviour, learning disability in addition to the mandatory training courses. Computer training should be provided to staff where necessary for completion of care plans. The registered person must ensure that all staff members receive one-toone supervision sessions at least six times annually. The registered person must ensure that an appropriately trained and experienced manager is appointed for the home and applies for registration with the CSCI, and that the CSCI is formally notified regarding the status of the previous registered manager so that the registration certificate can be corrected as appropriate. 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 and a copy of this certificate should be sent to the local CSCI area DS0000010755.V298918.R01.S.doc 29/12/06 23/02/07 25/01/07 12/01/07 22/12/06 100 Whitehall Street Version 5.2 Page 31 office. 20. YA42 23(4abce) The registered person must ensure that fire alarm call points are tested weekly, call points to be tested must be rotated weekly and regular fire drills (including at least one at night each year) must be arranged and these must be recorded. Fire risk assessment and emergency plan. A fire risk assessment and emergency plan must be provided for the home and copies must be sent to the local CSCI area office. 15/12/06 21. YA42 23 (4) 22/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It remains recommended that an alternative format for recording service user plans be considered, as none of the service users in the home are able to understand Widget symbol formats. It is recommended that use be made of photographic material on the ground floor of the home to facilitate communication with service users. It is recommended that multi sensory equipment be obtained for the home particularly for the use of service users on the ground floor. It is recommended that the policy regarding no use of homely remedies for service users on the ground floor, be reviewed to ensure that service users’ rights are respected. 2. 3. 4. YA6 YA18 YA14 YA20 100 Whitehall Street DS0000010755.V298918.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 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. 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