Inspection on 30/06/08 for 100 Whitehall Street

This inspection was carried out on 30th June 2008.

CSCI found this care home to be providing an Adequate service.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

100 Whitehall Street 05/11/07

100 Whitehall Street 17/05/07

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 07/11/2008.

CARE HOME ADULTS 18-65 100 Whitehall Street Tottenham London N17 8BP Lead Inspector Susan Shamash Unannounced Inspection 30th June – 23rd July 2008 2:00 100 Whitehall Street DS0000010755.V366241.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.V366241.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.V366241.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 john.campbell@haringey.gov.uk London Borough of Haringey Manager post vacant Care Home 18 Category(ies) of Learning disability (18) registration, with number of places 100 Whitehall Street DS0000010755.V366241.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. 5th November 2007 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.V366241.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 at July 2008. 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.V366241.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was not announced to the home. It took place to check on how people were being supported at the home. The visit lasted approximately ten hours over two days, including an evening inspection until 9pm, on the first day. The length of time taken to complete this inspection was due to the manager being on annual leave, and the sad and unexpected death of a service user from the home. On the first day of the visit no managers were available at the home, and it was therefore not possible to see staff files and financial records at this time. Instead I was assisted by team leaders on each floor of the home. On the second day of the visit, I received assistance from the manager, and deputy managers on each floor of the home. I also spoke to people living on all floors of the home and six staff members in all. All staff cooperated fully with the inspection. The majority of people living at the home were out at day activities at the start of the inspection, however all returned during the afternoon. There were six people living on the ground floor and five on the first floor. The residents on the ground floor have a higher level of needs to those on the first floor and the home is staffed accordingly. Two people were staying at the respite service based on the second floor during the inspection. I conducted a tour of the building and I sampled staff and resident individual records as well as health and safety records and those regarding the general running of the home. Information provided in the Annual Quality Assurance Assessment was also taken into account as part of this inspection. What the service does well: There is a 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. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 7 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. 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. People are supported to have holidays, at least annually, away from the home, with staff support. What has improved since the last inspection? What they could do better: Improved complaint recording procedures are needed, so that people can be sure that there concerns will be addressed. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 8 Dark marks in the carpet in the dining area and corridors on the ground floor must be removed or this carpet should be replaced, for the comfort of people living at the home. The garden must be maintained regularly to ensure the comfort and safety of people living at the home. All staff in the home must have current training in fire safety, and all relevant staff need updated training in first aid, manual handling, health and safety and food hygiene to ensure that the needs of people living at the home are met safely. All staff members, including team leaders should be supervised regularly, to ensure that they work in line with best practice to meet the needs of people living at the home. An appropriately trained and experienced manager must be appointed for the home, monthly monitoring visits must be undertaken, and comprehensive quality assurance audits must be undertaken at least annually, to ensure that people living at the home receive a high quality of care. The fire risk assessment for the home should be reviewed at least six-monthly, and all fire call points must be tested sequentially for the protection of people living and working at the home in the event of a fire. It is recommended that the service users guide and care plans for the home be produced in more accessible formats to all people living at the home, that clearer signposting for the home’s entrance be provided to avoid confusion when people visit the home for the first time, and that a room should must be made available for the use of sensory equipment, for the comfort and stimulation of people living 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. The summary of this inspection report can be made available in other formats on request. 100 Whitehall Street DS0000010755.V366241.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.V366241.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Adequate information is available to assist people in making a decision about whether to move in. Detailed assessment procedures are in place to ensure that people’s needs and goals are met effectively. People’s rights are protected through contractual arrangements with the home. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 11 EVIDENCE: At the time of the inspection six people were accommodated on the ground floor, five were living on the first floor and two people were staying at the second floor respite service. One new person had been admitted to the home since the previous inspection, and appropriate assessments, and care planning guidelines were in place for this person as appropriate. Assessments were in place for all the people living in the home, including information regarding their cultural, and lifestyle preferences and risk assessments. I spent time with people living on all floors of the home, confirming that they felt their needs were being met as appropriate. A statement of purpose is in place for the home including all the information required under Schedule 1 of the Care Homes Regulations 2001 as required at the previous inspection. It remains 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. At the previous inspection the acting manager advised that work was underway to make the service users guide more accessible to people living on the ground floor of the home, however this was not yet in place. Completed contracts were available for people living at the home, between social services and the home to protect people’s rights within the home. It is recommended, however, that the rooms to be occupied by people living at the home should be included on all contracts, to further protect residents’ rights as far as possible. 100 Whitehall Street DS0000010755.V366241.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs and goals are assessed and responded to, in consultation with them, to ensure that these are met effectively. 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 six care plans for people living in different areas of the home. High quality care planning systems were in place and these had all been reviewed within the last six months as appropriate. Information was available regarding people’s cultural needs and lifestyle choices as appropriate. Detailed risk assessments had been produced for people living on the ground and first floors as appropriate, and these had been reviewed within the last six months as required at the previous inspection. Care plans and risk assessments for people living on the first floor are no longer recorded in the Widget symbol format, as no residents living on this floor are able to understand this format. However they are still not available in 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 13 a format that people living on this floor can understand. Work had been undertaken to ensure that person centered plans for people living on the ground floor included pictures and formats to make these as accessible as possible for them. However this was not yet in place for people living in the first floor of the home, so that they are not currently as involved in determining their care plans as they might be. A recommendation is made accordingly. Signatures indicated that people living at the home are consulted regarding the care plans and risk assessments as appropriate. The people that I spoke to indicated that they were given opportunities to be involved in choosing their own activities and helping out in the day to day running of the home. Observation of staff and resident interactions on all floors also confirmed that people are encouraged to make choices about their activities and that these are respected. Minutes of resident meetings for all floors indicated that these are held regularly and are used to disseminate information and provide people with an opportunity to make choices about home life. These meetings are held approximately weekly on each floor, with any people staying at the respite service on the second floor, and with those living on the other floors as appropriate. Use of audio and video formats to disseminate information continues to be used in some of these meetings. Records indicated that people living at the home had had at least annual social services reviews as appropriate. As required, records were now being kept of the outcome of these meetings. 100 Whitehall Street DS0000010755.V366241.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. 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: Inspection of peoples’ care plans, discussion with staff and discussion and observation of residents indicated that they have varied day activities including attendance at college and day centres. Staff advised that there had been an improvement in the provision of leisure activities to people on the ground floor, in the evenings, due to having a more flexible rota, so that sufficient staff members were scheduled to work on particular shifts when people wanted to go out e.g. on one day of the inspection, people from the ground floor had the 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 15 opportunity to attend a social club near the home. All people 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. A wide range of leisure activities were available to those living on the ground floor of the home including pub lunches, music therapy, shopping trips, horse riding and trips out with their day services. People had been to the Science Museum, Bluewater, Lakeside, Brent Cross, Southend-on-Sea, Victoria Park, and Tottenham Carnival within the last few months. One service user had been supported to attend a Turkish centre in accordance with their cultural choice, other people had joined a local cycling club for people with disabilities. Team leaders advised that holidays were being planned for people living on different floors of the home. Following consultation with occupational therapists, multi-sensory equipment had been purchased for the home, particularly for the use of people living on the ground floor. Items available include hedgehog balls, indoor skittles, a ‘bell ball,’ ‘tipping targets’ and mats. However it continues to be noted, and confirmed by staff members, that there is no designated space available for use of this equipment, other than within the resident’s lounge, so that few items purchased were being used. Another (previously communal) room, opposite the dining area, was being used temporarily as the manager’s office, but may be made available for this use in the future. 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. A musician entertainer visits the ground and first floors of the home on a weekly basis, and those spoken to indicated that they enjoyed singing along at these sessions. People living on the first floor did not wish to go out more during the evenings, preferring quiet evenings at home instead. 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. An impressive selection of activities continues to be available for people staying on the second floor of the home. Five staff members are able to drive the minibus, making regular trips out were possible. Records for people living on all floors, alongside the visitors book, discussion staff and residents confirmed that staff support people to maintain links with friends and families. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 16 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. A team leader on the ground floor was working to produce a video of how he supported a particular person to make milkshakes, so that other staff could replicate this support. The home is commended for this practice. Menus for both floors included a variety of choices and were nutritionally balanced as appropriate. People spoken to 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 occasional Caribbean meals. Staff spoken to were aware of the food preferences, and allergies of each person living in the home. Use of pictorial cards was being made in helping people to make menu choices. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 17 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. People who use this service experience good outcomes in this area. 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 met appropriately, and their medication needs are met to protect people’s health as far as possible. 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. Less contact with health care professionals is undertaken for people staying at the respite service, but important and up to date health care information was available in their files as appropriate. Due to the communication difficulties of people living on the ground floor it is important that they are weighed regularly, and appropriate equipment was available for this, and records indicated that people were being weighed regularly as appropriate. Records on all floors indicated that people attend regular health care appointments and discussion with staff and residents confirmed this. People 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 18 spoken to advised that they were satisfied with the support provided to them by staff at the home. 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. A monitored dosage system was being used on the ground and first floors, so that the risk of staff error is reduced. Medicines were being signed in and out of the home, so that a clear audit trail regarding all medicines was available. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 19 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. People who use this service experience adequate outcomes in this area. 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 is not sufficiently rigorous 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 format is available for recording complaints, and people spoken to, advised that they would feel able to speak up about issues that concerned them. However, although three complaints were recorded, the record did not include sufficient detail regarding how these complaints were addressed or timescales by which a response was given to the complainant. It is required that the complaints record must include clear details of how each complaint is dealt with and timescales for action. 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. A relevant issue arising since the previous inspection had also been dealt with appropriately. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Bedrooms and communal facilities are sufficiently comfortable to meet people’s needs, however their comfort is compromised by poorly maintained garden areas. The standard of cleanliness is satisfactory to ensure a hygienic environment for people living at the home. EVIDENCE: The home is divided into three separate units, so that residents live in smaller groups rather than a large less personal setting. A lift has been installed, and domestic style kitchens are available on each floor. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 21 People living or staying at the home, 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. One included a number of multi-sensory decorations in line with the needs and preferences of that resident. At the previous inspection it was required that the chest of drawers in an identified residents’ room be repaired/replaced and that replacements should be provided for other people’s furniture in a poor state of repair, following consultation with residents. New furniture was in place at the current inspection, following consultation with the identified residents as appropriate. Bathrooms were fitted with handrails as appropriate for the needs of people living at the home. On the first day of the inspection the bath on the first floor was out of action due to the shower hose having become detached. However this was addressed by the second day of this inspection. Communal areas were adequately decorated and the home was clean, tidy and free from unpleasant odours. However the garden area was overgrown indicating that regular garden maintenance was not being undertaken to ensure that it is accessible to people living at the home. I was particularly concerned about this, as a previous requirement was made regarding this issue at two previous inspections. Staff and residents spoken to, confirmed that people were not using the garden areas because they were overgrown and therefore not safe or comfortable for residents to enjoy. The manager undertook to ensure that routine maintenance was carried out within two weeks of the inspection. He confirmed that this had been undertaken by 6th August 2008. One of the team leaders had drawn up extensive plans for totally overhauling the garden areas, so that they are more stimulating and accessible to people living at the home. I was impressed with the content of these plans, which included a water feature, and sensory areas, however they are dependent on a sufficient budget being available for the home. At the previous inspection, it was noted that there was not sufficient labelling around the building, making it very difficult to navigate. There was a substantial improvement in the labelling of the building during this visit, but it remains recommended that there be clearer signposting for the home’s main entrance. As noted in the previous section, I was concerned to note that there was not a suitable room available for people living at the home to use multi-sensory equipment. It is recommended that a room be made available for this purpose. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 22 Although the home was generally clean throughout, the carpet in the dining area and corridors on the ground floor were badly marked, by what appeared to be the tyres from wheelchairs. Speaking to a domestic worker engaged in cleaning these carpets, they confirmed that the marks were very difficult to remove, despite these being relatively new carpets, and being cleaned at least weekly. It is required that these carpet be professionally cleaned, or that arrangements should be made for its replacement, to ensure the comfort of people living at the home. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 23 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. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is adequately staffed to meet peoples’ needs, and staff are appropriately experienced and qualified to support people effectively. There are appropriate recruitment practices in place to protect people living at the home from harm. However insufficient current staff training and irregular staff supervision may place people at risk of harm. EVIDENCE: On the second day, I looked at staff files for people working on all floors. Seven staff files were inspected in all, including those for new staff employed. They included references and application forms, and evidence that enhanced Criminal Records Bureau disclosures had been undertaken, as required at the previous inspection. 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 of the day 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 continue to 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 24 be 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. The manager advised that further staff are in the process of being recruited to work at the home. Staff advised that, as required at the previous inspection, sufficient staff are now made available on the ground floor, so that people can attend activities of their choices in the evenings e.g. a social club on Mondays, and I was able to observe that this was the case on both days of the 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. More than the required number of staff members working on all floors, are undertaking or have completed NVQ level 2 or 3 in care as appropriate, and the home is commended for this practice. The majority of staff spoken to advised that they had undertaken training in communication with people who have learning disabilities, addressing challenging behaviour and the protection of vulnerable adults. As required at the previous inspection, matrices of staff training undertaken and required had been completed for all floors of the home, to ensure that all staff are appropriately trained. However, I was concerned to learn that despite being required at three previous inspections, current fire safety training had not yet been arranged for all staff. The manager advised that he had been unsuccessful in his efforts to arrange for staff to attend an external training course in this area due to budgetary constraints. Instead a training video had been procured which all staff were due to watch and then complete written tests about the information provided. Shortly after the inspection he advised that the first six staff members had watched the video on fire safety training, and completed the questionnaires. He advised that this training was to be rolled out to the remainder of staff at the home without delay. Inspection of staff training certificates, alongside discussion with staff members and deputy managers indicated that the majority of staff no longer have current training in first aid, manual handling, health and safety and food hygiene. This is necessary to ensure that the needs of people living at the home are met safely. Many had undertaken this training five or six years earlier, although certificates indicate that this training needs to be updated on a far more regular basis. The manager advised that he had been requesting refresher training for staff members for some time from the local authority, but was unsuccessful in obtaining course dates for the majority of staff. He advised that new training courses, for staff who had never attended these 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 25 courses was less of a problem, but refresher courses had not been available of late. A requirement is made accordingly. Records indicated that there had been an improvement in the regular provision of staff supervision sessions throughout the home. This was confirmed by staff spoken to. However supervision sessions for team leaders were not provided at the required frequency to meet the national minimum standard of at least six times annually. This must be addressed to ensure that staff work in line with best practice to meet the needs of people living at the home. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 26 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 People who use this service experience adequate outcomes in this area. 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. Insufficient monitoring visits by the provider organisation and quality assurance procedures mean that people may not receive a consistently high standard of care. Financial records and health and safety checks within the home are generally sufficient to protect people living and working in the home from harm. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 27 EVIDENCE: Each floor of the home is being managed by a deputy manager and team leaders, and appeared to have an open, positive and inclusive atmosphere. The manager had not yet applied for registration with the CSCI despite a requirement being made about this at the previous two inspections. Two managers were recruited to the home previously, but left after short periods of time. The manager advised that he was awaiting authorisation from his line manager prior to applying for this position. I was concerned that this situation has been ongoing for some eighteen months during which there has been no Registered Manager for the home. The vacant Registered Manager position must be filled without delay to avoid enforcement action being taken against the home. On 1st August 2008, the manager advised that his application was complete other than a medical reference. Records indicated that there are regular resident meetings held on all floors of the home and regular staff meetings held on each floor covering 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, and records showed that they had recently been involved in choosing menus, activities and holiday destinations. Records in the home indicated that some unannounced monitoring visits were being undertaken to the home by the provider organisation, however there were insufficient reports to meet the national minimum standard of monthly visits. Since January 2008, there had been no monitoring visits for three out of seven complete months that had passed. A requirement is made accordingly. Likewise the manager advised that a quality assurance audit had not yet been arranged for the home. The Annual Quality Assurance Assessment for the home had been completed for two of the three floors of the home, however information was not provided about the middle floor. Information provided was also variable in quality and detail provided. A comprehensive quality assurance system must be put in place to ensure that people living at the home receive a high quality of care. 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. I checked two records for people living on each floor of the home. Clear records are being maintained of support provided to people living at the home who need help managing their finances as appropriate. As required a record was in place detailing all valuables kept on 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 28 behalf of people living at the home (including building society books, passports etc.) Satisfactory fire extinguisher and fire alarm servicing certificates were available. Current satisfactory gas safety, electrical wiring and portable appliances testing certificates were also available as required at the previous inspection. Fire alarm testing was being undertaken on a weekly basis, and fire drills were also being arranged regularly including a fire drill at night to ensure that staff are fully aware of their responsibilities at this time. A fire risk assessment was available for the home, and there was evidence that requirements made at the most recent local fire authority inspection had been met. However the fire risk assessment for the home should be reviewed at least six-monthly, to ensure that it remains current for the home. Records of weekly fire alarm testing involved random testing of different fire call points, leading to the risk of a particular fire point not being tested over a prolonged period. Call points should therefore be tested sequentially as part of weekly fire checks and this should be recorded, to ensure that each call point is checked regularly for the protection of people living and working at the home in the event of a fire. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 X 4 X 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 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 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 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 2 X 3 2 X 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 30 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 YA22 Regulation 22 17(2) Sched 4(11) Requirement The registered person must ensure that all complaints are clearly recorded in the home’s complaints record, including details of how each complaint is dealt with and timescales for action, so that people can be sure that there concerns will be addressed. The registered person must ensure that the carpet in the dining area and corridors on the ground floor is professionally cleaned, or arrangements should be made for its replacement to ensure the comfort of people living at the home. The registered person must ensure that the garden is maintained regularly to ensure the comfort and safety of people living at the home. (Previous timescale of 13/07/07 not met). The manager notified the CSCI that basic maintenance on the gardens was completed by 06/08/08. DS0000010755.V366241.R01.S.doc Timescale for action 22/08/08 2. YA24 23(2a) 12/09/08 3. YA24 23(2o) 15/08/08 100 Whitehall Street Version 5.2 Page 31 4. YA35 18(1ci) 5. YA35 18(1ci) 6. YA36 18(2) 7. YA37 8 The registered person must ensure that all staff in the home have undertaken current training in fire safety for the protection of people living and working at the home. (Previous timescale of 29/02/08 not met). The manager advised the CSCI that fire training was being rolled out to all people working at the home, with 6 staff having undertaken the training by 08/08/08. The registered person must ensure that all relevant staff receive updated training in first aid, manual handling, health and safety and food hygiene to ensure that the needs of people living at the home are met safely. The registered person must ensure that all staff members, including team leaders receive individual supervision sessions at least six times annually and that these are recorded, to ensure that they work in line with best practice to meet the needs of people living at the home. 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 timescales of 12/01/07, 27/07/07 and 28/12/07 not met). Failure to comply with this requirement within the timescale set may result in DS0000010755.V366241.R01.S.doc 12/09/08 24/10/08 12/09/08 15/08/08 100 Whitehall Street Version 5.2 Page 32 8. YA39 24 9. YA41 26 10. YA42 23(4acv) further action being taken against the home. The registered person must 31/10/08 ensure that a comprehensive quality assurance policy is put in place for the home with an audit at least annually, to ensure that people living at the home receive a high quality of care. The registered person must 29/08/08 ensure that there are no gaps in the undertaking of monthly unannounced visits to the home by the responsible individual, to ensure that the quality of care and support at the home is monitored effectively with the needs of people living at the home in mind. The registered person must 22/08/08 ensure that the fire risk assessment for the home is reviewed at least six-monthly, and that all fire call points are tested sequentially as part of weekly fire checks and that this is recorded, to ensure that each call point is checked regularly for the protection of people living and working at the home in the event of a fire. 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 YA1 Good Practice Recommendations It is recommended that the service users guide for the home be produced in a format that is accessible to all DS0000010755.V366241.R01.S.doc Version 5.2 Page 33 100 Whitehall Street 2. YA5 3. YA6 4. YA24 5. YA24 people living at the home. It is recommended that the rooms to be occupied by people living at the home should be included on their contracts to ensure that their rights are protected as far as possible. It is recommended that people’s care plans in all areas of the home should be made accessible to them, so that they can be involved in making choices about their care and support as far as possible. It is recommended that there should be clearer signposting for the home’s main entrance which is accessible to people with learning disabilities to avoid confusion when people visit the home for the first time. It is recommended that a room should must be made available for the use of sensory equipment, for the comfort and stimulation of people living at the home. 100 Whitehall Street DS0000010755.V366241.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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