Inspection on 05/11/07 for 100 Whitehall Street

This inspection was carried out on 5th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

100 Whitehall Street 30/06/08

100 Whitehall Street 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 08/07/2008.

CARE HOME ADULTS 18-65 100 Whitehall Street Tottenham London N17 8BP Lead Inspector Susan Shamash Key Unannounced Inspection 5th November 2007 01:30 100 Whitehall Street DS0000010755.V355510.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.V355510.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.V355510.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.V355510.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 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.V355510.R01.S.doc Version 5.2 Page 5 and daily living. The home provides three main meals per day and people living at the home have facilities to make themselves drinks and light snacks whenever required. Home fees are from £618 per week as from May 2007. Copies of the most recent CSCI inspection report can be obtained from the office at the home or the CSCI website www.csci.org.uk 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. 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 seven hours. I was assisted by an ‘expert by experience’, Darren Cunningham, accompanied by his support worker, for part of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. We received assistance from the interim manager, a deputy manager, administrator, senior support workers and support workers on duty on the three floors of the home. We had the opportunity to meet and speak to all of the people living or staying at the home and spoke to four 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. People living on the first floor had previously lived at the home and moved out to temporary accommodation whilst the home was being refurbished. A new respite service is based on the second floor, with two people staying there at the time of the inspection. We 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. 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.V355510.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. What has improved since the last inspection? What they could do better: The service users guide needs to be made available in a format accessible to people living on the ground floor of the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 8 All people living in the home must be provided with completed statements of terms and conditions to ensure that their rights are protected. A more suitable format must be found for recording care plans on the first floor, as none of the people living there are able to understand Widget symbols. More evening activities outside of the home must be made available. Stocks of medicines no longer required for people living at the home should be returned to prevent confusion. A clearly recorded complaint record is still required for the home and it is recommended that any concerns raised should also be recorded, to demonstrate that the home is responsive to all feedback received. Clearer and more accessible labelling is needed around the building including picture formats of bathroom and toilet doors etc. There should also be clearer signs for the home’s main entrance and a room is needed for the use of sensory equipment to be used. The two new baths provided for the home must be operational, and the garden must be maintained regularly. It is recommended that photographs of people living at the home should be used to personalise communal areas. Copies of all relevant recruitment documents are still needed on staff files and further staff must undertake training in a number of key areas. Sufficient staff must be available on the ground floor for people to attend activities of their choices in the evenings and staff members must receive regular supervision to ensure that they work in line with best practice to meet the needs of people living at the home. An experienced manager for the home must register with the CSCI without delay to avoid enforcement action being taken against the home. The Annual Quality Assurance Assessment must be completed for the home and sent to the local CSCI area office, and a quality assurance system must be put in place to ensure high standards of care within the home. Clearer records are still needed for people living at the home who need help managing their finances and valuables. Reports of unannounced visits to the home by the responsible individual must be sent to the CSCI every month. Copies of emergency lighting, gas safety and electrical installation certificates remain required for the home. A current portable appliances testing certificate must also be obtained and all requirements made by the local fire authority must be met without delay. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 9 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.V355510.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 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 people prior to moving into the home however it could be improved by being made more accessible. Detailed assessment procedures are in place to ensure that the needs and goals of people living at the home are effectively met. Their rights could, however, be further protected through improved contractual arrangements with the home. 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 which had commenced since the previous inspection. Assessments were in place for all the people living in the home, including information regarding their cultural, and lifestyle preferences and risk assessments. We spent time with people living on all floors of the home, confirming that they felt their needs were being met as appropriate. As required at the previous inspection the statement of purpose had been updated to include all the information required under Schedule 1 of the Care 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 12 Homes Regulations 2001, including information about fire precautions and emergency procedures, and the dimensions of all rooms. 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. 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. Once this is complete this must be made available to all people who are moving or who have moved into the home. Contracts were available for people living at the home, between social services and the home, however there were still no agreements in place between residents and/or their advocates and the home. It therefore remains required that all people living in the home are provided with completed and signed statements of terms and conditions, to further protect their rights within the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. 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 needs and goals of people living at the home are assessed and responded to, in consultation with them, to ensure that these are met effectively. However these are not recorded in a format accessible to people living at the home. 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 had been put 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, including a risk assessment for a resident whose taps needed to be removed from their bedroom. However these had not all 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 14 been reviewed with the last six months. Care plans and risk assessments for people living on the first floor are still recorded in the Widget symbol format. Although there was recorded evidence that these were up to date and being reviewed regularly as appropriate, it is required that an alternative format for recording care plans be considered, as none of the residents are able to understand Widget symbol formats. Clearly this may also entail some staff training in using a new format. Signatures indicated that people living at the home are consulted regarding the care plans and risk assessments as appropriate. The people that we spoke to indicated that they were given opportunities to be involved in choosing their own activities and helping out in the running of the home. Observation of staff and resident interactions on all floors also confirmed that the people living on this floor are encouraged to make choices about their activities and that these are respected. Minutes of resident meetings for 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 was being used in some of these meetings. Records indicated that, as required at the previous inspection, the majority of people living at the home had had at least annual social services reviews, or reviews since they had moved into the home, and reviews were scheduled for the remaining identified people living at the home. However records were not being kept of the outcome of these meetings. It is required that records of actions agreed at each social work review must be maintained within people’s care files in the interim period before the formal minutes are received. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. 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. There remains room for improvement in leisure activities in the evenings, and staff advised that this was partially due to insufficient staff members scheduled to work on particular shifts. For example on the day of the inspection, I was told that no people from the ground floor had the opportunity to attend a social club near the home due to 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 16 insufficient staff working on that shift. More evening activities outside of the home must be made available to people living at 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 Whipsnade Zoo, Southend-on-Sea, Planet X (a sensory experience) and Notting Hill carnival over the summer. The deputy manager advised that holidays were being planned for people on this floor. As recommended multi-sensory equipment had been purchased for the home particularly for the use of person living on the ground floor. Items purchased, following consultation with occupational therapists, include hedgehog balls, indoor skittles, a ‘bell ball,’ mats and ‘tipping targets.’ However it was noted, and confirmed by staff members, that there was no designated space available for use of this equipment, other than within the resident’s lounge, so that it was not yet being used. Another 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. One had been on holiday to visit a relative in Wales (with staff support) and all had been on a day trip to Brighton and enjoyed a holiday in Lincolnshire over the summer. A musician entertainer visits them weekly at the home, and those spoken to indicated that they enjoyed singing along at these sessions. People living on this 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 were available for people staying on the second floor of the home. With two staff members able to drive the minibus, regular trips out were possible. It is hoped that as further staff in the home are trained to drive the home’s minibus, more trips out may be made possible for people living in other areas of the home. Records for people living on all floors, alongside the visitors book, discussion 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 17 staff and residents confirmed that staff support people to maintain links with friends and families. Residents on the first floor are involved in helping to lay the table for meals and clear up, as well as undertaking their own laundry and keeping their rooms clean. Observation of residents on the ground floor during a mealtime indicated that they enjoyed the food served. Menus for both floors included a variety of choices and were nutritionally balanced as appropriate. People spoken to 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 on the ground floor, where people’s communication needs are more complex. Use of some pictorial cards was being made in helping people to make menu choices. It is recommended that more use be made of pictures of foods to assist people living at the home in choosing menu options. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. 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 peoples 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 a requirement was made accordingly at the previous inspection. The interim manager advised that the necessary equipment had now been obtained and records indicated that people were being weighed regularly as appropriate. Records on all floors indicated that people attend regular health care 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 19 appointments and discussion with staff and residents confirmed this. People advised that they were satisfied with the support provided to them by staff at the home. 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. As required at the previous inspection, medicines were being signed in and out of the home, so that a clear audit trail regarding all medicines was available. However a large quantity of medicines no longer needed by people living at the home, were being stored in the home. It is recommended that stocks of medicines no longer required for people living at the home should be returned without delay, to prevent confusion. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. 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 must be improved to ensure that the concerns of people living at the home are acted upon effectively. Procedures and training are in place to ensure the protection of people living at the home from abuse. EVIDENCE: The home has a very clear and accessible complaints procedure, an adult protection procedure and guidance for staff regarding whistle blowing. A suitable complaints record was available on the first floor and people spoken to indicated that they would feel able to speak up about issues that concerned them. However, although it was required at the previous inspection, no complaints record was available on the ground floor. The interim manager advised that the only complaints received were made directly to the provider’s head office (Social Services). It remains required that a complaints record must be available for all of the home, including clear details of how each complaint is dealt with and timescales for action. The manager advised that he had received some email communications from relatives about issues of concern to them. It is recommended that records should be maintained of any concerns raised by people living at the home or their representatives, to evidence that the home is responsive to all feedback received. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 21 Records indicated that almost all staff members at the home had undertaken training in the protection of vulnerable adults. Appropriate policies and procedures are available regarding action to be taken in the event of an allegation, disclosure or suspicion of abuse, including a whistle blowing policy. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. 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 had been refurbished resulting in a number of improvements for people living at the home, although it does not meet national minimum standards regarding space available to residents. Bedrooms are sufficiently comfortable to meet people’s needs, however inadequate bathroom facilities on the first and second floors do not fully meet people’s needs. The standard of cleanliness is satisfactory to ensure a hygienic environment for people living at the home. EVIDENCE: During the time that the home was closed for refurbishments, improvements were made to the physical structure. These included a lift being installed, domestic style kitchens being available on each floor and improved communal areas and furnishings within the home. 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. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 23 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. As required at the previous inspection, sufficient handrails had been fitted for people to hold onto when using toilet facilities. However staff advised that although new baths had been fitted on the first and second floors, these could not now be used due to a problem with insufficient water pressure. Therefore people living on these floors only have shower rooms available to them. This must be addressed without delay. It is of concern that people living at the home have been left for so long without bath facilities. Bedrooms on the ground and first floors had been personalised as required, one included a number of multi-sensory decorations and all bedrooms contained lampshades and mirrors as required, so that people can check their appearance when getting ready. 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. Staff advised that items had been ordered to replace the identified furniture, but these had not yet been received at the home. As required at the previous inspection, the television reception in the residents’ lounge on the ground floor had been improved. Communal areas were adequately decorated and the home was clean, tidy and free from unpleasant odours. The garden area was overgrown indicating that regular garden maintenance is required to ensure that it is accessible to people living at the home. It remains recommended that an operational intercom system be available for access to first and second floors of the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 24 The expert by experience recommended that photographs of people living at the home should be used to personalise communal areas, and the use of photographs of staff to illustrate key workers for each resident. Insufficient labelling made it very difficult to navigate the building. This is required. Clearer signposting for the home’s main entrance should also be provided. A broken pane of glass on the front door is in need of replacement and as noted under the previous section, a room needs to be made available for the use of sensory equipment must be made available, for the comfort and stimulation of people living at the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. 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 generally adequately staffed to meet peoples’ needs, and staff are appropriately experienced and qualified to support people effectively. However there is insufficient evidence of appropriate recruitment practices, staff training and supervision toe ensure the people’s needs are met safety. EVIDENCE: 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 26 I looked at three staff files on the ground floor, as it was not possible to view staff files on the other floors, in the absence of personnel with access to these files. These staff files did not include references or application forms, and only one contained an enhanced CRB disclosure as required at the previous inspection. This requirement is therefore restated. 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 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 were due to be recruited to work at the home early in the new year. Records were available to evidence that staff had received appropriate induction training. Staff spoken to advised that they had received a corporate induction, and a detailed induction specific to the home is now in place. Adequate numbers of staff members working on both floors, are undertaking or have completed NVQ level 2 or 3 in care as appropriate. The majority of staff spoken to advised that they had undertaken training in communication and protection of vulnerable adults. The manager advised that in-house computer training is being provided as and when needed. Specific learning disability training has not yet been sourced and some staff have yet to undertake training in addressing challenging behaviour. Staff training in manual handling is to be arranged shortly. It is also required that fire safety training be arranged for all staff without delay. As required at the previous inspection, a matrix of staff training undertaken and required must be completed for the home to ensure that all staff are appropriately trained. Records indicated that staff supervision sessions on the ground floor were not being held sufficiently regularly 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. Sufficient staff must be made available on the ground floor for people to attend activities of their choices in the evenings e.g. a social club on Mondays. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42 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. There is room for improvement in financial records maintained for people living at the home and health and safety checks carried out within the home to ensure the protection of people living at the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 28 EVIDENCE: Each floor of the home is being managed by a deputy managers and senior support workers, and had an open, positive and inclusive atmosphere. Staff and people living at the home appeared to have adapted well to the new setting, and appeared settled. The interim manager was reminded that the Registered Manager position for the home remains vacant, although a requirement was made about this at the previous inspection. Two managers were recruited to the home previously, but left after short periods of time. The interim manager advised that he would be applying for this position. The vacant Registered Manager position must be filled without delay to avoid enforcement action being taken against the home. 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. 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. Nor were sufficient reports of these visits being received at the local CSCI area office despite a requirement at the previous inspection. This remains required. The manager advised that a quality assurance audit had not yet been arranged for the home, but that this was planned. The Annual Quality Assurance Assessment for the home had not yet been completed, and this must be sent to the local CSCI area office without delay. 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. Clear records are now being maintained of support provided to people living at the home who need help managing their finances as appropriate. However it remains required that a record must be maintained of all valuables kept on behalf of people living at the home (including building society books, passports etc.) Satisfactory fire extinguisher and fire alarm servicing certificates were available. The emergency lighting test certificate that was available still indicated that further work needed to be undertaken. Discussion with staff and observation of financial records indicated that this work had been carried out, however no new certificate was available to evidence this. This must be 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 29 addressed without delay. A current portable appliances testing certificate must also be obtained for the home. No gas safety and only the first page of the electrical wiring certificate was available at the home despite a requirement at the previous inspection. Copies must be sent to the local CSCI area office without delay. Fire alarm testing was being undertaken on a weekly basis, and fire drills were also being arranged regularly including a fire drill must at night to ensure that staff are fully aware of their responsibilities at this time. A fire risk assessment was available for the home, however the recent inspection by the local fire authority had resulted in a long list of requirements to be addressed. It is required that all of these requirements must be met without delay, and confirmation must be obtained from the local fire authority that they are satisfied with the action taken. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 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 2 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 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 2 2 X 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1b) Requirement The registered person must ensure that all people living in the home are provided with completed and signed statements of terms and conditions to ensure that their rights are protected. (Previous timescale of 10/08/07 not met). The registered person must ensure that all risk assessments are reviewed at least sixmonthly. An alternative accessible format must be used for recording care plans on the first floor as none of these people are able to understand Widget symbol formats. Records of any actions agreed at people’s review meetings with their social workers, must be available within care files. The registered person must ensure that more evening activities outside of the home are made available to people living at the home. DS0000010755.V355510.R01.S.doc Timescale for action 25/01/08 2. YA6 14 15 29/02/08 3. YA14 16(2mn) 11/01/08 100 Whitehall Street Version 5.2 Page 32 4. YA22 22 17(2) Sched 4(11) 5. YA24 23(2a) The registered person must ensure that there is an internal system for recording complaints for all areas of the home, including clear details of how each complaint is dealt with and timescales for action, so that people can be sure that there concerns will be addressed. (Previous timescales of 08/12/06 and 22/06/07 not met). The registered person must ensure that there is clear and accessible labelling around the building including pictorial formats of bathroom and toilet doors etc. Clearer signposting for the home’s main entrance should also be provided, The broken pane on the front door must be replaced and, A room must be made available for the use of sensory equipment, for the comfort and stimulation of people living at the home. The registered person must ensure that the chest of drawers in an identified person’s room on the first floor is repaired/replaced. (Previous timescale of 10/08/07 partially met). The registered person must ensure that the assisted baths on the first and second floors are safely accessible to people living at the home. (Previous timescale of 13/07/07 partially met). The registered person must ensure that the garden is maintained regularly to ensure the comfort and safety of people DS0000010755.V355510.R01.S.doc 14/12/07 29/02/08 6. YA25 16(2cd) 23(2cd) 21/12/07 7. YA27 16(2j) 23(2n) 21/12/07 8. YA28 23(2o) 29/02/08 100 Whitehall Street Version 5.2 Page 33 9. YA32 18(1a) 10. YA34 17(2) Schd 4 19 Schd 2 11. YA35 18(1ci) 12. YA36 18(2) 13. YA37 8 living at the home. (Previous timescale of 13/07/07 not met). The registered person must ensure that sufficient staff are available on the ground floor for people to attend activities of their choices in the evenings e.g. a social club on Mondays. The registered person must ensure that verified references, enhanced Criminal Records Bureau (CRB) disclosures and application forms are available in the staff files of all people working at the home to ensure the adequate protection of residents. (Previous timescale of 22/06/07 not met). The registered person must ensure that all staff in the home have undertaken training in managing challenging behaviour, learning disability and fire safety. A training matrix must be produced for all staff in the home indicating courses completed and dates for undertaking proposed training to meet the needs of people living at the home. A copy of this matrix must be sent to the local CSCI area office. (Previous timescales of 23/02/07 and 07/09/07 not met). The registered person must ensure that all staff members 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 DS0000010755.V355510.R01.S.doc 11/01/08 14/12/07 29/02/08 28/12/07 28/12/07 100 Whitehall Street Version 5.2 Page 34 with the CSCI without delay, to ensure that the home operates with the needs of residents in mind. (Previous timescales of 12/01/07 and 27/07/07 not met). Failure to comply with this requirement within the timescale set may result in enforcement action being taken against the home. The registered person must ensure that the Annual Quality Assurance Assessment is completed for the home and sent to the local CSCI area office. A comprehensive quality assurance system must be put in place to ensure that people living at the home receive a high quality of care. The registered person must ensure that clear records are maintained of support provided to people living at the home who need help managing their finances. A record must also be maintained of all valuables maintained on behalf of residents (including building society books, passports etc) to ensure their protection from financial abuse. (Previous timescale of 22/06/07 not met). The registered person must ensure that the reports of unannounced visits to the home by the responsible individual are sent to the local CSCI area office and the appropriate areas of the home every month, to ensure that the quality of care for people living at the home is monitored. (Previous timescale of 06/07/07 partially met). The registered person must ensure that a current emergency DS0000010755.V355510.R01.S.doc 14. YA39 24 28/12/07 15. YA41 17(2) Schd 4(9) 28/12/07 16. YA41 26 28/12/07 17. YA42 23(4cv) 13(4) 21/12/07 100 Whitehall Street Version 5.2 Page 35 18. YA42 13(4) 19. YA42 13(4) 23(4cv) lighting safety certificate is available for the home. All works specified on the previous testing certificate must be undertaken to ensure the protection of staff and residents at the home. A copy of this certificate must be sent to the local CSCI area office. (Previous timescales of 22/12/06 and 22/06/07 not met). The registered person must ensure that a current gas safety certificate and all pages of the electrical installation certificate are available for the home, to ensure the safety of staff and residents in the home. Copies of these certificates must be sent to the local CSCI area office. (Previous timescale of 29/06/07 not met). The registered person must ensure that a current portable appliances testing certificate is available for the home, and All requirements made by the local fire authority must be met without delay. 21/12/07 21/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA1 YA17 YA20 Good Practice Recommendations It is recommended that the service users guide for the home be produced in a format that is accessible to all people living at the home. It is recommended that more use be made of pictures of foods to assist people living at the home in choosing menu options. It is recommended that stocks of medicines no longer DS0000010755.V355510.R01.S.doc Version 5.2 Page 36 100 Whitehall Street 4. YA22 5. YA24 6. YA29 required for people living at the home should be returned to prevent confusion. It is recommended that records should be maintained of any concerns raised by people living at the home or their representatives, to evidence that the home is responsive to all feedback received. It is recommended that photographs of people living at the home should be used to personalise communal areas. The use of photographs of staff to illustrate the key workers for each resident should also be considered. It remains recommended that an intercom system be provided for entry to the first and second floors of the home. 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 100 Whitehall Street DS0000010755.V355510.R01.S.doc Version 5.2 Page 38 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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