Inspection on 21/10/09 for 14 Colne Road

This inspection was carried out on 21st October 2009.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

14 Colne Road 07/07/09

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: 14 Colne Road 14 Colne Road London London N21 2JD zero star poor service 07/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: David Hastings Date: 2 1 1 0 2 0 0 9 Information about the care home Name of care home: Address: 14 Colne Road 14 Colne Road London London N21 2JD 02083609988 02083609988 14colne@hillgreen.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Hillgreen Care Ltd Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 learning disability Conditions of registration: 6 The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning Disability - Code LD Date of last inspection Brief description of the care home 14 Colne Road is a detached house designed to meet the needs of its residents. It is situated in the Enfield area of North London within walking distance of local amenities. There are six bedrooms. The house has a lounge , dining room, bathroom, large kitchen, utility room, a total of eight toilets. Hillgreen Care aim to provide a home Care Homes for Adults (18-65 years) Page 2 of 11 0 7 0 7 2 0 0 9 Brief description of the care home and normal life at 14 Colne Road for six adults between the ages of 18 - 65 years, with learning disabilities, challenging behaviour and autistic spectrum disorders, by enabling then to settle and integrate within their own community, to become accepted and valued as individuals and to enjoy the facilities and amenities available to all people within the community, whilst also providing professional guidance and support to enable then to live independently. Each person is encouraged to exercise their right to choice and take responsiblity for their daily lives, also to do as much for themselves as possible within their daily routine. High standards of support are maintained so as to optimise each persons quality of life. Fee levels for 14 Colne Road range from £1500 to £2200 per week. Care Homes for Adults (18-65 years) Page 3 of 11 What we found: We carried this unannounced random inspection of 14 Colne Road on Wednesday 21st October 2009. This inspection was carried out by two inspectors from the Care Quality Commission. The inspection lasted six hours and we were assisted throughout the inspection by the registered manager. The reason for this visit was to check compliance with the requirements we made at the last key inspection in July 2009. We spoke with the two residents and two staff who were on duty at the time of the inspection. We observed the interactions between staff and residents. We inspected the building and examined various care records as well as a number of policies and procedures. At the last key inspection we issued four immediate requirements and eighteen statutory requirements. The four immediate requirements related to physical intervention deployed by staff at the home and the recording and reporting of incidents. Care plans examined at the last inspection did not give clear instructions to staff regarding the use of physical intervention. The two service users that these issues related to have since left the home. However we saw evidence that the service had tried to obtain multidisciplinary advice and agreement about this issue. The manager and service manager told us that the two existing residents at the home have been assessed as not requiring any physical intervention measures but they were clear about their responsibilities should the need arise in the future. The manager told us that there have not been any major incidents since the two service users had left the service. The manager was clear about her responsibilities to report any incidents to the appropriate authorities including the CQC. The manager has carried out staff training in reporting and recording incidents with the staff team. A template for recording incidents has been devised to assist staff and this issue is discussed in staff meetings. Given the evidence provided by the service prior to this inspection and the evidence we saw on the day of the inspection we consider these immediate requirements to have been met. Two care plans were examined. Both care plans outlined the service users needs and how staff are to meet these needs. Both staff we spoke to had a good understanding of the needs and wishes of the service users and gave examples of how these are being met. One of the service users told us about activities he has undertaken with staff and said he was happy at the home. There is a section in each care plan called, What is important to me. In both peoples care plans these were both identical. This generic formulation of care plans does not support a person centred approach to care. The language used in care plans and in daily reports was supportive, non judgemental and age appropriate. The manager told us that staff have received training in this area. Interactions we observed between staff and residents were respectful and age appropriate. Although both staff on duty have only been employed recently we were impressed by their conduct and knowledge of service users at the home. Both staff said they are still undergoing induction training and that this has been useful for them. Care Homes for Adults (18-65 years) Page 4 of 11 We examined the induction procedure which included the issue of informing senior staff about any significant events involving service users. Service users weight is being monitored on a regular basis and recorded in each persons care plan. We noted that a referral had been made to the local authority in relation to an assessment of a service user under the Mental Capacity Act. This should ensure that the rights and safety of service users are respected and assured. Risk assessments had been carried out for both service users. These related to risks associated with activates of daily living such as going out of the home and preparing food in the kitchen. Risk assessments outlined the perceived risk and detailed action that staff need to take to minimise these risks. Although the risk assessments had different actions depending on the individual, they did not give staff adequate information about what they should do if these measures did not work. For example one persons risk assessment clearly described to staff the possible indicators that the service user may be becoming agitated. The advice to staff was to calm the person down however there was no further advice to staff should this strategy not work. We were told that all staff carry mobile phones to call for support if needed. This needs to be recorded on risk assessments. Care plans were not being reviewed as often as the organisations policy states. We saw a number of examples where service users needs had changed but this was not recorded in their plan of care. Care plans and risk assessments for both service users need to be updated. There was no mention in care plans about how staff are to support service users to express their sexuality. A staff member told us that this was an issue for both service users and although from discussion it appeared that the staff member had dealt with this issue sensitively, advice for staff must be recorded in individual care plans. We were informed that as there are only two service users in the home staffing levels at night have been reduced. There is now only one waking night staff throughout the night. There is a folding bed in the office which will be used by a sleep in staff when admissions to the home increase. We examined the lone working policy as this now relates to night staff. This policy had not been reviewed and stated that there should always be two staff on duty at the home. This policy will need to be reviewed and a satisfactory risk assessment developed. The service manager told us that he would update this policy and risk assessment as a matter of urgency. When we arrived at the home one service user was assisting staff with the preparation of lunch. Staff told us that service users are now much more involved in food shopping, preparation of meals and menu planning. This was confirmed by a service user we spoke with. The manager informed us that a small safe had been purchased to hold services users money and valuables if required. A requirement was issued at the last inspection for the service to ensure that service Care Homes for Adults (18-65 years) Page 5 of 11 users televisions are working properly in their rooms. The service manager told us that the home needs a new aerial and that scaffolding must be put up to facilitate this. The manager told us that the two current service users enjoy watching DVDs and using the internet. There is a large flat screen in the communal lounge. This requirement has been partially met and will not be restated as we were assured the new aerial will be fitted soon. We toured the home with one member of staff and visited a service users bedroom with their permission. There were no pictures up on any of the walls in the home and we were told this was due to a former service user taking them all down. Staff told us that both current service users had been choosing pictures for the home. Toilets contained anti bacterial soap and paper hand towels to limit the risk of cross infection. We examined four staff files. All contained the required recruitment information including proof of identity, written references and criminal record checks. There were also evidence that staff are being supervised on a regular basis. Records of staff training were patchy. Although it appears that most staff have undertaken health and safety training there were gaps. One member of staff did not appear to have had first aid training since 2000. The service manager told us that he would make sure this particular member of staff and other staff who needed it would undertake First Aid training within the next couple of weeks. We saw evidence that other training has been booked for staff. The requirement we issued at the last inspection has been partly met and has been amended and restated. The service manager has been undertaking monthly visits to the home and providing the Commission with a copy of these reports. The reports are detailed and include information about safe working practices and current issues for service users. The manager has now applied to the Commission to be registered. We examined the staffing rota. At the last inspection we were concerned that staff were working long hours and over a number of days without a break. The manager and service manager acknowledged that this was still a problem. Since the last inspection a member of staff has left and two staff have been recruited. These two staff are just completing their induction and the manager told us that they would then be able to undertake night shifts. Hours worked by some staff in the home has been excessive and is potentially unsafe. It is hoped that the new staffing rota will ensure staff work reasonable hours at the home. In June of this year a resident climbed through a skylight in the roof and was seriously injured. This issue is still being investigated by the local Health and Safety unit and is also subject to an Adult Protection investigation. The skylight was fitted with window restrictors shortly after the incident. We were informed by the registered provider that this skylight had been designated as a fire exit. There was no written evidence from the fire department that this was the case. The registered provider later told us this was discussed during the inspection of the home by the fire department and that they had told the service manager the skylight was needed for fire access rather than for a fire exit. The fire department sent a letter to the service confirming that the home was fit for purpose. We examined the general risk assessment for the building. This is an environmental risk Care Homes for Adults (18-65 years) Page 6 of 11 assessment that the service is required to develop and should cover the assessed risks associated with the building and should take into account the current service users safety in the home. Although this risk assessment was completed recently it will need to be reviewed and updated as it related to some service users who have since left the home. This was discussed with the manager on the day of the inspection. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 7 of 11 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 8 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 13 The registered person must ensure that service users sexuality is sensitively addressed in individual care plans. This is to ensure that staff are aware of the service users needs and wishes in this area. 08/12/2009 2 6 15 The registered person must ensure that service user plans are reviewed and updated on a regular basis. This is to ensure that staff are aware of service users current needs and wishes. 08/12/2009 3 9 13 The registered person must 08/12/2009 ensure that risk assessments have detailed information and advice for staff regarding minimising risks to service users and others. This is to ensure that both service users and staff are safe. Care Homes for Adults (18-65 years) Page 9 of 11 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 9 13 The registered person must 08/12/2009 ensure that risk assessments are reviewed and updated on a regular basis. This is to ensure that staff are aware of the current risks faced by service users at the home. 5 9 13 The registered person must 08/12/2009 ensure that the staff lone working policy and risk assessment are reviewed and updated. This is to ensure the safety of staff and service users at the home. 6 42 13 The registered person must ensure that staff undertake first aid training. This is to ensure that there is always a staff member, qualified in first aid, on duty at all times in the home. 31/12/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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