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Inspection on 14/06/05 for Waterfall House

Also see our care home review for Waterfall House for more information

This inspection was carried out on 14th June 2005.

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 but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The service users benefit from six monthly in-house reviews of their assessed needs that are reflected in their individual plans ensuring that their needs are met and that staff are supporting them in the way they prefer to promote independence. Service users benefit from fulfilling activities to enhance their lives and meet their aspirations all within the guidelines of measured risk. Service users benefit from the experience of multidisciplinary working to ensure that their personal care, social and emotional health needs are met. The home ensures that service users, relatives and other professional`s views are listened to and addressed to improve service provision. Service users benefit from a well-established staff team who understand their needs and are provided with the support and information to work with service users in a consistent way. Robust policies and procedures are followed in the recruitment of staff to ensure service users are protected. The home is well managed and all health and safety checks are carried out to ensure the health, welfare and safety of service users living in the home. Service users say that the staff are very helpful, caring and friendly. All service users said that they felt comfortable in the home and that enjoyed the food.

What has improved since the last inspection?

Seven requirements were made at the last unannounced inspection two are restated, one is amended and restated. Two recommendations were made one was restated as a requirement the other had been met. The two requirements made following an additional visit had also been met. All service users who self-medicate have been risk assessed which had been documented to safe guard against any medication administration errors. Service users have benefited from recent redecoration to some areas of the home and new carpets have been replaced in some key areas making the home more homely. Service users who have expressed their wish to continue to share a bedroom have now been provided with screening to maintain their privacy and dignity. The financial arrangements for service users had been partially documented in their individual plans. All service users receive and manage their own benefits, which promotes independence. The registered person is fully aware of when to notify the CSCI of any occurrence listed under regulation 37 of the Care Homes Regulations. There have not been any notifiable incidences effecting service users. Each service user can be reassured that staff have a good knowledge of their background, interests, social and emotional well-being needs following the development of their pen pictures held on their individual files.The home carries out annual quality assurance surveys involving service users to ensure that the development of the service is a priority and to improve service provision for service users. Staff have received infection control and fire training to safeguard service users.

What the care home could do better:

Thirteen requirements were made, three have been restated. Staff must receive specific training in mental health issues relating to the service user group, for example schizophrenia, depression and alcoholism. This is essential if staff are to understand and meet the service users needs fully. Staff must receive all statutory training such as first aid, food hygiene and health and safety on an annual basis to safe guard service users and themselves. The financial arrangements and support needs for managing money including how service users specifically access their benefits as part of the weekly fee must be documented in the individual file. This will provide clarity for the service user, auditors and prevent any confusion. Each service user is entitled to, as part of the basic contract price a seven day holiday each year. This cost must be negotiated with the placing authority to be part of the basic contract price. Many service users have not had an annual holiday for more that ten years and deserve the experience of choosing and going on holiday if they wish. Service users must have annual reviews involving the placing authority to ensure that the placement is still suitable for them and that their needs are still being met. Weight reductions documented in individual files must be monitored more closely to identify the reasons for the weight loss for example, is it due to the individual`s mental health or physical health. This is necessary for the health and welfare of service users. It is recommended that the activities in the home be reviewed regularly with service users as per the remarks made on the comment cards received. All new staff must receive all statutory training within six months of employment, to ensure competency and safety in the work place. It isrecommended that the designated roles of staff be documented on the duty rota for clarity. The complaint received by the Commission must be logged in the complaints book and the action taken by the home after the additional visit must be recorded. Carpets must be cleaned and /or replaced in key areas of the home for the safety of service users and to promote a homely environment. Further decoration is needed to maintain a homely environment; a maintenance plan must be developed and sent to the Commission to demonstrate these efforts. An Occupational Therapy assessment must be carried out for one service user whose mobility is changeable to ensure his safety and to minimise the risk of falling. The homes risk assessment must include a smoking risk assessment to safeguard both service users and staff. The homes policies and procedures, more specifically adult protection, recruitment and missing persons procedure for one service user must be reviewed as a priority. This is to ensure that all policies and procedures reflect current legislation and to safeguard service users from unnecessary risk.

CARE HOME ADULTS 18-65 Waterfall House 363-365 Bowes Road New Southgate London N11 1AA Lead Inspector Rebecca Bauers Announced 14th June 2005 @ 10:00 am 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 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 Stationary 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. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Waterfall House Address 363-365 Bowes Road, New Southgate, London N11 1AA & 24 Brookdale, New Southgate, London N11 1BP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 368 0470 Mr Haresh Dhunnoo Mrs Marina Dhunnoo PC Care Home only 27 Category(ies) of MD Mental Disorder registration, with number of places Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: 1 Not to exceed 18 adults of either gender with a mental disorder, excluding learning disability or dementia (MD) at Waterfall House 363-365 Bowes Road, New Southgate, London, N11 1AA. 2 Not to exceed 4 adults of either gender with a mental disorder, excluding learning disability or dementia (MD) at 24 Brookdale, New Southgate, London, N11 1BP (satellite). 3 Not to exceed 5 adults of either gender with a mental disorder, excluding learning disability or dementia (MD) at 26 Brookdale, New Southgate, London, N11 1BP (satellite). 4 Thirteen specified service users who are over 65 years of age may remain accommodated in 363-365 Bowes Road. 5 The home must advise the regulating authority at such times as any of the specified service users vacate the homes. 6 One specified service user who is over 65 years of age may remain accommodated in 26 Brookdale, Waterfall House. The home must advise the regulating authority at such times as any of the specified service users vacates the home. 7th March 2005 (additional visit). 3rd November 2005 (last unannounced) Brief Description of the Service: Waterfall House is a care home registered to provide support and accommodation to 27 adults of either gender with mental health problems. The home’s service user guide states that Waterfall House offers rehabilitation to those with a mental illness with a view to living an ordinary life in the community.Waterfall House consists of three separate units: 363/365 Bowes Road accommodating 18 service users, 24 Brookdale accommodating 4 service users and 26 Brookdale accommodating 5 service users. Fourteen service users are over the age of 65. The registered person has a variation of conditions on their registration in respect of these service users. The building in Bowes Road consists of two-semi detached houses, which have been connected internally and extended to provide additional living space. Local shops and all other amenities are close by. Arnos Grove tube station is five minutes walk away. 24-26 Brookdale are both ordinary suburban semidetached properties positioned next to each other and about five minutes walk from Bowes Road. The home was opened in 1998 with seven service users all around 50 years of age. In 1992, 24 Brookdale opened and a few years later 26 Brookdale was opened – these homes are for more independent service users. Waterfall House is a home for life but service users can move on if they choose to. There are currently three long-term vacancies in 24 Brookdale. All properties are adequately furnished in a homely way. The properties have well maintained front and back gardens. Date of last inspection Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on the 14th of June 2005 as part of the annual inspection programme to identify progress with previous requirements made and following an additional visit in March 2005 when a complaint was made to the Commission. In addition, the standards of care were checked against the core standards. The inspection took five and a half hours to complete. A full tour of the home took place; seven service users were spoken to both on an individual basis and in a group. No relatives requested to speak to the inspector. Care records, quality assurance audits, staff records and health and safety records were examined. Three staff were spoken to. The inspector spoke briefly to the registered person and the registered manager was present throughout. Further information was obtained from the pre-inspection questionnaire and comment cards. Twenty-five comment cards were received in total, two from health care professionals including GPs. Positive comments were given with regard to the care received and the caring, enthusiastic attitude of the staff team to meet the needs of the service users. Twenty- three comment cards were received from service users. What the service does well: The service users benefit from six monthly in-house reviews of their assessed needs that are reflected in their individual plans ensuring that their needs are met and that staff are supporting them in the way they prefer to promote independence. Service users benefit from fulfilling activities to enhance their lives and meet their aspirations all within the guidelines of measured risk. Service users benefit from the experience of multidisciplinary working to ensure that their personal care, social and emotional health needs are met. The home ensures that service users, relatives and other professional’s views are listened to and addressed to improve service provision. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 6 Service users benefit from a well-established staff team who understand their needs and are provided with the support and information to work with service users in a consistent way. Robust policies and procedures are followed in the recruitment of staff to ensure service users are protected. The home is well managed and all health and safety checks are carried out to ensure the health, welfare and safety of service users living in the home. Service users say that the staff are very helpful, caring and friendly. All service users said that they felt comfortable in the home and that enjoyed the food. What has improved since the last inspection? Seven requirements were made at the last unannounced inspection two are restated, one is amended and restated. Two recommendations were made one was restated as a requirement the other had been met. The two requirements made following an additional visit had also been met. All service users who self-medicate have been risk assessed which had been documented to safe guard against any medication administration errors. Service users have benefited from recent redecoration to some areas of the home and new carpets have been replaced in some key areas making the home more homely. Service users who have expressed their wish to continue to share a bedroom have now been provided with screening to maintain their privacy and dignity. The financial arrangements for service users had been partially documented in their individual plans. All service users receive and manage their own benefits, which promotes independence. The registered person is fully aware of when to notify the CSCI of any occurrence listed under regulation 37 of the Care Homes Regulations. There have not been any notifiable incidences effecting service users. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 7 Each service user can be reassured that staff have a good knowledge of their background, interests, social and emotional well-being needs following the development of their pen pictures held on their individual files. The home carries out annual quality assurance surveys involving service users to ensure that the development of the service is a priority and to improve service provision for service users. Staff have received infection control and fire training to safeguard service users. What they could do better: Thirteen requirements were made, three have been restated. Staff must receive specific training in mental health issues relating to the service user group, for example schizophrenia, depression and alcoholism. This is essential if staff are to understand and meet the service users needs fully. Staff must receive all statutory training such as first aid, food hygiene and health and safety on an annual basis to safe guard service users and themselves. The financial arrangements and support needs for managing money including how service users specifically access their benefits as part of the weekly fee must be documented in the individual file. This will provide clarity for the service user, auditors and prevent any confusion. Each service user is entitled to, as part of the basic contract price a seven day holiday each year. This cost must be negotiated with the placing authority to be part of the basic contract price. Many service users have not had an annual holiday for more that ten years and deserve the experience of choosing and going on holiday if they wish. Service users must have annual reviews involving the placing authority to ensure that the placement is still suitable for them and that their needs are still being met. Weight reductions documented in individual files must be monitored more closely to identify the reasons for the weight loss for example, is it due to the individual’s mental health or physical health. This is necessary for the health and welfare of service users. It is recommended that the activities in the home be reviewed regularly with service users as per the remarks made on the comment cards received. All new staff must receive all statutory training within six months of employment, to ensure competency and safety in the work place. It is Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 8 recommended that the designated roles of staff be documented on the duty rota for clarity. The complaint received by the Commission must be logged in the complaints book and the action taken by the home after the additional visit must be recorded. Carpets must be cleaned and /or replaced in key areas of the home for the safety of service users and to promote a homely environment. Further decoration is needed to maintain a homely environment; a maintenance plan must be developed and sent to the Commission to demonstrate these efforts. An Occupational Therapy assessment must be carried out for one service user whose mobility is changeable to ensure his safety and to minimise the risk of falling. The homes risk assessment must include a smoking risk assessment to safeguard both service users and staff. The homes policies and procedures, more specifically adult protection, recruitment and missing persons procedure for one service user must be reviewed as a priority. This is to ensure that all policies and procedures reflect current legislation and to safeguard service users from unnecessary risk. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,4,5 Prospective service users needs and aspirations are assessed prior to admission. Service users are able to visit the home prior to making a decision about the suitability of the home. All service users have an individual contract. EVIDENCE: There have been two new admissions in the last twelve months. Service users individual aspirations and needs are assessed prior to admission through a comprehensive assessment and a summary care plan. Service users and their records confirmed that they had a trial visit to the home prior to moving in. Each service user has a signed contract held on file to ensure that they know the terms and conditions of the placement. One service user has been served her notice by the registered provider, but had been given three months instead of one month to find an alternative placement as she had expressed a wish to live independently and her needs could no longer be met by the home. The deadline date was the 15/6/05. The providers have not received any correspondence or had any communication from the placing authority with regard to this matter. The service user expressed that she had visited four other placements but did not like them and preferred Waterfall House. She did confirm her wish to have her own flat or to live with a family of the same cultural background as herself. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 Service users know their assessed needs and changing needs and goals are reflected in their individual plan based on their own involvement. Service users actively participate and are consulted on all aspects of their lives. The home is proactive in supporting service users to take risk as part of an independent lifestyle. Not all service users have had annual reviews. EVIDENCE: A recommendation made at the last inspection for each service user to have a pen picture/life history held on their file so that a holistic view of the individual is obtained had been developed. The care plans are comprehensive and service users can feel confident that their individual files give a full indication of their personal history including work life, likes dislikes, general interests, social and emotional support needs. Service users confirmed that they had been involved in the development of their pen pictures. Service users were observed interacting with staff and making decisions. Progress sheets indicated decisions made by service users; service users also spoke about how they helped each other with aspects of their responsibilities in and around the home. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 12 Service user risk assessments were appropriate and had been reviewed every three months. Care plans are reviewed six monthly with service users who confirmed their involvement. Not all service users had received annual reviews involving the placing authority. This must be rectified; all service users must have annual reviews to ensure the placement is still suitable for their needs. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 Service users have opportunities for personal development and generally access appropriate activities. The majority of service users have not had a holiday in more than ten years. Service users feel that their rights and responsibilities are recognised and respected. Family and friend contact is promoted and the food provided is judged positively by all service users and the inspector. EVIDENCE: A recommendation restated from the last two inspections for service users to have as part of the basic contract price and through negotiation with the placing authority the option of a minimum seven-day annual holiday outside the home which they help to choose and plan had not been complied with. The registered person commented that he had tried on several occasions to negotiate with the various placing authorities to achieve this recommendation but that he had not managed to secure any additional resources for the service users to enable this to happen. The fees in the home are currently very low and it would be unreasonable for the home to meet these costs. Most of the service users have not had a holiday in more than ten years; others do Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 14 occasionally go on holiday with their families. This recommendation is restated for the third time. Individual plans clearly indicated a range of opportunities for development, activities in the wider community accessed and regular family and friend contact. Seven service users spoken to said that they liked living in the home very much and that they had free access to most activities they wanted to do. Seven out of twenty three of the feedback comment cards received noted that service users felt that the home either sometimes or did not provide suitable activities. This should be addressed and monitored through for example resident meetings. Service users said that they open their own post and staff sometimes help them to understand their post. All service users spoken to said that staff respected their wishes, were approachable and kind. This positive interaction was observed during the inspection. All service users spoken to said “ I like the food”, one commented “I am a vegetarian and I cook my own food with staff help” others said “ I can choose a different meal if I want, its not a problem the staff are really good like that”. One service user when asked would you like more vegetables? Said, ‘yes’, others said ‘no I don’t like vegetables too much.’ Fresh vegetables and fruit were available, the registered manager was aware of the individual preferences of service users; these had been noted on their files. Menus were varied and balanced. The home has several fridges and freezers that were well-stocked, fresh fruit and vegetables are bought weekly from a local supplier. All 23 comment cards received from service users stated that they “liked the food”. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Service users say that they receive personal support in the way they prefer and their emotional needs are fully met by the home. Most physical needs are being met. Service users retain, administer and control their own medication where appropriate and are protected and safeguarded by the homes policies and procedures. EVIDENCE: A restated requirement made for a risk assessment to be carried out for those service users who self-medicate in the Brookdale annex had been met. The risk assessments had been agreed and signed by the service users, they are reviewed three monthly and service users sign their own medication book to indicate that they have taken their medication, which is checked by staff. During an additional visit, following a complaint made to the Commission with regard to the registered providers perceived reluctance to reduce medication and to ask for service users medication to be increased, a requirement was made for one service user’s night-time medication to be reviewed. This had been complied with. The complaint was not upheld. An increase in the service user’s medication was made by the GP. A further requirement was made for the registered person to ensure that a record of current medication is obtained from the consultant, GP and CPN, specifically relating to the changes in dose made for service users prescribed depot injections had been progressed as far Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 16 as it is likely to. The CPN verbally informs the home of the dose and frequency of the depot injection, this had been documented in the three service users individual plans by the registered manager. A recommendation made for the registered person to ask the CPN’S, GP’s and consultants to read and sign the documented observations of changes noted in individual service users behaviour following any changes to prescribed medication had been progressed by the homes pro-activeness to inform these key people with a team member and to document that this had occurred in the individual plans of the service users. It is likely that this recommendation cannot be progressed further. Service users’ personal preferences with regard to their personal care needs are documented as part of their individual plans. Service users confirmed that staff are respectful and support them with personal care in the way they prefer. Service users’ physical and emotional health needs are well documented and are mostly acted upon according to records of health care intervention and service users actual comments during the inspection. Six individual plans were examined, weight monitoring is common place, however in two instances service users had lost weight consistently over five months, but there was no indication as to what action may be taken to identify if this was related to the person’s mental health, or physical health. This must be rectified. Clear consistent triggers must be identified and clear actions to be taken by staff must be documented. Service users are protected by the homes medication policies and procedures. All staff that administer medication have been suitably trained. Medication records were checked and a clear audit trail was found. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22-23 Service users do feel that they are listened to and issues raised are acted upon. The complaints record is not however up-to-date. Adult protection procedures do not reflect recent changes in legislation, but service users are protected from abuse, neglect and self-harm by well trained staff. EVIDENCE: A complaint made to the Commission by the Enfield social work team in February 05 concerning the food provided over the Christmas period and the registered persons perceived reluctance to reduce medication and to ask for service users medication to be increased was investigated by the Commission. This involved the regulation inspector and the pharmacist inspector. The complaint was not upheld however further requirements were made. These had been met. It appeared that there had been a break down in communication between the home and the social work team who visit the home regularly. With regard to the food provided over the Christmas period this was addressed during this inspection, all comments were positive. The registered provider had also addressed this with every service user. No negative comments had been made. The registered person had not recorded this complaint in the complaints book. This must be recorded and any action taken by the registered person must be recorded. Service users stated that they felt that their views are listened to and acted upon. No complaints had been made to the provider since the last inspection. None of the service users wished to complain about the home and said that they felt that they could approach the staff if they were unhappy about Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 18 something. Feedback received from health care professionals and GP’s commented that they had not received any complaints about the home. The adult protection procedure was last reviewed in 2002; this must be revised to include the most recent POVA guidance. All staff had received adult protection training. A requirement made at the last inspection for the financial arrangements and support needs for managing money to be documented in service user plans had been partially progressed. In many cases the service users manage their own money, but receive their benefits from the local authority as part of the weekly fee paid to the provider. This process must be documented in the individual plan. There were accurate records of service users receiving their weekly benefits and they had signed to evidence this. One service user receives DLA and two service users are under the court of protection; a further service user may also have his financial affairs dealt with through court of protection. This is currently being addressed by his social worker. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,29,30 The home is brighter, more homely and safe since the last inspection. Service users say that their bedrooms suit their needs. Good efforts have been made to address maintenance issues, which are ongoing. The home is clean and hygienic. There is no specialist equipment in the home to maximise service users independence if needed, which could present a risk. EVIDENCE: A requirement made at the last inspection for two bedroom carpets and the stairs and landing carpet to be replaced at Bowes Road had been complied with. A new central heating system had been fitted in both Bowes Road and Brookdale. Four bedrooms had been redecorated in line with service users personal choice. Service users confirmed this. The downstairs toilet had been painted and the floor had been re-tiled. A requirement made for a suitable domestic screen to be provided for those service users who wish to share a bedroom had been complied with, although the screen was a little clinical, the service users expressed that they did not use it anyway. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 20 The home was brighter and more homely since the last inspection, the gardens had been well tended and one service user had planted herbs, tomato plants and runner beans in the garden, which he tended to. Further requirements have been made for the landing and stair carpets in Bowes Road to be replaced, as they are threadbare in some places. The lounge carpet in Bowes Road was stained, similarly one of the bedroom carpets (room 12) was also stained these must be cleaned or replaced. Some lights shades were missing in some of the bathrooms and toilets, these must be replaced. The registered person said that he was planning to redecorate several of the bedrooms in the next year. Many of the service users smoke and so the home requires more frequent redecoration due to discolouration caused by the smoke. The registered provider has made good efforts to keep on top of this issue. The home was clean and free from offensive odours. One service user expressed his anxieties with regard to his own mobility and said that he feels a little unstable at times. There are several older service users in the home and so it would be of benefit to make a referral to an Occupational Therapist for advice with regard to possible adaptations in and around the home. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,35,36 Service users do benefit from a stable, well supported staff team who are clear about their roles and responsibilities. Staff morale is good. Service users are protected by the homes recruitment practices. Service users individual and specific needs are not wholly met by trained staff, which restricts their care practices. EVIDENCE: A restated requirement made at the last inspection for staff to receive training specifically related to the service users mental health needs had not been complied with. This training must be addressed as a priority to ensure that all staff are up-to-date with current practice and understanding of the needs of the people they work with, with mental health needs. A restated requirement made at the last inspection for all staff to receive statutory training had been progressed partially. All but three staff had completed first aid training. All staff must complete first aid training including the newly appointed member of staff. Staff had not completed food hygiene or health and safety. This must be achieved by all staff. All staff had completed infection control and fire safety. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 22 The most recently recruited member of staff had not yet received any certified training, although she had completed a basic induction. All new staff must receive all statutory training within six months of their employment date. Thirty three percent of staff have completed NVQ level 2 in care. One staff member is undertaking NVQ level 3 in care. The service users benefit from being supported by a stable friendly staff team. Service users commented, ‘staff are nice they treat me well.’ One health care professionals feedback from comment cards was as follows: ‘in my experience, the staff at Waterfall House are kind, caring towards their residents and I have always found the atmosphere calm and contented. I have never heard any resident speak negatively about the home.’ Staff spoken to advised that staff morale was very good and that everybody helped each other out. The rota demonstrated that there are sufficient staff on duty to meet the current needs of the service users. There is always an identified designated responsible person on duty. It is recommended that the rota identify care staff roles and whether they are part-time or full time. Service users are protected by the homes recruitment procedures and practice. The two new staff members files examined were complete and contained all relevant information to safeguard service users. Supervision records were upto-date demonstrating continuity in care and practice to benefit service users. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 23 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,42 Service users do benefit from a well run home. The registered manager has an open management style that facilitates positive development in service provision. Service users are very confident that their views underpin selfmonitoring in the home. Policies and procedures have not been reviewed. This is essential to ensure that all practice in the home reflects current legislation and protects the service users. The health, safety and welfare of service users is promoted and protected, minor amendments to risk assessments will ensure more comprehensive protection for service users. EVIDENCE: A requirement made at the last inspection for all reportable incidences under regulation 37 to be reported to the CSCI had been complied with. There have however been no further reportable incidences, but the registered person is fully aware of his responsibilities. Service users do benefit from a well run home; service users spoken to were very complimentary about the registered provider, registered manager and Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 24 staff. Service users are very much involved in the running of the home and have a good awareness of their surroundings. Staff spoken to felt that the registered manager was very approachable, service users also said that they felt comfortable with talking to the manger or provider about anything that concerned them. Quality assurance systems such as annual questionnaires and resident meetings ensure that service users can feel confident that their views underpin all self-monitoring, review and development by the home. The homes policies and procedures were most recently reviewed during 2002. The registered person must review all policies and procedures, giving priority to the adult protection procedures and recruitment procedures to ensure all refer to new changes in legislation, for example POVA. This must be completed to safeguard service users. The missing person procedure for one service user must be revised to ensure it reflects his current independence levels and to ensure unnecessary panic is not caused. A recent photograph must also be available on his file. All health and safety checks had been carried out, all records were in place and up-to-date to safeguard service users. Most service users do however smoke. The registered person must ensure that the homes risk assessment includes a detailed risk assessment to identify the risks of smoking and how to minimise the risk of fire in the home from smoking. The home does have an up-to-date fire risk assessment and emergency plan in place that has been approved by the fire brigade during an inspection on 13/6/05. The registered manager is currently undertaking the registered manager’s award. Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 25 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x x 2 3 Standard No 11 12 13 14 15 16 17 x 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score 3 x x 3 1 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 Waterfall House Score 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 x 2 x Version 1.20 Page 26 G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc 21 x Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 27 yes Are there any outstanding requirements from the last inspection? 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 35 Regulation 18(1)(i) Requirement The registered person must ensure that staff receive training specifically related to the service user group. For example, mental heath conditions such as depression, schizophrenia and alcoholism. This requirement is restated from the last two inspections. Timescale for action was 31/1/05. The registered person must ensure that staff receive all statutory training on an annual basis. Three remaining staff must have first aid training; all staff must have food hygiene, and health and safety training. Planned and attended training dates must be documented in staff training profiles. This requirement is amended and restated from the last two inspections. Timescale for action was 28/2/05. The registered person must ensure that the financial arrangements and support needs for managing money are documented in individual service user plans. This must include the process in which they access Timescale for action 1/9/05 2. 35 18(1)(c),( i) 23(4)(d) 13(4)(c ) 1/9/05 3. 23 13(6) 1/8/05 Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 28 4. 8 5. 19 6. 22 7. 24 8. 29 9. 35 10. 40 11. 40 their income support. This requirement is amended and restated at this inspection. 15(2)(b)(c The registered person must ) ensure that all service users have annual reviews involving a social worker from their placing authority. 12(1)(b) The registered person must ensure that documented weight loss is accompanied by clear actions for staff to monitor individual service users mental health and any necessary triggers to seek medical and or psychiatiric intervention. 17(2) The registered person must 22(8) ensure that the complaint received by the CSCI is documented in the homes complaint book. 23(2)(b) The registered person must provide a maintenance plan with timescales to replace carpets that are either stained or threadbare in some areas of the home at Bowes Road and 24-26 Brookdale. 23(n) The registered person must ensure that an O.T assessment is carried for one service user who is anxious about his mobility. 18(1)(c ) The registered person must (i) ensure that all new staff receive all statutory training within six months of commencing employment. 17(3)(a) The registered person must ensure that the homes policies and procedures are reviewed. Priority must be given to the adult protection procedure and the recruitiment policy and procedure. 17(2) The registered person must Schedule ensure that the missing persons procedure for one service user in particular is reviewed and that G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc 1/9/05 1/8/05 1/7/05 1/9/05 1/9/05 1/9/05 1/11/05 1/8/05 Waterfall House Version 1.20 Page 29 a recent photograph is attached. 12. 42 13(4)(b) The registered person must include as part of the homes risk assessment an assessment for smoking and ways to minimise the risk of fire as a result of smoking. 31/8/05 13. 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 12 Good Practice Recommendations It is recommended that the registered person review the activities provided in the home in line with the feedback from the comment cards from service users to identify specifically what they would like to do. This could be addressed during a service user meeting. It is recommended that the staff rota includes the designated role of each staff member on duty. The registered person should enable service users to have, as part of the basic contract price and through negotiation with the local authority the option of a minimum sevenday annual holiday outside the home, which they help choose and plan. This was a recommendation that had been restated from the last two inspections and is restated at this inspection. 2. 3. 31 14 Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 30 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road, Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Waterfall House G59 S10684 Waterfall House V221170 14.06.05 Stage 4.doc Version 1.20 Page 31 - 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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