Inspection on 07/05/08 for Dimensions 49 Chichester Court

This inspection was carried out on 7th May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dimensions 49 Chichester Court 06/12/06

Dimensions 49 Chichester Court 20/01/06

Similar services:

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Adepta 49 Chichester Court 49 Chichester Court Stanmore Middlesex HA7 1DX Lead Inspector Andreas Schwarz Key Unannounced Inspection 7th & 8th May 09:00 Adepta 49 Chichester Court DS0000062735.V363318.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 Adepta 49 Chichester Court DS0000062735.V363318.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. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adepta 49 Chichester Court Address 49 Chichester Court Stanmore Middlesex HA7 1DX 020 8905 0068 020 8343 8876 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) www.pentahact.org.uk PentaHact Limited trading as Adepta Manager post vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2006 Brief Description of the Service: 49 Chichester Court is the largest of four houses in a purpose-built complex previously managed by Hillstream Care but now by Adepta (formerly known as PentaHact) following a merger during the late summer of 2004. Metropolitan Housing Association maintains the building. The home provides long-term care and accommodation for up to seven adults with learning, physical and sensory disabilities. There were two vacancies at the time of the inspection. All people using the service have their own bedrooms. The home has been completely refurbished since the last key inspection. Bedrooms are on the ground and first floors. There is a spacious lounge, two dining areas, and a large garden to the rear. The ground floor is fully wheelchair accessible. Access to the first floor is by stairs only. The home is close to shops, leisure facilities and local transport. It shares a mini-bus with three homes in the same complex. Unrestricted parking is available on the road leading to the house. Fees and charges can be obtained from the Homes Manager or Operational Manager. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This unannounced key inspection took two days and lasted 15 hours altogether. The newly appointed manager was available during both days of this key inspection. We interviewed three members of staff, viewed three staffing files and training records. We case tracked three people using the service and viewed care plans and any other documentations relating to the residents. Residents living in 49 Chichester Court are non-verbal or have very limited verbal communication skills. We observed staff interacting and supporting residents. The home has returned a completed Annual Quality Assurance Assessment on the 7th January 2008. We send out seven service users surveys, ten staff surveys and seven relative surveys, none of these have been returned to us at the time of writing this report. We looked at various records and documents relating to the care and support provided by the home, helping us to make an objective quality judgement about the service. What the service does well: The home is undertaking good consultation processes and people using the service, staff and stakeholders are involved in the forward planning of the home and organisation. The manager has a wide range of experience and is qualified to manage the home. Health and Safety monitoring is done regularly and a safe environment is provided for people using the service. Staff interviewed provided good feedback about the training and support received from the manager. Recruitment processes are robust and staff are vetted to ensure people using the service are protected from unsuitable staff. The home is supporting staff to undertake National Vocational Qualification in Care and over 60 of staff hold these or similar qualifications. The home has undergone Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 6 a complete refurbishment and the upstairs area is now self-contained, this allows the home to match and support residents according to the ability and needs. New prospective residents are encouraged to test drive the home and appropriate information is provided to purchaser and people using the service. What has improved since the last inspection? What they could do better: We made fifteen new requirements during this unannounced key inspection. The home must review the statement of purpose to capture changes in the service provided to people using the service and prospective residents. Care plan reviews and care plans must demonstrate more clearly if people have been involved in the process. People’s cultural and spiritual needs must be addressed in the care planning process to ensure people’s needs are fully met. We found that activities could be better planned and people’s choices are taken into account in the planning process. Residents should be provided with a menu in written or pictorial form to ensure that they aware what meals are provided. Recommendations made by clinicians during assessments must be followed to ensure people’s needs are met holistically. For instance staff informed us that peoples mobility has deteriorated and physiotherapy was stopped due to the physiotherapist being no longer available. Previous inspections highlighted the need to provide staff with communication training as recommended during an assessment made by the Speech and Language therapist; the training was still outstanding during this key inspection. Issues around medication such as signatory list, labelling of opened bottles and staff training must be addressed to ensure people are administered medication safely. We have great concern of staffs understanding around adult protection and the lack of staff training provided in this area, which must be resolved to ensure a safe environment for people. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 7 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. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 8 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 Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 9 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): We assessed National Minimum Standards 1 and 2 during this unannounced key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. New prospective people using the service receive detailed information about the home, prior to being assessed appropriately, to establish if the home is able to meet their needs. EVIDENCE: The service users guide and statement of purpose is of very good standard and detailed. Some information in both documents are not current and staff have left as well as details such as the Commission for Social Care Inspection contact details have changed. We discussed this with the new manager and asked to review both documents to capture these changes. The home has an admissions procedure and policy in place. The procedure states that new prospective people using the service are able to test-drive the home. The home has currently two vacancies and had no admissions since the last key inspection. Assessments of people currently living at Chichester Court are archived. The funding authority has assessed all residents living in Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 10 Chichester Court using the fair pricing tool. We viewed these assessments during this key inspection. The information provided in these assessments addresses the support residents need on a daily basis in Chichester Court, it gives no information of how the support is provided. We recommend for Adepta to assess all residents to ensure needs can be met, with the hours provided by the placing authority. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 6, 7 and 9 during this unannounced key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service understands the right of individuals to take control of their lives and to make their own decisions and choices. There is some evidence that individuals are involved in some decision-making about the home, such as day to day living and social activities. Each individual has a care plan but the practice of involving residents in the development and review of the plan is variable. Risk assessments are completed and are of good standard, but are not reviewed regularly to respond to changes. EVIDENCE: We assessed three care plans during this key inspection. Care plans are of different standard and quality. The manager informed us that he is currently in the process of changing the care planning format. All care plans have been Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 12 reviewed, we viewed minutes in all care plan folders. The minutes had no dates, and have not been signed by the resident or any significant other. Care plans are holistic and address health, community living, behaviour, personal care, domestic duties, money, communication and leisure facilities. One care plan had a cultural and spiritual section, which has not been filled out. Staff told us that the resident is interested into Rastafarianism and enjoys meals and activities relating to his culture and background. Another care plan is part of the Adepta Person Centred Planning pilot and uses photos, pictures. The resident’s family and his circle of support is involved Person Centred Planning process and records have been signed. All care plans have been reviewed internally by key worker, resident and family, and externally by the placing authority involving the above. The deputy manager is facilitating the pilot and has attended a one-day training course. Key workers meet with residents monthly and a monthly report is produced reviewing achieved objectives and plan for the coming months. We noted that one of the key workers did fail to do this and monthly reports for his key client could not been assessed. The manager informed us that he is aware of this and is currently in process of dealing with this. We observed staff interacting and supporting people using the service appropriately. On one occasion a member of staff supported a person to prepare a sandwich. Staff offered the person a choice of bread and filling and explained each step of the preparation to the person. The home has access to an advocacy project in Hertfordshire and some residents have an advocate allocated while other residents are currently on the waiting list. The home tried to obtain advocacy from Brent Advocacy Concern, but had great difficulties with this due to the long waiting list of this service. The placing authority has audited resident’s accounts and found some irregularities. Following this a safeguarding adults strategy meeting was arranged and one of the actions was, that all accounts are independently audited. The manager informed us that this is currently in the process and receipts; records account statements are with the auditors. We were therefore not able to assess people’s finances. We asked the manager to forward the audit report to the Commission for Social Care Inspection. We observed handover, resident’s finances are checked at each handover; the home is using special bags to keep the money, which are sealed. Staff explained to us that they only count the money if the seal is broken. We observed staff giving money to residents before leaving the home for activities. Staff explained that due the level of residents ability they are not able to self manage their finances. We viewed risk assessments in peoples care plan folders. The manager told us that risk assessments are normally reviewed within the care planning process. We noted however that one of the risk assessments viewed has not been reviewed since April 2005. Risk assessments are detailed and address issues such as absconding, swallowing difficulties, moving and handling, etc. The home has a detailed Health and Safety risk and fire risk assessment dated the Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 13 18/03/08 in place. We viewed detailed challenging behaviour guidelines for people using the service, one of the reactive actions to minimise challenging behaviour in these guidelines is the use of “Proactive Strategies for Crisis Intervention and Prevention” (SCIP). We noted during our previous key inspection that only two staff have received training in using this techniques, training records and staff spoken to confirmed that they have received training since the last inspection. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 12, 13, 15, 16 and 17 during this key inspection. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have the opportunity to develop and maintain important personal and family relationships. Residents are involved in the domestic routines of the home and take responsibility for their own room, menu planning and cooking meals with the help of staff. There are limited opportunities for residents to be independent and involved in community activities. EVIDENCE: Three residents living at the home go to Strathcona daycentre in Harrow and one person is going to Albert Road day centre in Queenspark. The home is providing day service for one of the people living at 49 Chichester Court. During the day of this key inspection one person was not able to go to the day Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 15 centre due to staff training. The home arranged for the resident to go out with staff instead, which seemed to be very enjoyable as the person was full of smiles and looked very happy on his return. Part of the care plan is looking at developing domestic skills; this was observed during this inspection when staff supported one resident to make his own sandwich. The manager told us that residents go to the local community for some of their activities. As raised earlier the home is providing in house and community based day service for one of the people living at Chichester Court. The manager and staff informed us that daily activities and participation is recorded in daily records. We viewed daily records for this person from 01/03/08 to 28/03/08; it was recorded that the person accessed the community on three occasions. Once he went to the pub, once to the park and once he went out with his family. At the same time there was an increase of challenging behaviour. The manager informed us that he is aware of this and a new activity programme has been designed, but has not been implemented. We noted that during the last care plan review, activities such as swimming and hydrotherapy was part of the action plan. Application forms and other information relating to these activities were on file, but no further actions were taken by the home to apply for these. The home has access to transport, which is shared with two other schemes. The home has three staff on shift during the morning and three staff on shift during the afternoon and during weekends. We noted in one care plan that the home is supporting the person to go to church every Sunday. The home is addressing relationships and sexuality within the care planning process and residents are encouraged to maintain relationships with families. The home has done a lot of work to establish relationships with family members and two residents have increased contact with their family. The home has a relationship policy in place. Families and representatives are regularly invited to parties and are involved within the quality assurance process. Residents have the opportunity to meet non-disabled people in pubs, café’s, and community based activities. The manager informed us that the home is planning to meet parents and significant others, to discuss the planned change of service to domiciliary care. This change is planned to go ahead in July 2008. We observed one member of staff interacting with residents respectfully and asking him what radio station he would like to choose. Staff did interact with residents throughout this visit. One of the residents at the home is provided one to one support, which was observed during this key inspection. We observed residents move around freely and the ground floor of the home is fully wheel chair accessible. Residents are encouraged to take part in household activities and staff told us that residents who are not able to clean their room are encouraged to be present when staff do the weekly cleaning. Each day a different person is encouraged to take part in cooking of the main meal. One member of staff told us that due to the fact that residents are not in Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 16 the home during the day, rooms can cannot be accessed as they are not present. He and other staff find it difficult to involve them in washing of their clothes. We discussed this with the manager and recommend providing a rota for laundry days. Staff informed us that meals are discussed at the weekly residents meeting using a pictorial menu book allowing residents to make a choice. A picture of the daily meal was displayed on the notice board in the kitchen, but when we were asking staff if that is the meal residents would cook they could not give us a clear answer. This could be confusing for people using the service and we recommend to only display a picture of the meal, which is actually provided. The manager decided to stop the weekly menu and residents can choose on a day to day basis what they would like to eat. Staff is supporting residents to do their shopping daily and choose what they want to have. The manager told us that currently one of the residents is cooking for the other people living at the home. All staff interviewed told us that they are confused about the new practice around cooking, menu and shopping. The home is recording food consumed by residents in their daily logbook. Fruit and drinks were available during this key inspection. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 18, 19 and 20 during this key inspection. People using the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service are supported and provided with and around health care appointments, but on some occasion’s recommendations or follow up appointments are not followed through. There are gaps in the medication administration and process, which could lead to people being administered medication incorrectly. EVIDENCE: We viewed detailed personal care guidelines in care plans assessed during this key inspection. The guidance provides staff with information in which areas people require support and which areas they can do independently. Residents clothes were gender appropriate and staff told us that they support residents in purchasing new clothes. Staff told us that during weekends residents get up later unless they have anything arranged. The home has fitted ceiling hoists in the bathroom and in two bedrooms, which is used by residents with mobility Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 18 problems. We viewed detailed risk assessments in how to use these hoist safely. Staff told us that since fitting the ceiling hoists it is much easier to support people around their personal care. Previously a massage therapist and physiotherapist visited residents. Staff informed us that the massage therapist had stopped due to the high cost to residents and external funding is not available. The physiotherapist has retired and the locum physiotherapist did not attend regularly. Staff told us that since the sessions have stopped one of the persons mobility has deteriorated and we recommend recommencing the sessions. This also explains why we have received number notifiable incidences about one of the residents falling out of the wheelchair, bed, etc. A longstanding member of staff told us that the team is not fully clear which health authority is accepting referrals for clinical support such as psychiatrist, psychologist, etc. Speech and language therapy has been involved and recommended for staff to attend a two days communication course. Training records provided by the home dated the 07/05/08 showed non such training has been provided. Staff spoken to confirmed this. In care plan files we found records of people using the service meeting health care professionals such as General Practitioner, dentist, dietician, psychologist, psychiatrist, etc. Records do document the outcomes of these visits and if there are any follow up appointments necessary. Previous inspections addressed the need for regular chiropodist appointments, this was still found to be an issue and staff told us that they have difficulties in accessing chiropodist services. The home is using Monitored Dosage System supplied by Boots. We viewed three Medication Administration Sheets during this inspection and all records were complete and had no gaps. Some residents receive liquid medication, it was not clear when bottles have been opened or if they were still in date. Staff did not record the day of opening, which is required. We found that allergies are not recorded on the Medication Administration Sheet, which is required. This ensures that residents are not administered any medication, which could be harmful to them. It was not clear to assess the competency in staff administering medication; a signatory list was not available. Training records show that five out of nine staff has attended medication training. We discussed with the manager, he must risk assess and ensure staff that who have not attended formal medication training are competent to administer medication. This is particularly important in view of the two medication errors (05/12/07 & 11/04/08), which have been reported to the Commission for Social Care Inspection. One of the people living at the home is self-administering insulin, a risk assessment is in place and consent was obtained from the person’s relative. We observed the community nurse visiting the home and prepare the syringe with the correct amount of insulin. We found that there was a metal medicines cupboard on the floor and not screwed to the wall, staff told us that they use the cupboard for creams and ointments. We told staff that it is required to fit the medication cupboard safely on the wall to ensure medication is stored securely. The home is monitoring the medicines fridge temperature Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 19 daily, records show that the temperature is slightly above 9° Celsius; we recommend turning the temperature down to ensure that the temperature is between 2° and 9° Celsius. Adepta 49 Chichester Court DS0000062735.V363318.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): We looked at all the above standards during this key inspection. People using the 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 open culture that allows residents to express their views and concerns The service has a complaints procedure that is clearly written and easy to understand. Staff do not receive training and have little awareness of abuse and its many forms. The policies and procedures for safeguarding adults are available to staff, but not all staff know what it says or read the policy. EVIDENCE: The home has a complaints policy in place, which is available in pictorial form. The manager told us, that the home has received one complaint since the last key inspection; this complaint has been resolved. Staff spoken to informed us that they would inform the manager if someone were complaining to them. The home has a complaints log to record complaints. We spoke to three staff during this key inspection; all staff told us that they did not receive any adult protection training since starting to work for Adepta. We looked at training records which confirmed that none of that staff has received formal adult protection training, with the exception of training provided during the cooperate induction. Two staff have received the corporate induction since the last key inspection. Only one member of staff could give a satisfactory answer when asked about the six areas of abuse and how to report Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 21 abuse. Three staff told us that they know about the abuse policy, but only two staff told us that they have read the policy. In the Annual Quality Assurance Assessment the home told us that the organisation is planning to provide the safeguarding adults policy in pictorial form within the next twelve months. The manager informed us that he has received safeguarding adults training in the last year and demonstrated good understanding of reporting and how to involve other agencies in the processes. The home had one adult abuse allegation in regards to resident’s expenditure since the last key inspection. The manager showed us a finance risk assessment, which he has implemented following the safeguarding meeting, which provides additional protection of people’s finances. Adepta 49 Chichester Court DS0000062735.V363318.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): We assessed National Minimum Standards 24 and 30 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is well lit, clean and tidy and smells fresh. EVIDENCE: The home has undergone refurbishment work, which was lead by Metropolitan Housing Trust who owns the property. The refurbishment work has now been completed. The home is on two levels and a self-contained flat, which can accommodate four people, has been created on the first floor, this is to enable the home to move from a registered care home to a supported living scheme. The upstairs flat is nicely decorated and the kitchen has a dining area. The manager told us that the home is currently not using the cooker as it is seen Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 23 as not safe. The cooker has ceramic rings, which could lead to people using the service burning themselves. The manager has asked to have the cooker replaced or a cover purchased. On the ground floor the home has provided a ceiling hoist in two of the three bedrooms and in the bathroom. Staff told us that this makes it easier to support residents who require this equipment. Two residents invited me to see their rooms, both rooms were very nicely decorated and personal items were on display. One of the rooms was very hot; the manager told us that he has turned off the central heating the previous day. I touched the radiator in the person’s room and it was very hot. We left an immediate concern form with the manager to resolve this and provide an environment with an acceptable temperature. The situation had been dealt with during the second day of this key inspection. Furniture and equipment are of domestic character. Laundry can be washed on both floors. The laundry room on the ground floor has been redecorated and a semi-professional washing machine is provided. Controls of Substances Hazardous to Health items are locked away safely. The home has an infection control policy and procedure in place. Staff told us that they discuss infection control during their induction. The home was clean and free of any offensive odours during this key inspection. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 24 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): We assessed National Minimum Standards 32, 34, 35 and 36 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service are supported by staff who are vetted and trained appropriately, there is however sometimes a slippage in the provision of training. EVIDENCE: The manager told us that the home has currently seven permanent, one relief and two agency staff employed. Four staff hold and three staff work towards their National Vocational Qualification in Care. Altogether 60 of staff employed by the home hold or work towards National Vocational Qualification in Care. The home does not employ staff under the age of 18. The manager told us that the home recruits staff with experience in care; this however is not an essential criteria during the recruitment process. Staff will receive training in induction and in practice during their probationary period. Staff spoken to confirm this. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 25 We viewed three staffing files during this inspection, which included some recruitment records. The manager told us that he is in the process of transferring these records to the central office. It was agreed with Adepta and the Commission for Social Care Inspection Providers Relationship Manager in September 2006, that staff records could be stored centrally in the Colchester or Finchley office. Staff told us that they had to provide two references, passport, medical history and a Criminal Records Bureau check during the recruitment process. The manager and deputy manager received recruitment and selection training. The manager told us that diversity issues are addressed during the interview. Staff receives copies of General Social Care Councils Code of Conduct with their handbook. We viewed training records during this inspection. One member of staff has attended challenging behaviour training since the last inspection. The records show none of the other staff employed did receive any challenging behaviour training. Due to the nature of the client group in Chichester Court previous inspection required that all staff have received training in challenging behaviour. Staff have received training such as Autism, Service users risk taking, working with Diversity, Food Hygiene, Health and Safety, etc. Staff spoken to are happy with the training provided by the organisation and no concerns were raised. The manager told us that training is addressed during supervision. The home has a very good training manual in place, which provides information of forthcoming training. The new manager started to supervise staff since starting in March 2008; previous records were not available. Staff told us that the previous manager has provided supervisions to staff. We viewed two supervision records during this inspection training and performance is part of the agenda. Staff told us that they find supervisions helpful. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): We assessed National Minimum Standards 37, 39 and 42 during this key inspection. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications and experience and is competent to run the home. There is a strong ethos of being open and transparent in all areas of running of the home. The Annual Quality Assurance Assessment contains clear, relevant information that is supported by a wide range of evidence. The home has a good record of meeting relevant health and safety requirements and legislation, and closely monitoring its own practice. EVIDENCE: Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 27 A new manager has started in March 2008; the manager has experience of running a registered care home and supported living schemes. He told us that he is currently in the process of completing his Registered Managers Award and he has National Vocational Qualification in Care Level 4. The three staff spoken to are positive about the support they receive from the manager. The manager told us that he has started the registration process, but needs to apply for a Criminal Records Bureau check. One of the surveys received made negative comments about the support provided by the manager, but there was no evidence found during this key inspection. We noted that the public liability insurance certificate has expired and asked the manager to follow this up and display a valid certificate. We viewed the service development plan for 2007/08. This audit is very comprehensive and takes service users, staff and family views in consideration. It also looks at internal and external audits, such as Regulation 26 visits and Commission for Social Care Inspection inspections. The home is also addressing safeguarding and diversity issues in the service development plan. We have received a completed Annual Quality Assurance Assessment in January 2008, which gave us some useful information about the service. The home is holding regular staff and residents meetings. The manager informed us that a consultation meeting about the planned changes in registration is planned for June 2008 and families, residents and stakeholders are invited to attend. We looked at a range of certificates during this key inspection, the Electrical Installation certificate is valid until 2012, the Landlords Gas Safety Certificate expires on the 12/06/08, the Portable Appliances Test Certificate expires on 25/10/08, the boilers have been replaced and a previous Legionella test certificate is in place. The home is undertaking weekly Health and Safety checks. The fire risk assessment is up to date and regular monitoring and servicing of fire procedures and systems are undertaken. The home has a range of Health and Safety policies in place and staff have attended training. Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 1 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 1 X 3 X X X X 3 X Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 29 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 YA1 Regulation 6 (a & b) Requirement The registered person must ensure that the statement of purpose and service users guide is reviewed to provide prospective people using the service with up to date information about the home and the support provided. The registered person must ensure that minutes of care plan reviews are signed and dated by the resident or any significant other to demonstrate participation and validation of the document. The registered person must address cultural and spiritual needs within the care planning process, to demonstrate people’s needs are fully met. The registered person must send the finance audit report produced by the independent auditors to the Commission for Social Care Inspection for DS0000062735.V363318.R01.S.doc Timescale for action 01/07/08 2. YA6 15(1) 15/06/08 3. YA6 16(3) 15/06/08 4. YA7 37(1)(g) 01/07/08 Adepta 49 Chichester Court Version 5.2 Page 30 assessment. 5. YA9 14(2)(a) The registered person must 15/06/08 review all risk assessments at regular intervals to respond positively to changes to risks. (Previous Timescale of 31/12/06 not met) 6. YA13 16(2)(m) The registered person must ensure that activities discussed, chosen and agreed during care plan reviews must be actioned to ensure the needs of people are met. The registered person must ensure that residents can take part and are offered various activities and have a full filling and interesting life. 15/06/08 7. YA13 16(2)(m) 15/06/08 8. YA17 17(2) The registered provider must Schedule 4(13) provide a menu for residents living at the home; this enables everybody to know what meals are provided. 13(1)(b) The registered person must refer residents to a physiotherapist to maintain people’s mobility and independence. The registered person must ensure that staff attends a two-day communication training as recommended by the Speech and Language Therapist during the last assessment. This is to enable staff having a better understanding of the complex forms of communication used by DS0000062735.V363318.R01.S.doc 15/06/08 9. YA18 01/07/08 10. YA18 18(1)(c)(i) 01/07/08 Adepta 49 Chichester Court Version 5.2 Page 31 people using the service. (Previous timescale of 31/03/07 not met) 11. YA19 12(1) The registered person must ensure that residents attend regular chiropodist appointments, to have their toenails looked after appropriately. (Previous timescale of 31/12/06 not met) 12. YA20 13(2) The registered person must ensure that containers for liquid medication are dated when opening to ensure that they are within the expiry date when administered. 01/06/08 01/07/08 13. YA20 13(2) The registered person must 01/06/08 record people’s allergies on the Medication Administration Sheet to prevent people being administered medication, which could be harmful to them. The registered person must provide a signatory list, signed by staff that is competent to administer medication. The registered person must risk assess the competency of staff administering medication without having received accredited medication training. The registered person must ensure that all staff involved in the medication administration receives accredited medication DS0000062735.V363318.R01.S.doc 14. YA20 13(2) 01/06/08 15. YA20 13(2) 15/06/08 16. YA20 13(2) 01/07/08 Adepta 49 Chichester Court Version 5.2 Page 32 training. 17. YA20 13(2) The registered person must 01/06/08 ensure that medication storage is safe and medicines cupboards are screwed to the wall. The registered person must ensure that all staff receives adult protection training to learn about the reporting and recording of safeguarding adult’s allegation and people using the service are protected. (Previous timescale of 31/03/07 not met) 19. YA23 13(6) The registered person must ensure that all staff are aware and have knowledge of the safeguarding adults procedure and policy. The manager must ensure that all staff will have received training in challenging behaviours to ensure that people who present challenging behaviour are supported appropriately. (Previous timescale of 01/07/06 & 31/01/07 not met) 01/07/08 01/07/08 18. YA23 13(6) 20. YA35 18(1)(c) 01/08/08 Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 33 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 YA2 Good Practice Recommendations The registered person should undertake assessments of all residents living at Chichester Court to ensure that the suggested hours provided by the placing authority is enabling the home to meet peoples needs. The registered person should discuss laundry arrangements with people using the service and try to arrange a rota when the laundry room is available. The registered person should discuss the arrangement of shopping, cooking and menu with staff and people using the service to ensure everybody is clear of their responsibilities. The registered person should only display the picture of the meal, which is actually provided to avoid confusion to staff and people using the service. The registered person should inform staff which health authority is responsible for referrals to obtain clinical input such as physiotherapy, psychology, psychiatry, etc. The registered person should lower the temperature of the medicines fridge and maintain a temperature between 2° and 9° Celsius. The home should find out staff training around the use of an EPI pen for insulin injections. It is recommended that each complaint within the complaints file be clearly summarised, in terms of what the issue was, what actions were taken, and what the outcome was. 2. YA16 3. YA17 4. YA17 5. YA18 6. YA20 7. YA20 8. YA22 Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Adepta 49 Chichester Court DS0000062735.V363318.R01.S.doc Version 5.2 Page 35 - 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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