Inspection on 18/08/06 for Alexandra Road Crisis Unit

This inspection was carried out on 18th August 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Alexandra Road Crisis Unit 24/03/09

Alexandra Road Crisis Unit 02/04/07

Alexandra Road Crisis Unit 31/10/05

Alexandra Road Crisis Unit 02/06/05

Alexandra Road Crisis Unit 03/02/05

Alexandra Road Crisis Unit 24/06/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Alexandra Road Crisis Unit 32 Alexandra Road Hornsey London N8 0PP Lead Inspector Peter Illes Key Unannounced Inspection 18th August 2006 09:30 Alexandra Road Crisis Unit DS0000035135.V303295.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 Alexandra Road Crisis Unit DS0000035135.V303295.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. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Road Crisis Unit Address 32 Alexandra Road Hornsey London N8 0PP 020 8365 7287 020 8888 9829 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) London Borough of Haringey Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2005 Brief Description of the Service: The Alexandra Road Crisis Unit is owned and run by London Borough of Haringey. The unit is unique in the borough as it only provides short-term emergency and respite services for up to eight people with mental health problems. Stays are typically from three days up to two weeks and may be an alternative to hospital admission. The unit is a three storey converted and extended domestic premises situated in a quiet residential street between Wood Green and Turnpike Lane. There are eight single rooms, several bathrooms and shower rooms, a choice of two lounges, a staffed kitchen, a separate dining room with facilities to make drinks and snacks, an attractive conservatory that is used as an alternative place to relax and to do artwork and a private garden. All referrals to the unit come via the statutory mental health services and the unit cost of an individual episode of respite care could not be ascertained at this inspection. The manager stated that information about the unit, including information from CSCI inspection reports, was shared with stakeholders. In addition the home keeps a copy of the latest CSCI report on the service user’s notice board in the unit. The unit has several aims: to provide good quality individualised support that is strengths and needs led; to facilitate personal development; to assist service users in development of alternative crisis responses and to foster appropriate coping strategies in order to return to their appropriate environment. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took approximately seven hours with the manager being present or available throughout. There were five service users accommodated at the time of the inspection and three vacancies. One of the service users was discharged on a planned basis during the inspection and the unit was preparing for further planned short stay admissions. The inspection included: meeting and speaking independently to one service user, the other four service users were informed that an inspection was taking place but chose not to talk to the inspector on this occasion; detailed discussion with the manager and independent discussion with the agency deputy manager and three crisis (support) workers. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: What has improved since the last inspection? What they could do better: Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 6 Three requirements are restated from the last inspection. These are in the following areas: documentation available to demonstrate a robust staff recruitment procedure, staff training in safe administration of medication and for the manager to be registered as such with the Commission. In addition a further nine requirements are issued in the following areas: storage of frozen food, a record relating to storage of medication for an identified service user, two requirements relating to the implementation of the unit’s adult protection policy and procedures, a routine maintenance requirement, foundation training for staff within their first six months of employment, two requirements regarding health and safety relating to portable appliance testing and the frequency of fire drills and displaying a current employer and third party liability insurance certificate. 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. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 7 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 Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 8 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 the following standard(s): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The unit gathers current and detailed information regarding service users needs before every short stay admission and also agrees a discharge plan at that stage. This greatly assists the unit in effectively addressing service users needs and maximising the benefit they receive from their short stay. EVIDENCE: The files of four service users were inspected and all four contained a range of detailed assessment information. The inspector was informed that after a referral was made to the unit a detailed assessment of need and two separate risk assessments from external care professionals were sought. From this the unit undertook its own assessment of need and risk management plan before an admission was made. Evidence to substantiate this was seen on all four files inspected. Assessment information seen on each file inspected included a Client Information and Service Monitoring Form. This form contained information under the following headings: presenting issues, psychiatric history, physical health needs, medication, aim of the referral and post discharge plan. The inspector was impressed with the overall assessment process used by the unit. The inspector felt that the detail and depth of this was commensurate Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 9 with providing a good quality short stay service for service users with complex and changing needs who may also be in crisis. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6, 7 & 9 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users needs and aspirations are clearly set out in their care plans including outcomes that are planned to have been achieved by the end of the stay. Service users are supported to make as many decisions as possible for themselves to retain and maximise their independence. They are also supported to take responsible risks to assist keep them safe during their short stay at the unit. EVIDENCE: The four service user files inspected contained detailed care plans that showed clear short term objectives with detailed guidance for staff on how to assist the service user achieve these. The plans were informed by post discharge objectives to which the short-term objectives were linked. The plans were also informed by a range of assessment information and included a separate risk management plan. The risk management plans had been based on both external and in-house risk assessments. The plans seen had been reviewed regularly throughout the stay, some on a daily basis. The unit had regular contact with external mental health professionals with evidence of multidisciplinary reviews held during the stay to monitor progress where Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 11 appropriate. The unit operates a key worker system and evidence was seen on service user files of key worker sessions. These primarily related to objectives set out in the service users care plan. The service users had signed the plans seen. The one service user spoken to confirmed that they had been involved in the writing and monitoring of their care plan. The files seen also contained a client profile form. This specifically recorded a range of needs and preferences of the service user related to equality and diversity. One worker spoken to stated that they found this very helpful as a prompt to ensure that the unit was clear about these needs and how to appropriately address them. The service user files inspected contained a signed copy of a client agreement form that specified what they could expect from staff and what staff would expect from them. This contained some restrictions on service users while staying at the unit such as the prohibition of alcohol and illegal drugs. The files also included a form to specify whether the service user gave consent to information about them being shared. This included information regarding emergency situations and whether this could be shared with relatives or other carers outside of the unit. Service users accommodated manage their own finances. The service user files inspected contained detailed risk management plans that had been agreed and signed by the service user. These were based on a range of detailed information primarily obtained from risk assessments. Risk assessments are undertaken by external health and/ or social care professionals. In-house risk assessments are also completed by staff at the point of admission. The plans showed identified potential risks and gave clear guidance to staff in assisting to minimise these. These risk management plans were reviewed at the same intervals as the care plans. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can choose to participate, or not, in a range of appropriate activities both within the unit and within the community depending on their assessed needs. Contact with friends and relatives is actively supported to the degree that the service user wishes. Service users are treated with respect and their rights and responsibilities are clearly stated with any limitations agreed with them. They also enjoy balanced and healthy meals that meet their needs and preferences although an improvement in the way that food is labelled when stored in the unit is needed. EVIDENCE: As the unit offers short-term care and support for service users activities are subject to individual negotiation during their stay. Service users can be supported to maintain employment, education or other activities if this is appropriate. It can also be agreed that service users stays are orientated to provide them with a break from the pressures of living in the community and their usual activities. Evidence to support this was seen in service users care plans. The unit offers a range of activities for service users, the majority of which are therapeutic in nature and appropriate to support service users that Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 13 are experiencing some form of crisis at the time of their admission. Activities on offer include yoga, massage and a relaxation group. The unit also runs its own library of books and videos that service users can enjoy. One service user who was being discharged from the unit on the day of the inspection told the inspector that they had been invited back to the unit for the next 4 weeks to attend the yoga class. Service users are supported to access the local community, or not, if that is appropriate to meeting their assessed needs. Individual service users entered and left the unit on their own during the inspection. Where service users go out on their own they are required to inform staff when they intend to return and also to contact the unit if they are being significantly delayed from returning at the specified time. There was evidence that service users are informed of this requirement when they are admitted to the unit. Service users continue to be encouraged to maintain links with family and friends on terms that they can cope with. Where it is agreed with the service user the staff also support service users to maintain their privacy during their stay. Service users are issued keys to their bedrooms when they are admitted to the unit. Staff were seen to interact appropriately and professionally with service users throughout the inspection. One service user spoken to indicated that staff consulted them appropriately with regard to their needs and preferences on how these were to be addressed during their stay. Rules on smoking, alcohol and illegal drugs are included in the client agreement form that is given to each service user on their admission. A clear notice in the main entrance to the unit reinforces this. The menu was inspected and showed a range of healthful meals. The lunch on the day of the inspection was pasta salad and looked very appetising. The unit has a full time weekday cook and a separate weekend cook that are responsible for the cooking of the main meals of the day. The unit’s permanent weekday cook was on leave during the inspection and an agency cook was being employed for the week. The manager stated that the unit had started to hold a weekly coffee morning for service users to which the cook was invited to discuss service users meal preferences for that week. The inspector was informed that the unit could manage a range of diets to meet health and cultural needs and preferences. An example given was of a recent admission from a Jewish service user. The inspector was informed that staff went shopping with the service user to purchase appropriate kosher food and that the unit could provide meals to meet other cultural requirements such as hal-al meat for Muslim service users. The agency cook stated that she had cooked rice and peas and a lamb curry during the week she had been employed at the unit to meet service users preferences that week. One service user spoken to stated that the meals were good at the unit although mentioned that they could sometimes be a bit “dry” for that person’s taste. The kitchen and dining Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 14 room were clean and tidy. The inspector was pleased to see that two requirements relating to the kitchen - cleaning the extractor fan and providing a diffuser for the fluorescent light, had been complied with. There was sufficient food in the unit that was generally appropriately stored. It was noted that a quantity of meat was being stored in the freezer. The meat was stored in its original packaging and had not been labelled as to when it was put in the freezer or with a revised use by date. A requirement is made regarding this. A satisfactory health and safety record of daily fridge and freezer temperatures was seen and also a daily record of food temperatures when the food was cooked. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate personal support in accordance with their needs and preferences. They are supported to remain as independent as possible in addressing their mental and physical healthcare needs and are supported by community based health professionals as required regarding this. Service users are also generally well supported with their medication although two identified improvements are needed in this area to ensure that service users and staff remain fully protected in this area. One of these is outstanding from the last inspection. EVIDENCE: The manager confirmed that the majority of service users who use the unit are generally independent with regard to their personal care. Where any personal care needs are identified these are reflected in the individual’s care plan. There were some issues relating to supporting service users with their personal care seen in care plans inspected. However, these were primarily related to supporting the individuals mental health needs to enable them to manage their personal care. The manager confirmed that staff support service users with any ongoing health care needs where they are identified in individual care plans. The acting Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 16 manager confirmed that health care professionals who are involved with service users in the community would normally deal with any ongoing health issues. Because of the short-term nature of stays, service users keep their own GP’s. There was clear evidence from documentation inspected and staff spoken to of mental health professionals input into monitoring and promoting service user’s mental and emotional health needs. This is done in partnership with the unit’s support staff when service users are accommodated in the unit. The medication and medication records of two service users were inspected. Both were generally satisfactory although the medication records for one stated that the service user takes their own medication and that the unit stored none. However, there was medication being kept by the unit for this service user in the medication cabinet. The inspector was informed that the service user does take responsibility for their medication but had asked the unit to look after their following week’s medication for safekeeping. A requirement is made that medication administration record (MAR) charts accurately record medication that is stored in the unit for all service users even if staff are not assisting in its administration. The inspector was disappointed that a requirement made at the last inspection that all staff that administer medication have current training in safe administration of medication was not met. This requirement is restated in the Staffing section of this report. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 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 the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are able to express any concerns and complaints and have these appropriately dealt with by the unit. The unit needs to review its adult protection policy and procedures to ensure that service users are properly protected in this area. EVIDENCE: The unit has a satisfactory complaints procedure. A copy of this was seen in an information pack for new service users that was in a vacant room prior to a service user moving in to that room. The unit had dealt with nine complaints since the last inspection. The records of two of these were sampled and were seen to have been dealt with satisfactorily. The service user spoken to indicated that staff took any issues raised seriously and dealt with them effectively. The unit had an adult protection policy that was seen. The manager stated that the unit also had a copy of the London Borough of Haringey’s adult protection procedure although that could not be located during the inspection. The unit’s policy was clear although did not contain all the essential information that the unit needed. The policy did not specify that any allegation or disclosure of abuse must not be investigated before the local authority had convened a strategy meeting using its own adult protection procedures. The unit had received an allegation of abuse since the last inspection. This had not been dealt with in accordance with the local authority policy in that an investigation had been started before the required strategy meeting had been convened. This could have jeopardised any following investigation required by a local authority convened strategy meeting. A requirement is made that the unit Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 18 must ensure that its adult protection policy and procedure is reviewed to ensure it covers all the requirements of the local authority adult protection procedure and that staff are made aware of the revised procedure. It was also noted that this allegation had not been reported to the Commission until two weeks after the allegation had been made to the unit. A requirement is also made regarding this. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 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 the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy their short stays in premises that are comfortable, well decorated and well maintained. The accommodation meets their short-term needs although an identified area of maintenance needs attention. The unit was clean and tidy throughout creating a pleasant environment for both those that live and work at the home. EVIDENCE: The unit is a three storey converted and extended domestic premises situated in a quiet residential street between Wood Green and Turnpike Lane. There are eight single rooms, several bathrooms and shower rooms, a choice of two lounges, a staffed kitchen, a separate dining room with facilities to make drinks and snacks, an attractive conservatory that is used as an alternative place to relax and to do artwork and a private garden. The building had been closed for a period at the end of 2005 to allow for some refurbishment work to take place. This included refurbishing the shower, bath and toilet facilities on the first floor and a range of other building and redecoration work throughout the building. On a tour of the premises the Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 20 refurbishment work was seen to have been completed to a satisfactory standard. The bedrooms seen were also decorated and furnished to a high standard. The inspector was informed that new curtains and furniture had been supplied to all the bedrooms. The inspector was also informed that there were plans to refurbish the kitchen in the current financial year. During the tour of the building it was noted that some wooden steps leading from the conservatory to the garden had started to rot. These had been cordoned off so they could not be used. The manager informed the inspector that these had been identified for repair through the home’s maintenance system. A requirement is made regarding this. The home was clean and tidy throughout during the inspection. The home has suitable laundry facilities with a new floor having been laid in the utility room as part of the refurbishment work undertaken. The inspector was informed that service users are encouraged and supported to carry out their own laundry. The home has a satisfactory infection control policy that was seen. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A generally competent and effective staff team is deployed in sufficient numbers to address service users needs. However, some staff need to receive further training or refresher training in key areas to ensure that their knowledge and skills are up to date to more effectively meet service users needs. The unit is not in possession of the necessary documentation to demonstrate that service users are properly protected by the unit’s staff recruitment procedure. EVIDENCE: The manager stated that there were twelve crisis (support) workers employed at the home at the time of the inspection. The manager went on to state that four of these had completed national vocational qualification (NVQ) level 3 in promoting independence and another one was currently undertaking that qualification. The inspector was informed that it was planned for another two staff to commence NVQ level 3 training in October 2006. Three crisis workers were spoken to independently and all were able to demonstrate that they had a range of knowledge about the needs of people with mental health difficulties. They were each able to describe ways that the unit worked with service users and the process of monitoring progress throughout an individual service user’s short stay. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 22 The staff rota inspected showed a minimum of three staff members on duty for the majority of the weekday morning and afternoon shifts with two staff members on duty for the remainder. There are also two staff on some shifts during the weekends and three staff on others. One waking and one sleeping in staff are on duty during the night. The manager and staff spoken to independently felt that this level of staffing was satisfactory to meet the needs of service users accommodated at the unit. Staff spoken to confirmed that the unit was able to match the needs of newly referred service users with those currently at the unit and that the unit controlled the referral process. This enabled the unit to plan who was admitted and when to assist in meeting the needs of each individual referred more effectively within the staffing and other resources available. At the last inspection a requirement was made that the unit must keep a copy of all staff member’s recruitment documentation including: proof of identity including a recent photograph, two written references including a last employer reference, employment history and evidence that the person has a current criminal record bureau clearance and protection of vulnerable adults clearance. The unit had employed three new support staff since the last inspection and their files were inspected. One of these files contained the required documentation but the inspector was very disappointed to find that the other two did not. The second file inspected contained one reference and no other documentation. The manager stated that she was the second referee for that staff member as they had been employed at the unit as an agency worker prior to applying for a permanent post. She went on to say that the London Borough of Haringey’s human resources department had advised her that she did not need to write a separate reference if she was satisfied with the staff member’s performance. This file contained no other documentation. The third file inspected contained two references but no other documentation. The manager stated that the London Borough of Haringey’s human resources department would not supply the unit with copies of the majority of the required documentation used during the recruitment process. The inspector was told that they only supplied copies of references. The manager went on to say that she had to ask staff to supply copies of other documentation if she was to keep copies in the home. The requirement is restated and amended that the registered provider must ensure that copies of the required documentation must be kept in the unit to evidence a robust recruitment procedure. A staff training matrix was seen that showed that longer standing members of staff had received training in core subjects and refresher training when required. The inspector noted that the three new staff had received induction training and staff spoken to confirmed that this was useful. The inspector was disappointed to note however that none of the three new staff had received any core subject foundation training since being appointed. One was appointed in February 2006 and the other two in March 2006. The inspector was informed that the amount of staff training available to the unit had been reduced for financial reasons. The inspector was also informed that no foundation training Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 23 in core subjects had been available since October 2005. The manager stated that training was now available again and that places were in the process of being booked currently. A requirement is made that all staff receive foundation training, to Skills for Care specification, within six months of their appointment. A requirement was made at the last inspection that all staff that administer medication must have received current training in safe administration of medication. The inspector was disappointed to note that one staff member that administers medication has still not received refresher training in safe administration of medication. The inspector was informed that the staff member was now booked on a course that would take place shortly. The requirement is restated. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from the unit being run by an experienced manager. However the manager still needs to be supported by the provider organisation to be registered as the manager of the unit with the CSCI. Service users benefit from the unit’s quality assurance system that incorporates their views and contributes to the ongoing development of the short stay crisis service. Health and safety procedures need improving in identified areas to maximise protection to service users, staff and visitors to the unit. EVIDENCE: At the last inspection the previous registered manager had left and the deputy manager was acting up pending the appointment of a new manager. A requirement was made at that time that the registered provider must ensure an application is made to the CSCI for an appropriate person to be registered as manager of the unit. The inspector was pleased to note that following the last inspection the then deputy manager had been appointed as the unit’s Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 25 permanent manager. However, this occurred in November 2005 and the inspector was disappointed to learn that the registered provider had still not submitted an application to the CSCI for the new manager to become the registered manager of the unit. This requirement is restated. The new manager stated that she has nearly completed her registered manager’s award and has six years management experience. Staff spoken to were very complimentary about the manager’s abilities and of the formal and informal support they received from her while at work. The unit monitors the quality of the service it provides in an appropriate manner for a short stay crisis unit. Every service user is invited to fill out an evaluation form at the end of their short stay and copies of these were sampled and found to be satisfactory. The responses from these evaluation forms are evaluated on a regular basis and contribute to the units overall business plan. The business plan for 2006/ 07 was seen to be satisfactory with achievable goals for the unit for the year being identified. A range of satisfactory health and safety documentation was inspected including: a gas safety certificate, water tank maintenance to minimise the risk of legionella, servicing of fire fighting equipment and regular checks of staff panic alarms. At the last inspection a requirement was restated from the inspection before that to evidence that necessary work had been completed as required in the unit’s electrical installation certificate. That certificate stated that the electrical installation was unsatisfactory and that identified work must be completed to the unit’s electrical wiring. The manager stated that the work had now been completed but the certificate to evidence this could still not be located at the time of the inspection. However, a copy of a certificate confirming the outstanding work had been completed was faxed to the inspector soon after the inspection was completed. This was seen to be satisfactory albeit it had taken over a year for this work to be completed since it was first required. During the inspection it was noted that two extension leads had been joined together and were connected to a single power socket in the lounge. Seven appliances including a television were powered from this lead. It was noted that the labels on each of the appliance’s plugs connected to the leads showed that they were tested as portable appliances on 25th May 2005. A requirement is made that all portable appliances are tested by a person competent to do so every 12 months and that a person competent to do so checks that the identified power socket is not being overloaded by the number of appliances connected to it. A requirement was made at the last inspection regarding the proposed removal of identified fire door closures. This was seen to have been complied with and the manager stated that the fire officer had been consulted as part of the process. During the inspection of the unit’s fire log it was noted that the unit’s fire prevention guidance stated that fire drills should be undertaken quarterly each year. The fire log showed that the last fire drill was undertaken in February 2006. A requirement is made regarding this. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 26 Evidence was seen that the environmental health department had inspected the unit in February 2006 and that recommendations made at that time had been complied with. The third party and employer liability insurance certificate seen in the unit had expired on 31st March 2006 and a requirement is made regarding this. Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 27 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 X 2 4 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 2 Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 13(4) Requirement The registered person must ensure that food stored in the freezer is properly labelled to show the date it was placed in the freezer and the date it must be used by. The registered person must ensure that medication administration record (MAR) charts accurately record medication that is stored in the unit for all service users even if staff are not assisting in its administration. The registered person must ensure that the unit’s adult protection policy and procedure is reviewed to make sure it covers all the requirements of the local authority adult protection procedure and that staff are made aware of the revised procedure. The registered person must ensure that all allegations or disclosure of abuse are reported to the Commission without delay. The registered person must ensure that the wooden steps DS0000035135.V303295.R01.S.doc Timescale for action 30/09/06 2. YA20 13(2) 30/09/06 3 YA23 13(6) 30/09/06 4 YA23 37(1) 30/09/06 5 YA24 23(2) 30/09/06 Alexandra Road Crisis Unit Version 5.2 Page 29 6. YA34 19(1&5), Sch.2&4 7. YA35 YA20 8. YA35 13(2) 18(1) 9 YA37 8(1&2) 10 YA42 13(4) leading from the conservatory to the garden are repaired. The registered person must ensure that the home keeps copies of the required documentation for each member of staff employed to evidence a robust recruitment procedure. This must include a copy of each staff member’s proof of identity including a recent photograph, two written references including a last employer reference, employment history and evidence that the person has a current criminal record bureau clearance and protection of vulnerable adults clearance (previous timescale of 31/12/05 not met) The registered person must ensure that all staff that administer medication have current training in safe administration of medication (previous timescale of 31/12/05 not met) The registered person must ensure that all staff receive foundation training to Skills for Care specification, within six months of their appointment. The registered person must ensure an application is made to the CSCI for the new manager to become the registered manager of the unit (previous timescale of 31/12/05 not met) The registered person must ensure that all portable appliances are tested by a person competent to do so every 12 months and that a person competent to do so checks that an identified power socket is not being overloaded by the number of appliances connected to it. 30/09/06 30/09/06 30/11/06 30/09/06 30/09/06 Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 30 11 YA42 23(4) 12 YA43 25(2) The registered person must ensure that a fire drill is undertaken quarterly each year to comply with the unit’s fire prevention guidance. The registered person must ensure that a current third party and employer liability insurance certificate is displayed in the unit. 30/09/06 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southgate 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 Alexandra Road Crisis Unit DS0000035135.V303295.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!