Inspection on 13/01/06 for Argyle Road (Respite Care Project)

This inspection was carried out on 13th January 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 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Argyle Road (Respite Care... 26/06/06

Argyle Road (Respite Care... 08/09/05

Argyle Road (Respite Care... 25/01/05

Argyle Road (Respite Care... 23/11/04

Argyle Road (Respite Care... 16/02/04

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Argyle Road (Respite Care Project) 36 Argyle Road Ilford Essex IG1 3BQ Lead Inspector Cathie McGeoch Unannounced Inspection 13th January 2006 09:35 Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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 Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Argyle Road (Respite Care Project) Address 36 Argyle Road Ilford Essex IG1 3BQ 020 8518 3064 020 8518 3064 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) Redbridge Community Housing Limited [RCHL] Ms. Sonia Lyng Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include 2 (two) named individuals over 65 To include 1 (one) named individual with mental health problems. Date of last inspection 8th September 2005 Brief Description of the Service: The home forms part of the Argyle project and is a six-bed respite unit. The other houses in the project are two-bedded flats and four single self -contained flats in the local area. The house is situated near to Ilford town centre and is close to local facilities and transport networks. The property is owned by the London Borough of Redbridge and managed by Redbridge Community Housing Limited (RCHL). The aim of the home is to provide short stay accommodation for up to six adults with mild to moderate learning disabilities. The home has six single bedrooms, one of which is situated on the ground floor. The ground floor shower and toilet are accessible to wheelchair users. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, therefore the home did not know the inspector was coming. Then inspection started at 9.35am and finished at 4.50pm. The inspector looked at four service users files, spent time talking with service users, observed staff, spoke to some staff members and completed an inspection of the premises indoors and outdoors. The manager was available for the majority of the inspection and detailed discussions were held. In the main service users are well cared for at Argyle Road, a number of the requirements made during this inspection are in relation to 1 service user who was admitted to the home on an emergency basis. A number of requirements were made at the last inspection and three of which have not been met and have been restated in this report with a new timescale for compliance. Unmet requirements impact on the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. All core standards were covered during the two inspections carried out in the home during the last 12 months. What the service does well: What has improved since the last inspection? The downstairs shower room has been decorated and the shower unit replaced. The home has acted on the two good practice recommendations from the last inspection, which is commendable. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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 Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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): 2,4,5 In general, the home caters well in ensuring that service user’s needs can be met prior to admission to the home. However, the home is not ensuring that they can meet the needs of a service user who was admitted on an emergency basis. EVIDENCE: A random sample of service user files indicated that assessments are undertaken prior to admission of the home when it is planned respite. In addition, the manager informed the Inspector that usually service users would be provided with the opportunity to visit the home for 3-4 hours on 3 different occasions. During these visits service users have the opportunity to talk with staff members, meet other service users, have a look around the home, have a meal and access the service users guide. The service users are given the opportunity to spend some of the visits without their parent/carer/advocate and there is a video, which has been made by service users, which they can watch to help them understand what is being offered. However, at the time of the inspection there was one service user who had been admitted to Argyle Road as an emergency placement the week before, which was initially for 2 days only. Following a review by the placing Local Authority the service user was still there one week later. The information provided during the inspection, about the circumstances surrounding this service user would appear to warrant an emergency placement. Therefore, it is accepted that there was not the time or opportunity to ensure that this service user was able to visit the service before the placement commenced. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 9 As part of selecting a random sample of files, the Inspector checked this service user’s file. An assessment of need dated (04-10-2005) and risk assessment dated (14-11-2005) had been completed by the service user’s social worker and provided to the home at the time of the referral. The manager stated that an up to date assessment of this service user would be completed by the home, but had not yet been done due to the fact that initially the placement was only for 2 days. The home must ensure that once it has been agreed that a service user will be staying for a longer period of time; that an up to date assessment is completed. Service users are not provided with a written contract, however, the manager stated that the home are currently working on implementing a pictorial service user contract. There is a resident users guide available for all service users, which outlines the rules and responsibilities within the home. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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): 6,7,8,9,10 In general, the home caters well for individual needs and choices. However, the home could not evidence this is the case for service users admitted to the home on an emergency basis. EVIDENCE: Risk assessments and service user’s plans were evident on the files inspected, except for one service user’s file. Those risk assessments and service users’ plans that were seen were clear and comprehensive and there is evidence that they are reviewed on a regular basis. As a result, the home is able to evaluate whether or not they are able to continue to meet the individual needs of service users. The service user’s file that did not have a service user plan or a risk assessment did have a risk assessment that was completed whilst the service user was living in the community. However, it was not adequate in replacing an up to date assessment. The manager stated that all the relevant assessments and plans will be undertaken, but had not been completed due to the fact this service user was placed in an emergency, but she was clear that there is a high level of concern for the safety and wellbeing of the service user. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 11 During the inspection the inspector spoke to this service user who stated that they did not have enough clothes, money and wanted to go home. When the inspector spoke to staff members they were not aware of what clothes the service user had, although were aware that some items of clothing had recently been purchased. The inspector requested, with the permission of the service user that staff and the service user check the situation. As a result, it was highlighted that the service user did not have an appropriate amount of clothing and this should have been assessed by the home upon the service user’s arrival considering it was an emergency placement. The inspector requested that the home liaise with the service user’s social worker and urgent arrangements were made in relation to this service user being provided with additional clothing. The inspector spoke to the manager about the concerns raised by the service user and she stated that the home had not been encouraging this service user to go out, or have their own money as there were concerns about self harm and abuse whilst in the community. The manager was clear that if the service user asked for money or wanted to go out then the home would provide up to £5.00 per day as the service user had no access to their benefits and a member of staff would accompany them on any outings. In addition to no risk assessment, there was no infringement of rights records regarding these matters. The home must ensure that service user plans and risk assessments are completed within the relevant timescales when service users are admitted on an emergency basis and that the reasons for any restrictions on service users rights are discussed with the service user and records are kept, which includes specific decisions made by others and the reasons. During the last inspection there was a requirement made for the registered persons to ensure that prompt arrangements are made for the “move on of service users whose changing needs may be outside the home’s ability to meet them and the home’s statement of purpose”. During this inspection the manager informed the inspector that this was regarding one service user who was suffering mental ill health as well as a learning disability. This service user recently moved to a more appropriate resource. However, the manager reported stated that the home secured additional funding to provide extra support in the evening and weekend. In addition, staff received training in dementia and introduced the use of photographs to ensure the needs of this service user continued to be met whilst at the home. The manager stated that the home does have clear guidance in place, which includes a timescale, to ensure that service users are living in an environment that can meet their needs. In this case, the manager also involved her line Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 12 manager in moving this situation forward which the home believes was in the best interest of the service user. The home places a high value on service user participation, the manager stated that service users are encouraged to sit on panels for interviewing staff and as mentioned previously service users were involved in making a video about the home. The home also provides a comments form to service users in order to obtain feedback on the service. The manager operates an open door policy and throughout the inspection service users were observed coming in and out of the office. Service users records are stored securely in a lockable filing cabinet in the office, which is also lockable. The manager stated that service users were aware that staff kept notes about them and on occasions would help staff fill them out. The sample records that the Inspector looked at were clear, concise and up to date. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,16,17 The home encourages service users to keep a level of independence and pursue leisure and social activities as is appropriate for the individual. The home cannot evidence that service users are receiving a varied and nutritional meal. EVIDENCE: At the time of the inspection some of the service users were seen arriving at the home after being to a day centre. In addition, one service user was present in the morning after an overnight stay and was waiting for transport to arrive to take them to the day centre. A staff member was observed assisting a service user as their transport had not arrived on time. Staff members also assist service users with their benefits. During the inspection, the inspector spoke to two service users about the home. One service user stated that they “went bowling last night which was good,” but also stated that: “it is boring here.” The Inspector asked what kind of activities are available in the home and the service user stated: “playing draughts and snooker with staff, going to the pub, listening to music, watching television”. This service user stated that they preferred to be at home with their parents and only usually stays overnight in the home once every three months. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 14 When the inspector spoke to another service user they stated: “I like it here, its good” when the inspector expanded on these comments the service user stated: “it is good because of the company.” Service users who are resident in Argyle Road have a good level of independence and are able to go out when they wish although this is not being encouraged for one service user as outlined elsewhere. During the inspection, staff were observed interacting with the service users and one member of staff was observed helping a service user to make their lunchtime meal. In addition, one service user who does not attend a day centre was observed hoovering and tidying some parts of the home. When this service user was asked about what they liked doing, they stated: “the domestic duties.” During the inspection the weekly menus were inspected, there were some omissions on the menu for the week before the inspection. In addition, the menu stated “service users choice” for lunchtimes, but did not record exactly what meal the service user had chosen. The inspector looked at the food available in the home and there was a satisfactory amount; which included some frozen, fresh and processed foods. The home must ensure that meals are recorded to show that service users are having a nutritionally balanced diet. Service users are able to access all communal areas within the home, one service user was observed in their bedroom, kitchen, dining area, living area and office. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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): 18,20,21 The home ensures that service users retain an appropriate level of independence regarding their personal and health care support, and has systems in place when help is required. Some of the medication practice within the home is not safe and as such places service users at risk. EVIDENCE: The two service users that the inspector spoke to, stated that they did not need any help with personal care both appeared clean, appropriately dressed and groomed. In one service user’s bedroom there was an alarm clock, which could be used to ensure that they woke up in time to attend the day centre. One service user is a wheelchair user and resides in the downstairs bedroom and is able to access the downstairs shower room, which has a toilet. This bathroom has been adapted for wheelchair users and ensures the maximum level of independence for the service user. During the last inspection a requirement was made “to finalise a protocol around the handling of as required medication.” The manager stated that this protocol was a working document at the time of the last inspection, however was in relation to one service user who is no longer at the home and therefore is no longer needed. The manager stated that records are kept for “as required” medication is given in line with the protocol. In addition, during the Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 16 last inspection a good practice recommendation was made that “the registered manager should consider reorganising the medicine cupboard to keep oral medication separate from topical medication.” Some service users medication is stored in a locked cupboard in the office and the inspector saw that tablets are stored on the shelves within the cupboard and there is a plastic tub for creams on the same shelf, thus meeting the recommendation. Some service users keep their medication in their own bedrooms and are provided with a lockable metal box for safe storage. However, the manager stated that there are 3 bedrooms that have lockable cupboards for service users to store their medication safely. There are plans to fit locks on cupboards in the remaining bedrooms, however this has not happened yet. The home must ensure that service users are provided with a lockable cupboard in their bedroom so that medication can be stored safely. A full medication audit was not undertaken on this occasion, however the Inspector noted that there was no record for one service user’s medication at the time of their arrival at the home. The home must ensure that appropriate records are kept so that a full audit trail can be kept. Argyle road is a respite home and therefore does not cater for service users on a long-term basis. Recently, there was a service user whose needs changed (as mentioned previously) and the staff handled the transition into alternative accommodation well. This included staff undertaking visits to the new home to help them settle which ensured the minimum anxiety for the service user. The Inspector spoke to one staff member who had worked at the home for a long time and it was confirmed that they had never experienced the death of a service user. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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): 23 The home has good procedures in place to ensure service users protection and the staff members spoken to appeared clear about the procedure for adult protection. EVIDENCE: The Inspector spoke to two staff members regarding issues of adult protection. Both had a good understanding of the policy and procedure for dealing with any concerns in relation to the protection of services users and were able to accurately describe the necessary steps. The Inspector was informed that issues of adult protection would be recorded in the incident log, however, the home does not currently use body maps to record physical marks/injuries. The Inspector recommends that this is introduced. On the day of the inspection the manager attended an adult protection strategy meeting. This was in relation to concerns regarding a service user before they came to Argyle Road. The manager informed the inspector that the minutes of this meeting would be completed that day but were obviously not available for inspection. In one service users plan, the Inspector noted that there was concern about them demonstrating inappropriate sexualised behaviour. The home had identified strategies to minimise any risk to service users and staff members and had a detailed risk assessment addressing this matter, which is good practice. Some service users have their money kept for them and it is stored in safe in the office. Records are kept of service users money, which includes signing monies in and out, with a running total. Two staff members countersign when Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 18 money is received and returned to and from service users. This is a good system to ensure that service users financial affairs are handled appropriately. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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): 24,25,26,27,28,29,30 The home must ensure that the maintenance of the building is kept under review, with the necessary action taken within a reasonable time limit. The general upkeep and overall presentation of the home was poor which is regarded as poor practice and which results in an unpleasant and sometimes dangerous environment. EVIDENCE: During this inspection, the Inspector undertook a tour of the premises and all service users bedrooms were seen. Each service user at Argyle Road have their own bedroom, some bedrooms have a table and chairs in them, and the home tries to ensure that if service users would like this facility then they are given one of those rooms. There is one bedroom on the ground floor, which is currently occupied by a wheel chair user, this room and all of the other rooms appear to be a good size. Currently, there is no lockable facility within the bedrooms, however, as stated previously the manager stated that there are plans for this to happen. One bed did not have any sheets, pillows and bedding on and the manager stated that this bedding was being washed and would be replaced later in the day. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 20 Two of the bedrooms required redecorating as there were chips in the wallpaper and different coloured paint showing where the old wardrobes had been replaced with new ones. In addition, there was a small damp patch in one of these bedrooms, which requires attention as it could present a risk to this service user. Furthermore, one of these bedrooms carpets had stains on, which the manager stated must have just happened, however, requires deep cleaning. The windows in this bedroom need to be cleaned as one pane had been smeared with a white substance and the manager stated that this must have just happened. The rest of the bedrooms were clean and well ventilated. Whilst looking at one bedroom with a service user they pointed out that the cold tap was broken, the manager said the service user had not reported this before the inspection. In addition, the cold tap in another service users bedroom was not working and had been covered in black insulating tape. The repair to this tap had been reported in the maintenance log. However, this raises the question of how service users are able to clean their teeth and wash themselves in their rooms. The home must ensure that as soon as they are aware that facilities within service users bedrooms are not working properly they take prompt action to repair them. During the last inspection a requirement was made to redecorate the ground floor shower room as there was damp over the shower unit. The manager stated that the bathroom was decorated on 29th November 2005, at the same time the shower unit was replaced. The replacement of the shower was a good practice recommendation from the last inspection and it is commendable that the home has followed this through. During the inspection this bathroom was observed as being clean and appropriately decorated and there was no evidence of damp. The shower unit, which has been replaced, allows access for disabled people and there is a cord; which has an alarm for service users can use in the event they need assistance. The shower unit located upstairs was clean, however the waterproof seal round the bottom of the shower tray had mould (black spots) present and this presents a health and safety risk. Therefore, the home must ensure that this is removed and resealed. The shower mat needs to be replaced as it too had mould present. In addition, to service users having their individual bedrooms, there is also a living/dining area, kitchen and garden. The living room had visible damp patches on the ceiling and the wallpaper was torn in places. The manager stated that there are plans to decorate the living room. The living room carpet Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 21 is stained and requires deep cleaning, however the manager reported that the carpet had just been cleaned in November. The kitchen was tidy and generally clean however, the floor was sticky, although the manager said that a service user had just cleaned the floor. The microwave had particles of food on the top of the inside. The garden is a good size and well maintained, but there was some rubbish that needs clearing. In particular, there was a unit with shelves that had a hard plastic covering. The plastic was broken and the edges were sharp and therefore needs disposing of to avoid any service users hurting themselves. The Inspector spoke to staff about what could be improved within the home and one stated that they thought it would be beneficial to have a maintenance person to undertake the necessary repairs and maintenance of the building. Staff members who sleep in are provided with a “blow up bed” which has to be put up every night and taken down in the morning as the sleeping area is in the office. One staff member raised concern about sleeping on this bed and stated that it was uncomfortable and therefore difficult to sleep. The manager stated this is a new development and that staff had been consulted about the sleeping arrangements and that it was their preferred option. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 22 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): 31,32,34,35 The home still cannot evidence that their recruitment practices safeguard service users. The staff at the time of the inspection appeared competent and committed, however, none of the current staff have completed the NVQ award and some staff members have not had adult protection training. EVIDENCE: The Inspector spoke to two staff during this inspection and they both appeared to have a good understanding of their roles and responsibilities. They both confirmed that they receive regular supervision, appraisals and team meetings. One staff member described working in the home as: “interesting, supportive, good communication and generally well organised.” One staff member outlined their responsibilities of a key worker as being: “to complete charts, risk assessments, support plans and to measure objectives for service users.” The two staff members spoken to appear committed to the service users and the work that they carry out within the home. The Inspector observed staff engaging with service users in a positive manner and a good level of communication taking place. Currently there is a manager, two senior support workers who are acting into the vacant deputy manager’s post and support workers. There are 10 staff in Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 23 total and the support workers work between Argyle Road and the other homes run by RCHL. Two of the current staff are on temporary contracts and there is currently one vacant post. There will be three new staff members starting shortly. Therefore the procedures around recruitment of new staff can be assessed more thoroughly. Currently, there are no staff members who have completed the NVQ level 2 or 3. However, two staff did start the NVQ level 3 and completed some of the units, however this training was discontinued. The manager stated that it is hoped that these two staff will start completing the outstanding units in April 2006, however this has not confirmed. Both staff members who were spoken to talk of their interest in completing the NVQ, in order to continue with their professional development. Both staff raised concern that they did not feel that they were given enough opportunity for ongoing training. The manager reported that 4 staff members had undergone the Learning Disability Award Framework training (LDAFT) and believed that this provided staff with in depth knowledge to enable them to carry out their roles within the home. The Inspector looked at the staff training records and most of the training had been undertaken in 2003 and 2004. Some staff had been trained in first aid, basic food hygiene and had undertaken medication safety assessments and medication training. There was no evidence of any adult protection training, but the manager stated that 4 staff had undertaken this as part of the LDAFT award. The home must ensure that all staff members receive training in adult protection and this is updated on a regular basis. The home must ensure that staff members are given the opportunity to attend the NVQ training to ensure continued professional development in line with guidance. The LDAFT is not a substitute for the NVQ but is good preparation for undertaking the NVQ. There is a copy of the General Social Care Council’s Code of Conduct (GSCC) available in the home and the manager said that all staff are expected to incorporate this in their work within the home. Each staff member does not have a copy, however, the manager stated that she has requested enough copies from the GSCC so that everyone will have a copy in the future. During the last inspection, a requirement was made to “ensure that their recruitment procedure is robust in line with regulation.” And “the registered persons are required to maintain records for the protection of service users in line with Schedule 2 of the Care Homes Regulations 2001, for new and existing staff.” The manager stated that this has been an organisational issue and usually staff files are held in another office. However, she has requested that Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 24 all the relevant information regarding staff be sent to her so that copies can be held on file at the home. The inspector chose two staff files at random. On one staff member’s file there were gaps in their employment history on their application form, which had not been explored and no birth certificate on file. There was evidence that Criminal Records Bureau checks had been undertaken. However, no date was provided therefore this made it difficult for Inspector to be sure that the home is complying with regulation. As a result this is a restated requirement. The manager stated that all new employees are subject to a 6-month probationary period and are provided with a copy of their terms and conditions, there was evidence on the files of the terms and conditions. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 25 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): 37,39,41,42,43 The manager of the home appears fairly competent in ensuring the running of the home. However, as a result of this inspection there have been 21 requirements three of which are restated from the previous inspection. Unmet requirements impact on the welfare of service users. EVIDENCE: The current manager has been working at Argyle Road for approximately 5 years and holds City and Guilds- Advanced Management in Care. At the time of the inspection there was a discussion about additional qualifications and the manager confirmed that there is no plan at this time to undertake the NVQ level 4. The Commission for Social Care Inspection accepts the qualification held by the manager meets the management component of the standard. However, the manager needs to have a qualification relevant to the care provided in addition to the management qualification. During the inspection the manager appeared to have an informal approach to the management of the home. As a result, the atmosphere within the home appeared calm, organised and friendly. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 26 The manager confirmed that there is an organisation development plan in place, which includes a financial plan and action plan. The home actively seeks service users views by using a comments form in order to improve the service as a whole. The registration certificate was on display in the hall area and service users and their families are provided with copies of the complaints procedures. The manager stated that service users are aware of the information kept in relation to them and on occasions they help staff to complete the daily logs. Service users files are stored in a filing cabinet in the office and both are fitted with locks. During the last inspection a requirement was made “to ensure that the health and safety of staff and service users is promoted by a) making accessible the manual for the fridge/freezer and or purchasing and using a separate fridge thermometer, b) ensure that the freezer temperatures are monitored and recorded consistently on a weekly basis and c) providing a lidded kitchen bin.” During this inspection the home has now purchased both fridge and freezer thermometers and the bin had a lid. However, when the inspector checked the recording of the temperatures this has not been consistently undertaken on a weekly basis. The temperature was taken on 15/08,24/10,07/11,07/12 2005. The home must ensure that the fridge/freezer temperatures are recorded on a weekly basis to ensure the health and safety of service users. This is a restated requirement. The inspector looked at the file regarding the unannounced monthly visits by the responsible individual. A visit took place on 16/09/2005,04/10/2005 and 16/12/2005, therefore no visit took place in November 2005. At the time of the inspection the visit for January 2006 had not taken place, however the Commission for Social Care Inspection received a report following the inspection, which was for January 2006. The responsible individual must ensure that monthly visits take place in line with regulation, and this is a restated requirement. Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 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 2 3 x 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 2 29 3 30 2 STAFFING Standard No Score 31 3 32 2 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 x 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 x 1 x 2 X 3 X 3 2 2 Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 28 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 YA2 Regulation 14(2)(b) Requirement The registered persons must ensure that when emergency placements take place, that service users have an up to date assessment completed. The registered persons must ensure they have confirmed in writing to the service user that following an assessment of need the care home is suitable for the purpose of meeting the service users needs. The registered provider must ensure that new service users have a service user plan outlining their health, personal and social support needs. The registered persons must ensure that in the event there are any restrictions on promoting a service users independence and choice that a record of any “infringement of rights” is completed in partnership with the service user, their family or representative. The registered persons must DS0000025885.V277427.R01.S.doc Timescale for action 13/04/06 2. YA2 14(1)(d) 13/04/06 3. YA6 15(1) 13/04/06 4. YA7 15(1) 13/04/06 5. YA9 13(4)(c) 13/04/06 Page 29 Argyle Road (Respite Care Project) Version 5.1 6. YA17 7. YA20 8. YA20 9. YA24 10. YA26 11. YA28 12. YA30 ensure that risk assessments are completed to ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. 17(2)Schedule The registered persons must 4 13 ensure that records of meals are recorded consistently, including when service users choose their own meal. 13(2) The registered persons must ensure that when a new service user moves to the home, that a record is kept of how much and type of medication they have brought to ensure that a full medication audit can be undertaken. 13(2) The registered persons must ensure that service users who self medicate have a lockable drawer/cupboard in their bedroom to allow the safe storage of medications. 23(b) The registered persons are required to repair the two cold water taps which are broken in the two bedrooms as discussed on the day of the inspection and carry out future repairs within a timely manner. 23(2)(d) The registered persons are required to decorate, paying attention to any damp areas, the two bedrooms belonging to service users highlighted on the day of the inspection and the living room. 23(2)(0) The registered persons are required to remove the plastic shelving unit located in the garden to ensure the safety of service users. 23(2)(d) The registered persons are required to clean the windows DS0000025885.V277427.R01.S.doc 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 Argyle Road (Respite Care Project) Version 5.1 Page 30 13. YA30 23(2)(d) 14. YA30 23(2)(d) 15. YA30 23(2)(d) 16. YA32 18(1)(a) 17. YA34 19(1)(b)(i) 18. YA35 18(1)(c )(i) 19. YA37 10(3) 20. YA42 13(4) belonging to one service user as discussed on the day of the inspection are cleaned. The registered persons are required to replace the waterproof seal and shower mat in the upstairs shower unit. The registered persons are required to deep clean the carpet in the living room and the service users bedroom as discussed on the day of inspection The registered persons are required to ensure that the microwave and kitchen floor are cleaned at regular intervals The registered persons are required to provide staff with the opportunity to complete the NVQ training. The registered persons are required to maintain records for the protection of service users in line with Schedule 2 of The Care Homes Regulations, for existing staff. This requirement is restated, previous timescale 20/11/05. The registered persons are required to ensure that all staff receive training in adult protection. The registered manager is required to complete additional training in the care components of the NVQ. The registered persons are required to ensure the health and safety of staff is promoted by ensuring the fridge and freezer temperatures are recorded on a weekly basis. This requirement is restated, previous timescale 07/11/05. DS0000025885.V277427.R01.S.doc 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 13/04/06 Argyle Road (Respite Care Project) Version 5.1 Page 31 21. YA43 26 The registered providers are required to carry out monthly provider visits to the home in line with Regulation 26 of the Care Homes Regulations 2001. This is a restated requirement previous timescale 31/10/05. 13/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The registered persons should consider introducing a system for monitoring whether service users have an appropriate amount of clothes to ensure their basic needs are being met. The registered persons should consider the use of body maps for recording physical injuries/accidents. The registered should consider an alternative bed for staff members who sleep in. 2. 3. YA23 YA28 Argyle Road (Respite Care Project) DS0000025885.V277427.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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