Inspection on 26/06/06 for Argyle Road (Respite Care Project)

This inspection was carried out on 26th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Argyle Road (Respite Care... 13/01/06

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 Stanley Phipps Key Unannounced Inspection 26th June to 19th July 2006 15:25 Argyle Road (Respite Care Project) DS0000025885.V299851.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 Argyle Road (Respite Care Project) DS0000025885.V299851.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. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 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 argyle.road@btconnect.com www.rchl.org.uk Redbridge Community Housing Limited [RCHL] 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) Ms. Sonia Lyng Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include (one) named person over 65 To include 1 (one) named individual with mental health problems. Date of last inspection 13th January 2006 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. There is an accessible rear garden that is suitable for the size and needs of the service user group. A statement of purpose is made available to all service users in the home and a pictorial service user guide is complimented by a video about the home. This has been developed with the input of service users and staff. Given that the service is short stay (respite), service users quite like the idea of having the information in this format. Fees are charged at £13.50 per night, although this may depend on the level of benefit/s a person receives. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning at 15.25 on the first day i.e. 26/6/06 to ensure meeting service users, the manager and relatives as far as far as possible and observing a staff, and tenants meeting. It must be noted that refurbishment and re-decorative works were taking place at the time of the first visit, which meant that most of the service users were away from the home. The last day of the inspection was the 19th July 2006. Prior to the inspection i.e. in May 2006 a visit was also made to the organisation’s head office to assess their recruitment practices and the records held for the protection of service users, as this was an area that gave the Commission considerable concern in relation to ensuring the protection of service users. The inspection found that significant progress was made with respect to meeting the requirements made at the last inspection visit. To this end service users were receiving an improved service and this is positive. There are three outstanding requirements that are repeated in this report. It must be noted that failing to meet outstanding requirements may adversely impact upon the welfare of service users and as such, the Commission would pursue enforcement action against the registered persons to achieve compliance, if the requirements are not met by the revised date. As part of the inspection four service users’ files were assessed, including the most recently admitted individual. The inspector interviewed staff and one service user, held detailed discussions with others including the manager and the deputy manager, and assessed a number of records held by the home. Care practice was observed throughout the inspection. This report also took into consideration a significant number of responses returned by professionals from health and social care, relatives and service users, who at some point in time over the last year had used Argyle Road. A tour of the environment also took place. What the service does well: Argyle Road continues to provide a service that is unique - in respite provision to individuals, which is generally of good quality. As part of this, the service seeks to actively engage individuals to participate in activities both inside and external to the home. In saying this there is a strong sense of user participation in the project. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 6 The manager and staff work closely to deliver the service and demonstrated a commitment in delivering the service in line with its statement of purpose and the expectations of individuals spending time there. There is strong sense of teamwork in the home. The service also maintains positive working relationships with the relatives of service users and professionals involved in their care. This ensures that service users needs are appropriately met. There are plans and assessments in place for admitting service users and the procedures for emergency admissions has been tightened up. In general the registered persons have been responsive in complying with requirements set by the Commission and this is a positive indicator of their willingness to improve the service. What has improved since the last inspection? Updated assessments were in place for service users and this included people requiring emergency placements – the most recent being 8/6/06. This helps to determine and deliver the service in line with the needs of each individual. Generally the home aspires to support individuals requiring emergency admissions to visit at least once prior to their admission and this was evidenced at this inspection. Service users plans were found to contain the health, personal and social support needs of individuals and this did contain a fair amount of detail. This plan also contains restrictions that may be placed on service users and is identified as part of the risk assessment for the individual. There was evidence that these decisions involve the service user and/or their representative in ensuring that the best interests of the individual are taken into account. The home is now recording the type and amount of medication that is brought in by service users. This ensures a clear audit trail of drugs in the home and is useful in safeguarding the health and welfare of individuals. Lockable drawers were now in place in all bedrooms to ensure that those individuals who self-medicate are able to safely store their medication. The registered persons carried out a number of repairs and refurbishment to the home as required at the last inspection, including the repair of two coldwater taps and the damp and unsatisfactory areas identified in the bedrooms and living room. The plastic shelving in the garden has been removed, the windows cleaned, the shower mat and waterproof seal replaced, the living room carpet deep cleaned and a system put in place to ensure regular maintenance of the kitchen floor and microwave. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 7 It was established prior to the inspection that the Commission now has more confidence in the robustness in the recruitment process of the organisation, as well as their compliance with ensuring that records are appropriately held for the protection of service users. This has been the subject of continuous monitoring and liaison work with the registered persons. Service users are therefore safer, once the organisation adhere to their policies and implement the systems developed for this purpose. The registered persons have also been consistently monitoring the service through monthly provider visits and this should have a positive impact on improving standards at Argyle Road. 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 Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (2,4,5) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are assured that their needs would be catered for by the thorough assessments that are carried out by the home – including those service users on emergency placements. Arrangements were also in place to facilitate visits to the home prior to agreeing to live at Argyle and service users are to have the benefits of a contract with the home. EVIDENCE: A random sample of service user files examined indicated that assessments were carried out prior to the admission of individuals to the home. The sample included those of the most recently admitted service users and were detailed enough to enable one to make a judgement with regard to suitability of the home in meeting their needs. There was also evidence that the most recent person placed on emergency placement had a detailed assessment of need on file and this was an improvement from the last inspection visit. The manager carried out the assessment on the day of the admission and pre-admission details on the service user were also on file. These assessments form the basis on which an individual service user plan is developed. There was evidence that a review was carried out on the placement by the learning disabilities team on 24/6/06 – which occurred just over two weeks following the admission. As part of the homes admissions procedure service users and/or their relatives are encouraged to visit the home prior to coming in for respite and this happens generally as a matter of practice. It was acknowledged that with Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 11 emergency placements – this practice becomes more of a challenge. However the home works closely with relatives and the placing authorities to ensure that they visit the home at least once prior to agreeing to live there. This still gives an opportunity to view the home, meet with other service users and staff, and is in line with good practice. At the last inspection, the registered manager was in the process of trying to develop pictorial service user contracts. However at the time of this visit this had not been achieved and it was explained that it became difficult in doing so whilst ensuring the legality of the document. It has been decided to therefore revamp the existing service user contract developed by RCHL for use by the home. A copy of this document was sent to the Commission and would be effective in safeguarding service users and meeting the national minimum standards. This is positive. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to the service. Service users needs and choices are documented in their service user plan and well catered for. They benefit from the input of staff in making decisions about their life and this includes the risks they take. Risk management in the home ensures service user safety, but they must be in place for all service users to fully achieve this. EVIDENCE: As part of case tracking three, service user files were examined and they all contained individual service user plans in them. They covered the personal, social and healthcare needs of the individuals concerned and there was evidence that relatives were involved in the process of service user planning, which is positive. The service user plans took into consideration the individual requirements as assessed by the home, in conjunction with the care management information provided by the placement authority. One service user spoken to during the inspection was aware of this document and the fact that he had a key worker who, as he described, ’ helps him along’ in achieving his goals. Feedback received from a health and social professional informed that she was impressed with the level of insight into the causes and needs of service user behaviours – exhibited by the staff. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 13 Staff were observed during the inspection referring to the service user plan, using it as a working document. The three service user plans viewed, were updated and provided satisfactory directions for meeting the needs of the individuals concerned. It should be noted that a service user plan was in place for the most recent emergency placement to the home. The home works well in supporting service users in making decisions about their lives and they provide various forums to enable them to so do. This could take the form of a key work session, an informal discussion, a tenants meeting (recently introduced) or case review. There is also an established forum for consulting with service users i.e. surveys and results of the most recently completed survey were produced at the inspection. It was noted that the results from the surveys were considered in the preparation of the annual development plan for the service. This is positive. Service users are involved in determining activities, the level/s of their involvement, the type of meals they would like and generally how they spend their time at Argyle Road. The organisation has explored training with an advocacy service to enable service users to take an active part in staffing recruitment and this is also quite positive. This is a strong area of the homes operations as they seek to shape the service in line with individual needs. From the sample of files examined it was clear that the home carry out risk assessments for the benefit of service users in the home. This identifies and sets out how the safety of individuals could be maintained. One good example could be drawn from the case of a service user who lacks road safety awareness and this was identified in his risk assessment. However there was another case in which a risk assessment was not available, although a risk was identified in the service user plan. This was discussed in detail with the manager and for the service user concerned. It was clear that although he was newly admitted to the service that there were risks that were not recorded e.g. the service user first stay in a residential respite service. It is of great significance that, particularly for new service users – at least an interim risk assessment is put in place to ensure their safety, until more information is gathered about that individual. This is an area for improvement. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected 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 the service. Service users benefit from being engaged in activities they choose and generally enjoy. Significant periods are spent engaging with their community and this is complimented by strong links that are maintained with relatives. The home actively promotes both the individuality and rights of service users. Meals are generally of a good standard and determined in discussion with individual service users. However the home must demonstrate from its recording that it adequately meets the nutritional needs of service users placed at Argyle Road. EVIDENCE: Although Argyle Road is a respite service, service users are encouraged to use community facilities to provide them with stimulation in enabling them to lead as full a life as possible. As a result most service users attend a day centre. This is done on a daily basis and is determined on individual preference and interests. It tends to border around recreational and social activities and most service users spoken to were happy with their involvement in them. Written feedback received from service users and their relatives confirmed this. For most service users being at Argyle Road was described as, ‘a family like environment – doesn’t really feel as though it is a care home’. The home hosts Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 15 cultural evenings at various times during the year and this is usually well attended with most service users looking forward to them. A summer fete was planned for 12/8/06 and includes planned appearances by the Woodbine Clubhouse Steel Pan band, Lizzie B and a DJ. Again service user participation and interest was highlighted from the most recent survey carried out by the home. An extensive activity programme is in place and this is complimented by activities that occur as and when opportunities for service users come up. The management and staff work really well in supporting service users to engage in activities. An essential part of engaging in the activities involved service users using the local community. This included the local park, cinemas, theatres and pubs. One service user interviewed at the time of the visit was enjoying viewing a world cup game between Australia and Italy. He was well into his football but had his eyes set on the clock as he was set to have a pub dinner with a member of staff – needless to say he was quite looking forward to this. Service users therefore have a good orientation to the community whilst using the service at Argyle Rd. As part of providing the respite support and care to service users - relatives and/or carers are involved in most, if not all cases with the home. Records along with verbal and written feedback received from relatives confirmed this. They are involved from the admission stage to when the service user is discharged and this relationship tends to continue, as some service users return for more than one period of respite. The staff team was also very good at involving relatives in the social, personal and healthcare matters of their relations and this is extended to acquiring feedback on the service provision at Argyle Road. It must be said that the positive feedback received from relatives about the service - was very high. One relative wrote – ‘I do not know what we would do without Argyle Road’. This is a strong area of the homes operations. In observing staff interaction with service users it was deduced that service users were respected, encouraged to maintain their independence and take responsibilities for agreed areas of their care and support. Staff were in fact actively engaging with service users and where necessary external professionals in meeting their needs. Service users may be involved in tidying their rooms or take responsibility for helping out in one of the communal area. The key to promoting service user rights lay in the level of service user involvement in their care. A good example could be drawn from a feedback form returned from a service user who commented that ‘I have to be accompanied by staff when I go out as I am not safe using the roads unaccompanied’. In essence he had the right to safety and for the staff to ensure this, whilst he was in their care. Menus were inspected on the day of the visit, as was the storage of food in the home. There was an improvement in recording meals but this did not go far Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 16 enough as there were gaps in the recordings on menu sheets viewed for the week prior to the first visit. The deputy manager advised on the day that staff are being reminded at team meetings and individually of recording meals provided. Gaps were also prominent where service users were taking packed lunches out. It was positive to see that service users decided what they had for their packed lunches as with their other meals. However, there was either nothing written in some cases or just sandwiches in others. Advice was given to record the type of sandwiches provided, so that a determination can be made about the quality and nutritional value of food provided by the home. Service users spoken to were generally happy with the food provided by the home and there was evidence of fresh fruit, frozen food and dry goods in adequate quantities. However the registered manager must ensure that meals are recorded to demonstrate that service users receive a nutritionally balanced diet. The last requirement would therefore be repeated. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Service users enjoy personal support in accordance with their needs and wishes and the staff team is proactive in ensuring that both their physical and emotional needs are met. Improvements in the medication practices in the home now enhance the safety of service users requiring support with medication. EVIDENCE: All service users were observed to be well presented and groomed during the course of the inspection. From the current group, most were able to independently carry out their personal care, while a few needed a little prompting and/or support. Where support was required this was recorded and a strategy agreed individually with regard to how this is achieved. This ensured consistency in the care provision of service users. One service user spoken to was pleased with the way in which staff supported him from a personal care point of view, although he was clear in stating that their input was minimal. Written feedback from service users supported this in that, most indicated that they did what they wanted to during the course of the day and this included how they received personal support. During the course of the inspection there were practical examples of work undertaken by the manager and staff in meeting the physical and emotional needs of service users. One individual was extremely distressed and the Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 18 interventions made by the team in promoting the well being of this individual were professional and highly effective. This included getting the community nurse to see the service user as well as the quality time spent reassuring and making the individual comfortable. Further arrangements were being made to arrange a visit from the psychiatrist. Staff were able to prioritise their work to ensure that the physical and emotional needs of the service user in question were met. It should be noted that the manager led by example during the course of the interventions made on the day. Six professionals including a consultant provided positive feedback on the home’s ability to meet the various needs of service users with a learning disability and this is positive. As part of their feedback they commented that staff showed an understanding of the needs of the service user group. An assessment was made of the home’s handling of medication. One of the areas of concern from the previous inspection was that lockable facilities for medication were not available in all service users bedrooms. This was assessed and all bedrooms now have a lockable drawer for individuals capable of handling their own medication. At the time of the visit none of the service users were self–medicating. The recording of medication was satisfactory and staff with the responsibility for handling medication were adequately trained to so do. Staffing interviews held indicated that staff understood their role in the safely supporting service users with their medication. Medication storage was also satisfactory and an updated medication policy was available for the benefit of the staff team. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 19 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 outcome in this area is good. This judgement has been made using available evidence including a visit to the service. A satisfactory complaints policy and procedure is available for the benefit of service users and their relatives. Sound procedures were also in place at the home to ensure the protection of service users coming into contact with the service. EVIDENCE: Service users and staff spoken to were aware of the home’s complaints procedures. One service user stated ‘I never have problems here, but if I did I would take it to the manager’. Assessing the written feedback received from service users, they all indicated that they knew who they would speak to if they were unhappy. In cases where service users were unable to raise a complaint independently – the feedback forms indicated that their relatives/carers would raise their concern/s. What was also positive was the fact that all service users indicated that they always felt listened to. The complaints record was examined and contained very few complaints over the last year. Of the two recorded – one was substantiated, but from the details, it was determined that they were adequately handled. There is also a log for compliments, which though few in number, were positive. Satisfactory protocols were in place for protecting service users from the various types of abuse. Staff interviewed demonstrated a sound understanding of abuse and from the training records up to eight had received adult protection training. There were no adult protection matters in the home, however the manager and staff have acted appropriately in situations that came to their attention, albeit outside the home. An example of this could be drawn from a case where information was shared with staff about the service user’s experience, whilst living in their home. The home’s management was Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 20 able to make a the decision referring the case to the relevant authorities and followed it up by attending meetings designed to look at the issues around the individuals vulnerability and protection. This is positive as a determination could be made regarding the safety of the service user retuning to their home environment. The registered manager usually notifies the Commission on such occasions. Monies were held for some service users and this is securely stored in the home. A policy was also in place for handling service users finances and part of this involves two staff countersigning when funds are moved in and out from individuals private funds. Service users therefore are assured that their wellbeing is preserved and promoted. The registered manager provided evidence that, where required, body maps are used by the home in recording marks or injuries that may be present on a service user. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 21 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, 26, 27,28, 30) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Improvements to the communal and private spaces at Argyle Road now make it more homely and pleasant for service users. Improved maintenance practices now enables service users to enjoy an environment that is generally clean and hygienic. The management needs to prioritise the fitting of net curtains to compliment and enhance the ambience of the home. EVIDENCE: A significant amount of works was carried out to the home following the last inspection and this was noticeable as you walked into the home. At the time of the first visit the builders were carrying out some of the works identified not only from the inspection, but also by the organisation. This included structural works to the bay windows – one in the staff office and the other in the service user’s lounge. During these major works, arrangements were made to ensure the safety of service users and so for some part, service users did not use the building. Service users now enjoy a newly redecorated lounge, with cleaned carpets and wall decorations that gave the room a stimulating feel to it. Service users spoken on both visits were happy with the redecorated lounge. The down side of this was the strategy not to replace the net curtains throughout the home, Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 22 until all the works were completed. This was discussed with the manager with the view to review this decision, as the most of current net curtains were dull, had holes in them and with paint splattered on some of them. This took away from pleasantness of the room and could be detected both from inside and outside the building in several cases. The discussion concluded that for those areas of the home that were redecorated- that replacement net curtains are made available once the work is complete. There was evidence that the kitchen floor and microwave had been cleaned up and through a maintenance schedule that they are kept in a satisfactory condition. A shelving unit was removed from the garden as required at the last inspection and this area was satisfactorily maintained. It is the area used for the barbecue and summer fete and service users and staff were looking forward to this event. A tour was made in the bedroom areas and works were carried out in bedroom 5 with plans to do bedroom 4 as well. The stain on one of the carpets in the bedroom had been cleaned as well as the dirty window. More importantly the damp areas in the bedrooms identified at the last inspection had been made good for the benefit of service users using them. One of the service users showed off his bedroom and this was in need of redecoration, but this had been identified by the organisation for improvement. He also showed a broken tap and upon checking the staff had already reported this for repair. His shaving light was also broken and from the records had been repaired, however it was noted for repair again. The service user concerned was happy with the way in which the staff dealt with the issues raised about his bedroom and was pleased that the room suited his needs. Improvements were also noted to the upstairs shower as the waterproof seal had been replaced and the shower mat was replaced. The shower room was clean and hygienic on the day of the visit. The shower when checked was in good working order. The laundry room was clean and tidy with equipment that was capable of cleaning soiled laundry satisfactorily. The room is accessible to service users who are supported by staff to launder their washing as part of promoting their independence. One service user stated ‘the staff help me with my laundry as I could not do it all on my own’. This is positive. Feedback received from relatives indicated that at most times when they visit the home in clean and hygienic. At the time of the inspection the weather was extremely hot – a literal heat wave. The home had taken adequate steps e.g. the purchase of fans, to ensure that the environment was comfortable for the service users. One relative wrote – ‘it is a nice, clean, homely establishment’. This description could be maintained, once the home continues to monitor and actively keep on top of the daily maintenance of the establishment. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 23 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): (32,33,34,35,36) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. At Argyle Road service users receive care and support from a dedicated and effective staff team. Improved recruitment practices by RCHL now ensure that service users are safer when engaging with staff. This safety has been enhanced by the increased number of staff in receipt of adult protection training. However, the overall quality of service would be enhanced with the provision of more training at NVQ level 2 or above for care staff working in the home. EVIDENCE: At the time of the inspection one member of staff was in the process of pursuing an NVQ level 3 qualification. The registered manager informed that a number of staff have either started or completed NVQ level 2or 3 across the organisation. She also informed that RCHL was looking at the Learning Skills Council’s initiative – ‘Train to gain’ with a view to giving staff the opportunity to attend NVQ training. Whilst this in itself is a useful to know, it is important that the organisation engages with staff at Argyle Road to get them on at least the NVQ level 2 in Care training. Staff are still without this opportunity as described in the previous report and as such the organisation need to act on this. From an interview held with a staff member it was clearly stated that she would like to pursue the NVQ training, but there was no indication as to how and when this would be achieved. An assessment of the key objectives from the Business and Development Plan 2006/2007 – the staff development Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 24 section showed no reference to a plan for staff to pursue NVQ level 2 in Care training. The home is in no way close to the fifty per cent ratio specified in standard 32.6 of the National Minimum Standards for Younger Adults. Service users may therefore receive a service that is compromised by the lack of training in this area. Whilst staff are generally dedicated and motivated to provide a great service they may be impeded by this lack of training. The staff team is mixed both in terms of gender and ethnicity and this provides a useful platform for working with the range of service users at Argyle Road. A deputy manager was now in post and a newly recruited staff member had started on the day of the visit. It was observed that the staffing turnover and absence through sickness was relatively low. This is positive as service users benefit from having a consistent staff team to work with them. From the staffing rota the numbers per shift were reflective of service users needs. Staff worked flexibly to ensure that the needs of service users were met. There is a sleeping in staff on nights and this is changed to a waking night if the need arises. Most of the feedback from relatives indicated that there was adequate staffing on duty and they were pleased about this. It should be noted that the bed used for the sleeping in staff is currently being reviewed with regard to its suitability. As part of the inspection - the importance of staff meetings was explored with both the deputy manager and a care staff. Held two-weekly these meetings cover essential areas of work and are key to looking at the most effective ways of managing service users. This includes looking at prospective cases in relation to their suitability. Staff found them supportive and felt that they are able to contribute their ideas for the good of the service. The meetings also cover development work with service users around their role with regard to health and safety in the home. New policies are also presented in this forum and major events like the most recent ‘Opportunities Fair’ hosted by Redbridge are discussed. Over the last year the Commission visited the human resources department (RCHL) to assess their recruitment practices. During this period significant pieces of work were carried out to ensure that their recruitment practices were more robust than previously. Systems were in now firmly in place to ensure that either CRB checks or POVA first checks were carried out prior to staff being employed with the organisation. Satisfactory references were also on file and clearer arrangements were in place to ensure that decisions made following further queries around applicants - were documented. The Commission was satisfied that the recruitment process was transparent and in line with current employment legislation and guidance. Service users are now safer engaging with individuals whose fitness to work with them is more rigorously assessed. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 25 The organisation has also made strides to getting service users actively involved in staffing recruitment, as it commissioned training via advocacy service for the benefit of service users who have an interest in this area. This is really positive. All staff are subject to a six-month probationary period and this exceeds the minimum requirements in relation to this standard. Staff are in receipt of a statement of terms and conditions as well as a copy of the GSCC code of conduct. There was evidence of a training analysis undertaken for staff, which is identified during supervision and appraisals. A dedicated training and development manager is in place and her role is key to ensuring that the organisation provides training for staff that is specific to its training objectives for each service area. Some examples of training provided in the last year included challenging behaviour, LDAF, Adult Protection, Food Hygiene, First Aid, Sexuality Awareness, (Advanced Supervision – for the benefit of the manager and deputy), Makaton and Dementia awareness. There was further training planned for the staff and this was in line with the service objectives. For new staff and as part of their induction they undertake RCHL’s core skills programme, which includes their code of conduct, First Aid and Moving and Handling. The training provided prepares staff for meeting the specific needs of service users and this is positive, although more needs to be done in relation for staff to acquire their NVQ level 2 in Care qualification (See above). As part of supporting staff, formal supervision is regular and carried out in line with the minimum standards. Staff spoken to confirmed that they find it supportive in enabling them to carry out their duties – particularly when faced with new challenges. The manager and the deputy manager have received advance supervision and this would benefit them in their support for staff. Supervision is also provided informally and in some respects, in team meetings. It was clear that there were adequate forums for supporting staff at Argyle Road. An area that required improving was the provision of appraisals for staff. The manager indicated that she was behind in this area and needed to carry them out. This would go towards the development of staff and by extension – an improvement in the quality of service provided at Argyle Road. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): (37,38,39,42,43) Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Service users benefit from a home that is generally well managed and run in their interests. They also benefit from having a dedicated manager. Improvements in monitoring the service and in some respects – health and safety helped to improve the overall quality of service provision. The service could be developed further with improvements to health and safety along with the manager’s acquisition of the relevant care component in relation to achieving her Registered Managers Award. EVIDENCE: The registered manager is very experienced, having managed the service for five years. As stated in the previous inspection she holds a City and Guilds – Advanced Management in Care, but this was inadequate in its equivalent of achieving the NVQ level 4 Award in relation to the qualifications required for managers as set out by the national minimum standard (37.2). In essence she was required to identify and complete the care component to enable her to achieve the qualification set by this standard. In discussion she had not done so up to the time of this inspection. However, she has identified a college that Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 27 would provide the necessary training, but this had a fairly long timescale. She plans to explore the possibility of having it done sooner. The previous requirement would be therefore repeated. There was evidence that the manager had undertaken a number of other courses to update her skills and knowledge and this is good for the service as a whole. Examples included: ‘Advanced LDAF Awareness’, ‘CSCI Updates and Developments’, ‘Advanced Supervision’ ‘Responsibilities of Managers’. During the course of the inspection the manager was observed leading her team, liaising with professionals, interacting with relatives and engaging with service users. Throughout the inspection she demonstrated a clear sense of direction to the staff and led from the front in reducing the level of distress experienced by a service user. The way the work was carried out with the service user clearly demonstrated that service users needs are put first. Feedback from staff, external professionals and relatives was overwhelmingly unanimous about the sound management of the service. One professional wrote that they were extremely pleased with the management of the service over the last four and one half years, working in Redbridge. Staff indicated that she is there for them and is a good source of motivation. All service users spoken to knew who she was and felt able to approach her. The atmosphere in the home continues to be relaxed, warm and friendly and this is even when someone is in distress. This is a strong area of the home’s operations. The home has been active in seeking the views of service users, relatives and stakeholders as part of their quality monitoring of the service. An assessment was made of the annual development plan and this incorporated the views of stakeholders, staff, relatives and service users. This is positive and in the interest of the service as a whole, particularly given the fact that it is a respite service. There was also evidence that policies and procedures were being reviewed although this is an area that the manager need to keep a close eye on. This is just to ensure that updated policies are kept in the home and available to staff. The health and safety practices in the home were generally satisfactory. This was determined from assessing the health and safety file covering areas such as fire, gas, electrics, food handling, first aid, temperature control, risk assessments, water testing, portable appliance testing, guidelines for moving and handling as well as the training provided for staff around this subject. Staff interviewed showed a good understanding of their responsibilities in ensuring a safe environment. Just prior to the inspection there was a rodent problem and this was dealt with in a swift manner by the home. It was also noted that the fridge/freezer temperature monitoring in the home had improved as required by the last inspection report. There is however a need to update the COSHH data sheets as part of promoting health and safety in the home. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 28 There was evidence of a quarterly financial statement for the service and this was satisfactory. Adequate systems were in place to ensure financial monitoring and this included an annual financial audit of the service. The inspector saw evidence of the areas covered in this type of audit and was satisfied that it provides financial protection for service users living at Argyle Road. There was also evidence of regular monthly provider visits carried on the home and this represented an improvement since the last inspection. These visits also act as a quality control measure in monitoring the service, although the reports could be enhanced with more detail. These reports would become more indicative in assessing how robust organisations are monitoring their services in the future. The emphasis would remain on outcomes for service users and therefore requires adequate detail to quantify this. A discussion was held in some detail with the manager regarding this subject. Insurance cover for the home was satisfactory and covered business interruption costs. Staff and service users spoken to, were aware of the lines of accountability in the home. The organisation is proactive in involving service users in their Annual General Meetings and this is positive. Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 29 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 3 3 X 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 3 x 2 4 3 X X 2 3 Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 30 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 YA9 Regulation 13(4)(c) Requirement The registered persons must 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. (See Standard 9 of this report). This requirement was previously made with a timescale of 13/4/06. The registered persons must ensure that records of meals are recorded consistently, including when service users choose their own meal and pack lunches. This requirement was previously made with a timescale of 13/4/06. The registered persons are required to replace or replenish the worn and/or damaged net curtains in the home. (Also see Standard 24). The registered persons are required to provide staff with DS0000025885.V299851.R01.S.doc Timescale for action 18/09/06 2. YA17 17(2) Schedule 4, 13 18/09/06 3. YA24 16(2)(c) 18/09/06 4. YA32 18(1)(a) 18/09/06 Argyle Road (Respite Care Project) Version 5.2 Page 31 the opportunity to complete the NVQ training. This requirement was previously made with a timescale of 13/4/06. 5. YA36 18 The registered manager is required to carry out staffing appraisals annually for all staff. The registered manager is required to complete additional training in the care components of the NVQ. This requirement was previously made with a timescale of 13/4/06. 30/09/06 6. YA37 10(3) 31/12/06 7. YA42 13 (4)(c) The registered manager is 18/09/06 required to review the COSHH data sheets to ensure that they are updated. 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 Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 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. Extracts may not be used or reproduced without the express permission of CSCI Argyle Road (Respite Care Project) DS0000025885.V299851.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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