Inspection on 18/08/08 for Booth Road 82

This inspection was carried out on 18th August 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Booth Road 82 11/04/07

Booth Road 82 26/07/06

Booth Road 82 04/10/05

Booth Road 82 28/04/05

Booth Road 82 07/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOME ADULTS 18-65 Booth Road 82 Colindale London NW9 5JY Lead Inspector Brian Bowie Key Unannounced Inspection 18th August 2008 18:00 Booth Road 82 DS0000010411.V368635.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 Booth Road 82 DS0000010411.V368635.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. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Booth Road 82 Address Colindale London NW9 5JY 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) 020 8200 8504 F/P 020 8200 8504 harpreet.ghatara@adepta.org.uk www.pentahact.org.uk PentaHact Limited trading as Adepta Manager post vacant Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 4 adults who have a learning disability (LD) and who may also have physical disabilities (PD) and have associated nursing needs. Specific Service User One specific service user who is currently resident in the home and is over 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. 11th April 2007 Date of last inspection Brief Description of the Service: This home is owned and run by Adepta, previously known as PentaHact. It comprises two houses that are side by side and are joined by an open corridor. Numbers 82 and 84 Booth Road were previously registered as two homes but now operate as one home. On the ground floor of each house is a lounge, kitchen-diner, toilet and laundry room. On the first floor of each house there are walk in showers, an assisted bath with a toilet and four bedrooms. On the second floor there is an office shared by both houses, a storage room and a meeting room. There is a small parking area at the front of the home and a garden at the back. The home is situated close to Colindale station on the Northern line, a short walk to Colindale hospital and approximately a mile away from Edgware Hospital. It is close to the shops, restaurants and public transport facilities that are located along the Edgware Road. The stated aim of the home is to provide twenty four hour care and support for people with profound learning disabilities to enable them to live as independently as possible within the community. Placements at the home costs around £1,336 for each person per week. Booth Road makes available information about the service, including inspection reports, to the people who use the service and other stakeholders. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection is the annual key inspection and the aim is to look at how well the service is meeting the key National Minimum Standards for Younger Adults. The unannounced inspection consisted of three visits over three days. The inspection began at teatime so that the early evening routines in the home could be observed. The manager and acting deputy were interviewed and assisted with the inspection. A resident together with a member of staff showed us around the home. All eight people resident in the home at the time of the inspection were seen. Most residents have significant communication difficulties, so throughout the inspection the way in which staff communicated with and supported residents was observed, as well as how residents got on with staff. We also interviewed staff to get their views and comments on the home. Two sets of relatives who are involved with Booth Road provided verbal feedback on what they thought about the home. We received five surveys completed by residents with support from staff and 5 from members of staff. A wide range of records, including care plans, staff files and health & safety documents, were also looked at. The home’s Annual Quality Assurance Assessment also provided considerable detail about the running of Booth Road. The inspector would like to thank the residents, relatives, staff and management team at Booth Road for their assistance with the inspection. What the service does well: The staff team works hard to support residents within a friendly and family-like atmosphere. Over time staff have got to know the specialised and complex needs of the residents and treat each person as an individual in their own right. As a result residents are pursuing a range of interests and activities, both inside and outside of the home, and are part of their local community. The home works closely with other agencies, especially the local community learning disabilities team, to meet the specialised need of residents. For example one person has severe epilepsy and there is close liaison with the specialist nurse for epilepsy to ensure this person’s needs are met as far as possible. The home is developing a person-centred approach to supporting people that builds on the residents’ strengths and wishes, and encourages their independence as far as possible, including using advocates to safeguard and promote residents’ best interests. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: A number of serious failings were identified in relation to the state of the bathrooms, showers and toilets at Booth Road. As a result residents’ needs were not being properly met. In addition Adepta and the housing association responsible for Booth Road had failed to ensure that essential repairs were dealt with promptly and put right. Consequently following this inspection a letter was sent to Adepta requiring them to take urgent action on three specific areas: There must be satisfactory hygiene arrangement in place in relation to the downstairs toilet at 82 Booth Rd by ensuring that residents have access in this toilet to a wash hand basin. The shower leak at 82 Booth Rd must be repaired so that residents at 82 are able to use this shower and thereby have their personal care needs properly met. The bath at 82 Booth Rd must be repaired so that the healthcare needs of residents at 82 are fully met. In addition there are a further 13 specific areas that must be improved. These included having an up to date Statement of Purpose and Service User Guide so that resident, families and professionals have correct information about Booth Road. The risk assessment of the premises must justify the need for environmental restraints, and each resident’s risk assessment must document that these restraints have been agreed as appropriate by relevant parties, such as relatives and professionals. The manager must ensure that the garden is an attractive area for the residents and is properly maintained. New flooring must Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 7 be fitted in the bathroom at 82 Booth Road so that residents have an attractive environment when using this room. At 84 Booth Road a new usable toilet must be provided in the bathroom and missing tiles replaced or renewed. The shower room at 84 Booth Road also had broken or damaged tiling and this must be replaced or renewed. The manager must ensure all staff at all times have the required frequency of formal supervision meetings so they can support residents effectively. Adepta must ensure that monthly visits to Booth Road are made by a senior manager and a report produced detailing how the home is running and areas to be improved. The manager must ensure the fire evacuation procedure is up to date and reviewed regularly. Eight recommendations are made to improve care practice further in the home. It is recommended that greater use of digital photos is made in care plans so that they become more accessible and meaningful for residents. The home should have a regular independent audit made of its medication arrangements. The flooring in the bathroom at 84 Booth Road is showing signs of wear and new flooring should be fitted. Kitchen units at both 82 & 84 Booth Road are showing signs of age, although usable. It is recommended that these units are renewed. New garden furniture and tables should be purchased to make the garden more inviting and comfortable for residents. It is recommended that Adepta finds ways to ensure the ethnic make-up of the staff team at Booth Road reflects more closely the ethnic make-up of the residents at the home. Staff should have further training in supporting people with an autistic spectrum disorder so that they can support specific individuals at Booth Road more effectively. It is recommended that given the needs of the current group of residents that fire drills are held at least quarterly so that residents become very familiar with this situation. At the conclusion of the inspection the manager indicated that she was keen to follow up all areas for improvement and recommendations made and would be making Adepta aware of the serious shortcomings identified. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Detailed information about the home is available so that residents and families know what they can expect from Booth Road, however they do not have the benefit of up to date information in the Statement of Purpose and the Service User Guide. People moving into the home can be confident that their needs and wishes will be fully assessed and an appropriate plan for meeting these needs will be drawn up. As a result their needs are met. EVIDENCE: The statement of purpose and service user guide are both clearly written and contain detailed information about Booth Road. Both documents make use of pictures so that it is easier for residents to make sense of them. However some information in these documents is now incorrect and out of date. Adepta must ensure that the Statement of Purpose and Service User Guide are updated so that resident, families and professionals have correct information about Booth Road. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 10 The files for 3 of the residents were looked at and indicated that before they moved in a full assessment had been received from Social Services. A care plan had then been drawn up by the home showing how these needs were to be met. Most residents have lived at the home for several years and indicated from observation that they were settled at Booth Road. One family member said: ‘I am happy that my relative is living at Booth Road. They are very happy there. They get on well with staff, especially their keyworker. ’ In one case the needs of an individual had increased to the point where it was necessary to review with other professionals whether other placements options would now be more appropriate. The home was working in a professional way with other agencies to ensure the individual’s best interests were maintained during this process, including getting an IMCA (Independent Mental Capacity Advocate) to support the resident concerned. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans provided detailed information so that the needs of residents are met. The staff team at Booth Road is good at finding ways for residents to make as many decisions for themselves as possible. Residents are protected by risk assessments that are comprehensive and indicate clearly how risks to the safety of residents are reduced, whilst still promoting independence. However residents do not have the protection of risk assessments that take account of environmental restraints used in the home. EVIDENCE: ‘I’m happy here. I like the staff. I haven’t any worries.’ This was the comment of one of the residents. frequent contact with the home said: Booth Road 82 A family member who has Version 5.2 Page 12 DS0000010411.V368635.R01.S.doc ‘My relative is getting on very well there.’ Three of the residents were able to verbally confirm that they enjoyed living at the home. The remaining residents were able to show by their behaviour and interaction with staff that they are very settled at Booth Road. Throughout the inspection residents were observed in their daily routines and their contact with staff. Residents were clearly relaxed with staff and looked to them where necessary for support and guidance. The records for 3 residents were looked at and indicated that for each one there was a detailed plan of care. Each care plan sets out the needs of the resident and how they are to be met by the home. A recent assessment by an independent reviewing team had noted: ‘The resident’s needs are currently being met at the home. They have some challenging behaviours that are well managed by staff.’ In addition for each resident there is a more general care plan that is written simply and clearly and makes use of pictorial images so that it is more userfriendly. It is recommended that greater use of digital photos is made in these plans so that they become more accessible and meaningful for residents. The residents’ independence is being promoted by staff at Booth Road who offer them choice in choosing activities they enjoy and assisting them to develop in all aspects of their daily living skills. Advocates have been obtained in order to assist residents make choices and decisions. In one case an advocate was helping a resident with employment options, and in another case an advocate was helping a resident with decisions about a possible change of placement. As a result residents are supported to have as much control as possible over their lives and this is contributing to their life at Booth Road being a positive experience for them. Residents’ files contain detailed risk assessments that are reviewed regularly. These include areas of risk and how they are to be managed in a way that ensures the resident’s safety, whilst promoting independence wherever possible. In one case a resident had had a number of falls in the home and safety measures had been put in place to minimise the risk of further falls, as well as liaising with the multi-disciplinary team to consider longer-term solutions. As a result there is some use of environmental restraints in the home, such as stair-gates and high-level door handles. The risk assessment of the premises must justify the need for these environmental restraints, and each resident’s risk assessment must document that these restraints have been agreed as appropriate by relevant parties, such as relatives and professionals. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is good at enabling residents to get out and about so that they lead as ordinary a life as possible. Residents are getting a better quality of life because of the good links with the local community and the range of leisure activities available. Staff support residents to keep in close contact with friends and family, as well as respecting their rights and encouraging them to act responsibly. Residents enjoy their meals and benefit from being offered a healthy diet. EVIDENCE: ‘My relative gets out and about- she goes to the day centre, clubs and goes to church.’ Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 14 Each of the residents has a weekly programme of activities. These include activities in the home to encourage people to be involved in ordinary domestic tasks such as cleaning and emptying the dishwasher, as well as helping with getting the shopping for the home. Staff play games with residents and make use of sensory materials to stimulate residents. Most of the residents enjoy music and participate in the regular sessions held in the home by a music therapist. During the inspection one resident went off on a holiday organised by their day centre. During the inspection residents went out and about in the community to a variety of locations, including going to their day centre, and going out with staff for a walk, to the local park, and to the shops. One resident has their own car and goes out regularly with staff on local trips and outings. The experience of the residents at Booth Road therefore is that they are part of their local community. Cultural and religious needs are responded to. One resident had been helped by staff to take part in festivals for people from their religious background and another resident is supported by staff to go to church regularly. Feedback from relatives confirmed that families of residents have close and regular contact with staff at the home. Staff confirmed that residents are having regular contact with their families. Residents have got to know each other well over the past few years and are relaxed in each other’s company. As a result residents have felt more settled at Booth Road. Observation throughout the inspection indicated that staff treat residents with respect and are patient when encouraging residents to do something. Where residents are able to they help with domestic tasks in the home, such as cleaning and tidying up. Relatives spoken to were positive about how staff cared for residents. Residents interviewed said that they enjoyed mealtimes and get a choice about what they eat. One resident commented after their dinner: ‘I enjoyed it.’ Healthy eating is encouraged with regular weight checks made. Residents have a variety of meals, with some ethnic dishes provided so that residents are enabled to make more choices about what they would like to eat. Staff files showed that staff have food hygiene certificates. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are good at meeting the physical and emotional health needs of residents. As a result residents feel more at home and relaxed at Booth Road. The residents are protected by effective arrangements regarding medication in the home. EVIDENCE: One relative commented: ‘We visited our relative recently and found them calmer, more content than previously, and looking well with their hair looking nice.’ Another relative said about their family member: ‘They are getting on very well at Booth Road.’ Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 16 These comments from relatives indicate how positive they are about how people are getting on at the home. A keyworker system is in place to ensure that residents get the support they need that is appropriate to their individual situation. The care plans are detailed and set out clearly how staff should respond to the individual needs and wishes of residents, with guidelines about any areas of risk. As a result residents feel supported and comfortable in their home. Interviews with staff showed that staff had a good knowledge of residents’ needs, interests and preferences. ‘Our relative has lots of health problems and the staff have been very good at looking after their health needs.’ This was the comment of a relative who has very regular contact with the home. In some cases residents have specialised and complex health needs. These are responded to with evidence seen of referrals made to other relevant professionals, such as the epilepsy nurse at the local community learning disabilities team. A psychiatrist sees the residents to assess their wellbeing and decide if changes in medication are needed. District nurses come in weekly to monitor progress with residents and provided essential input. The Interviews with staff showed that staff had a good knowledge of the health needs of each resident. Medication arrangements were gone through with a member of staff and were satisfactory. The records relating to the administration of medication to residents were seen and indicated that a detailed record is being kept. Improvements needed in recording changes in medication on the administration sheet and the amount of information on the medication profile were agreed and implemented by the home by the end of the inspection. All staff have had guidance about the home’s procedures regarding medication and have had specific training in the administration of medication. The manager said that the home was looking into using a different and more efficient pharmacy in future that was able to provide regular independent audits. It is recommended that the home has a regular independent audit made of its medication arrangements. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives can be confident in the complaints procedures in the home that make sure their concerns are responded to. The residents benefit from safeguarding adults procedures that make sure that they are safe and secure whilst at Booth Road. EVIDENCE: The complaints record showed that there had been no complaints since the previous inspection. An appropriate format is available to record complaints. Adepta have a general complaints procedure that people can use to raise concerns. Feedback from relatives indicated that they felt able to raise concerns with staff at the home. Adepta have their own detailed policy and procedure on protecting vulnerable adults. They also run an ongoing training programme that includes how to safeguard adults. This area is also covered in the induction programme that all new staff must attend. Staff said they had received training on the protection of vulnerable adults. One allegation of financial maladministration by the home had been investigated in 2008 under the procedures for safeguarding adults. This had been taken seriously both by the home and Adepta and a full Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 18 investigation made, including an independent audit of the finance arrangements in place at Booth Road. As a result improvements have been made in relation to residents’ monies so that they each have their own bank account. Finances for each resident are checked daily by staff. At the time of the inspection satisfactory procedures were in place in relation to residents’ finances. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents at Booth Road have a homely living environment. However they do not have a living environment that is properly maintained. Health needs of residents at the time of the inspection were seriously compromised by inadequate hygiene arrangements in the home. EVIDENCE: Booth Road consists of two adjoining houses sharing corridors at ground and first floor level. Each resident has their own bedroom that they have personalised to make more homely. The décor had been improved and brightened up by some recent redecoration. The manager is planning to have sensory areas within Booth Road to provide more stimulation to residents with sensory impairments. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 20 Following a tour of the building we identified a number of issues requiring urgent attention. The wash hand basin in the downstairs toilet at 82 Booth Road had been removed for repair work to take place on 24/12/07 and at the time of the inspection had not yet been put back in position. As a result residents at 82 after using the toilet have had to go to the laundry area to wash their hands. The manager acknowledges that as a result there has been an increased risk of infection in the home. The manager has tried to get the housing association to make necessary repairs so that this basin is usable. However nearly eight months on this has not yet occurred. It is our view that this delay has compromised the health of residents at 82 and has been unacceptably long. Adepta must ensure that there are satisfactory hygiene arrangement in place in relation to the downstairs toilet at 82 Booth Rd by ensuring that residents have access in this toilet to a wash hand basin. The urgency of this situation meant that following the inspection a letter was sent to the responsible person at Adepta requiring them to resolve this issue by September 1st 2008. Since 4/8/08 the bath at 82 Booth Road has not been usable since it had leaked into the area beneath on the ground floor. Action has been taken to make the situation safe. However the leak has not yet been repaired and as a result one resident at 82 has been having bed baths instead as a temporary arrangement, and all residents at 82 denied the opportunity to use their bath should they wish to or need to. As a result this situation has compromised the health and welfare of residents. The registered persons must ensure that the bath at 82 Booth Rd is repaired so that the healthcare needs of residents at 82 are fully met. The urgency of this situation meant that following the inspection a letter was sent to the responsible person at Adepta requiring them to resolve this issue by September 22nd 2008. Since early 2008 the shower upstairs at 84 Booth Rd has not been usable since it leaks water into the porch area on the ground floor. As a result residents at 84 Booth Road who prefer a shower have had to share the shower at 82 Booth Rd, with consequently increased risk of cross-infection. This is particularly an issue at the home since nearly all residents are doubly incontinent, and there are risks in relation to MRSA and open wounds. This situation has meant that the health and welfare needs of residents have not been met. The registered persons must ensure that the shower leak at 82 Booth Rd is repaired so that residents at 82 are able to use this shower and thereby have their personal care needs met. The urgency of this situation meant that following the inspection a letter was sent to the responsible person at Adepta requiring them to resolve this issue by September 22nd 2008. In addition a number of other important, but less urgent, issues were identified in relation to the living environment at the home. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 21 At 82 Booth Road the flooring in the bathroom is worn and badly discoloured following a leak. New flooring must be fitted in this bathroom so that residents have an attractive environment when using this room. At 84 Booth Road in the bathroom there was a broken and unusable toilet and broken and missing tiling that constituted a safety risk. Action was taken during the inspection to make these areas safe. A new usable toilet must be provided in this bathroom and missing tiles replaced or renewed. The shower room at 84 Booth Road also had broken or damaged tiling and this must be replaced or renewed. The flooring in the bathroom at 84 Booth Road is showing signs of wear and it is recommended that new flooring is fitted. Kitchen units at both 82 & 84 Booth Road are showing signs of age, although usable. It is recommended that these units are renewed. At the start of the inspection the garden area had an unattractive appearance with the grass needing cutting, old tables and chairs scattered around, and items for disposal lying around. By the end of the inspection some tidying up had taken place however the manager must ensure that the garden is an attractive area for the residents and is properly maintained. It is recommended that new garden furniture and tables are purchased to make this area more inviting and comfortable for residents. The home was found to be clean during the inspection. Feedback from surveys was positive that the home is kept clean. However the significant failings identified above in relation to the bathrooms, shower rooms and toilets at both houses has meant that hygiene standards have not been maintained in a safe manner over a period of several months at both houses. Following the inspection we required Adepta to submit an action plan to deal with these urgent and serious issues. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The committed, competent and experienced team of staff work hard to meet the needs of residents. Residents are protected by the home’s rigorous recruitment procedures for new staff. Residents have an improved quality of life because staff have the training and support they need to provide a good standard of care. Staff do not have the benefit of formal supervision meetings at the required frequency. EVIDENCE: Feedback from relatives was positive about the staff team at Booth Road, with one relative saying: ‘Staff do care- my relative gets on very well with their keyworker.’ One staff member said: Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 23 ‘We help each other here- most of the staff have been here several years.’ Staff are knowledgeable about the needs and interests of each resident and throughout the inspection were seen to interact well with residents. Staff use music, sensory stimulation, games and verbal communication, including humour, to stimulate and get a response from residents. At each house there is a minimum of two staff on during the daytime, with extra support from the manager as needed. At night one member of staff is awake and regularly checks that residents are well, whilst another member of staff sleeps in and is available if needed. This staffing level appeared to be sufficient to meet the specialised and complex needs of the residents at Booth Road. The majority of staff have achieved the NVQ Level 2 in care. The home has a manager, deputy manager and a number of support workers. At the start of 2008 there had been a significant number of vacancies. However the manager said that most vacancies had now been filled or were being recruited to, so that there was reducing use of Adepta bank staff. New staff were interviewed and confirmed the appropriate checks had been made, including obtaining written references and satisfactory CRB (Criminal Records Bureau) disclosures before they started working at the home. Adepta has comprehensive and robust procedures in relation to the appointment of new staff. As a result residents are protected by the arrangements Adepta has in place when recruiting staff. New members of staff confirmed that they had had a comprehensive induction when starting so that they could support residents effectively. At the time of the inspection the ethnic make up of the staff team did not reflect the ethic make up of the residents at Booth Road. It is recommended that Adepta finds ways to ensure the ethnic make-up of the staff reflects more closely the ethnic make-up of the residents at Booth Road. Staff interviews confirmed they had a good knowledge of each resident’s needs and wishes, including religious and cultural factors. Members of staff had supported a resident to attend church, and in another case to celebrate their religious festivals. The staff team has attended a range of relevant courses, including safeguarding adults, medication, first aid, food hygiene and health and safety. As a result staff are more effective in how they support residents, as confirmed by the feedback received from relatives involved with the home. Staff interviews indicated that they have knowledge of person-centred planning, with many elements of this approach in place in the home and some training provided. Some of the residents at Booth Road have an autistic spectrum disorder and feedback from staff indicated that they would welcome further training in this area. It is recommended therefore that staff have further training in supporting people with an autistic spectrum disorder. Staff said they felt well supported at Booth Road. Staff said they found the manager approachable and supportive. Records showed staff attend a variety of training courses and have supervision meetings with a senior member of Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 24 staff to improve their care practice. The manager acknowledged that not all staff were having formal recorded supervision meetings at the required frequency of at least 6 times each year. The manager must ensure all staff at all times get the required frequency of formal supervision meetings. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from being well supported at Booth Road. However residents have not had the benefit of living in a house that is well maintained and looked after. Residents benefit from living in a home where there are procedures in place to get the views of all key parties about how the home is running, but are not protected by a rigorous system of monthly visits and reports on the home by Adepta. The home has good procedures in place in relation to health and safety that help to ensure residents are protected at all times, however residents do not have the benefit of an up to date fire evacuation plan. EVIDENCE: Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 26 Over the past year Booth Road has had 3 managers. The new manager, Harpreet Ghatora, has worked hard since joining the home at the start of 2008 to improve the running of the home. As a result staff morale has improved and residents are being more effectively supported. Improvements have been made to the filing and recordkeeping in the home. Harpreet has applied to CSCI to be the registered manager for Booth Road. One relative said: ‘We’re very pleased with the current manager, Harpreet Ghatora. However it has been difficult to get senior managers in Adepta to take notice of our concerns.’ These concerns included the long delays involved when sorting out essential repairs and maintenance at the home. The manager explained that the housing association had a history of not responding promptly in sorting out essential repairs at Booth Road. Changes in senior management at Adepta had also contributed to the outstanding environmental issues highlighted above not being vigorously pursued. As a result residents have had a poor experience in relation to their living environment over a long period. For this reason an urgent action letter was sent to Adepta following the inspection so that this issue could be properly addressed and resolved by Adepta. Service user meetings are held regularly so that residents can contribute their ideas on the running of the home. The manager had completed the AQAA (Annual Quality Assurance Assessment) that provides detailed information about the running of the service and areas needing improvement. The home had recently surveyed residents and families for their comments on Booth Road with a team development day scheduled in September to follow up identified issues. As a result Booth Road is run in a way that is trying to improve further the service on offer and is responsive to the key parties involved. However changes in senior management within Adepta had meant that the monthly visit and report by a senior manager on Booth Road had not taken place regularly in 2008. Adepta must ensure that these monthly visits are made and a report produced detailing how the home is running and areas to be improved. A range of records was looked at, including health and safety and fire safety. In general these records were detailed, up-to-date and accurate and confirmed that essential checks are being made. A fire evacuation procedure is in place, but needs updating to reflect the current group of residents and their needs. The manager must ensure the fire evacuation procedure is up to date and reviewed regularly. A fire safety risk assessment is in place and kept under review. Fire drills take place at 6 monthly intervals. It is recommended that given the needs of the current group of residents drills are held at least quarterly so that residents become very familiar with this situation. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 1 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 2 x Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 28 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 Timescale for action The registered persons must 31/10/08 ensure that the Statement of Purpose is updated so that resident, families and professionals have correct information about Booth Road. The registered persons must 31/10/08 ensure that the Service User Guide is updated so that resident, families and professionals have correct information about Booth Road. The registered persons must 31/10/08 ensure that the risk assessment of the premises justifies the need for environmental restraints at Booth Road so that the interests of each resident are safeguarded. The registered persons must 31/12/08 ensure that each resident’s risk assessment documents that any environmental restraints at Booth Road have been agreed as appropriate by relevant parties, such as relatives and DS0000010411.V368635.R01.S.doc Version 5.2 Page 29 Requirement 2 YA1 4 3 YA9 13 (7) 4 YA9 13 (4) (c) Booth Road 82 5 YA24 23 (2) (o) 6 YA27 13 (3) & 13 (4) (a) 8 YA27 13 (3) & 13 (4) (a) professionals so that the interests of each resident are safeguarded. The registered persons must 30/09/08 ensure that the garden is an attractive area for the residents and is properly maintained. The registered persons must 01/09/08 ensure that there are satisfactory hygiene arrangements in place in relation to the downstairs toilet at 82 Booth Rd by ensuring that residents have access in this toilet to a wash hand basin so that residents’ personal care needs are met. The registered persons must 22/09/08 ensure that the bath at 82 Booth Rd is repaired so that the healthcare needs of residents at 82 are fully met. The registered persons must 22/09/08 ensure that the shower leak at 82 Booth Rd is repaired so that residents at 82 are able to use this shower and thereby have their personal care needs met. The registered persons must 22/11/08 ensure that new flooring is fitted in the bathroom at 82 Booth Road so that residents have an attractive environment when using this room. The registered persons must 30/09/08 ensure that there is a new usable toilet in the bathroom at 84 Booth Road so that residents’ hygiene needs are met. The registered persons must 22/11/08 ensure that broken and missing tiles in the bathroom at 84 Booth Road are replaced or renewed so that residents benefit from an DS0000010411.V368635.R01.S.doc Version 5.2 Page 30 9 YA27 23 (2) (c) 10 YA27 23 (2) (b) .11 YA27 23 (2) (c) 12 YA27 23 (2) (b) Booth Road 82 attractive and safe bathroom. 13 YA27 23 (2) (b) The registered persons must 22/11/08 ensure that broken and missing tiles in the shower room at 84 Booth Road are replaced or renewed so that residents benefit from an attractive and safe shower room. The manager must ensure all 31/10/08 staff at all times get the required frequency of formal supervision meetings. Adepta must ensure that 30/09/08 monthly visits to Booth Road are made by a senior manager and a report produced detailing how the home is running and areas to improve. 14 YA36 18 (2) 15 YA39 26 (2), (3) & (4) 16 YA43 23 (4) (c ) The manager must ensure the 30/09/08 (iii) fire evacuation procedure is up to date and reviewed regularly. 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 YA6 Good Practice Recommendations It is recommended that greater use of digital photos is made in these plans so that they become more accessible and meaningful for residents. Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 31 2 YA20 It is recommended that the home has a regular independent audit made of its medication arrangements. It is recommended that new flooring is fitted in the bathroom at 84 Booth Road. It is recommended that kitchen units at both 82 & 84 Booth Road are renewed. It is recommended that new garden furniture and tables are purchased to make the garden more inviting and comfortable for residents. It is recommended that Adepta finds ways to ensure the ethnic make-up of the staff team at Booth Road reflects more closely the ethnic make-up of the residents at the home. It is recommended that staff have further training in supporting people with an autistic spectrum disorder so that they can support specific individuals at Booth Road more effectively. It is recommended that given the needs of the current group of residents that drills are held at least quarterly so that residents become very familiar with this situation. 3 YA27 4 5 YA27 YA24 6 YA34 7 YA35 8 YA42 Booth Road 82 DS0000010411.V368635.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Booth Road 82 DS0000010411.V368635.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. 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