Inspection on 10/04/06 for Buxton Street (131-133)

This inspection was carried out on 10th April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Buxton Street (131-133) 10/07/07

Buxton Street (131-133) 02/08/05

Buxton Street (131-133) 05/04/05

Buxton Street (131-133) 28/09/04

Buxton Street (131-133) 08/07/04

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 08/07/2008.

CARE HOME ADULTS 18-65 Buxton Street (131-133) 131-133 Buxton Street Whitechapel London E1 5AR Lead Inspector Anne Chamberlain Unannounced Inspection 20th April 2006 10:00 Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Buxton Street (131-133) Address 131-133 Buxton Street Whitechapel London E1 5AR 020 7247 2004 020 7247 2004 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) Outward Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No persons with wheelchair dependency Date of last inspection 2nd August 2005 Brief Description of the Service: 131-133 Buxton Street is a 24 hour residential service for 5 people who have learning disabilities and complex needs. It is situated in Tower Hamlets in a central location close to public transport links and with local shops and a market. The home is located in a pair of terraced cottages which have been converted to provide two independent flats - 131 and 133. The flats have separate front doors but there is an intercommunicating door inside. The upper flat is occupied by three more independent service users. The lower flat is occupied by two service users who have rather higher needs. The provisions share a small but pleasant and private garden. They are run separately from one office which is located on the ground floor in number 133. The staff team currently consists of a manager, and ten care staff. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took place over one day. All key standards were inspected as well as standards which were the subject of requirements at the last inspection. The inspector spoke with three service users and observed the care of two others. She interviewed the manager and spoke with two staff members. The inspector viewed the files of three service users and their three key workers as well as other key documentation and records. She inspected the arrangements for the administration of medication and toured the premises including the garden. The inspector would like to take this opportunity to thank the service users, staff and manager of Buxton Street for their co-operation and assistance with the inspection. What the service does well: What has improved since the last inspection? Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 6 The home now has the prospect of consistent management. Staff supervision is being undertaken regularly. Progress has been made with addressing safety issues and recruitment checks. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, and 5. Outcomes related to choice of home are adequate, but two requirements have been restated. EVIDENCE: There was a previous requirement that the service user guide be expanded to include all the necessary information to comply with the regulations. This requirement has been restated three times and is now restated for a fourth time. The inspector explained to the manager the amendments which are needed. There have been no new admissions to Buxton Street. The placement of one service user is under review as it is felt he may be inappropriately placed. The manager stated that if a referral were being considered issues of compatibility would be very carefully weighed. The inspector is satisfied that the manager would assess the needs of any prospective service user carefully before offering a placement. Service users have contracts on file and the inspector viewed some of these. They are quite densely worded and the format is not accessible. There is also a rent figure stated which changes regularly. Tenants are informed by letter when this happens. The manager agreed that it would be better for the contract not to state the rent figure but to refer to a separate sheet which can be updated, also to be reproduced in a more accessible format. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 9 The above was all agreed at the previous inspection and the requirement made then is restated. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9. The individual needs of service users are adequately met but a number of requirements have been made to improve the service. EVIDENCE: The inspector viewed service user plans for three service users. Generally they contain a good deal of information. However the plans have not been reviewed and updated for a considerable time and do not reflect the current needs of service users. For example one service user used to have a regular service from an interpreter. This has been discontinued but the interpreter is frequently referred to in the care plan. One piece of guidance for personal care support was dated 1998 with no evidence of review. The manager must ensure that service user plans are updated to reflect the current needs of service users. The manager said that apart from one service user, annual reviews are overdue. It is understood that only one service user has an allocated social worker. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 11 The manager stated that service users make decisions regarding most aspects of their lives. They decide what activities they wish to undertake including attending day centres. One service user has changed his day centre and he told the inspector he likes the new one much better. Service users choose what they would like to eat and there is a lot of flexibility around meals at the home. The service users will be choosing the décor for the redecoration of the downstairs flat and also some new things for the kitchen. All five service users are going to different holiday destinations. The inspector heard the manager making a call regarding the holidays bookings of two service users. Service users attend Outward residents meetings and choose the agenda. The manager spoke with enthusiasm of the most recent one which he facilitated, and which had been well attended and lively. As mentioned previously the home has discontinued the use of an interpreter. This was because she was unregistered and unqualified and they were unsure as to the quality of her work. They have not however been able to find a substitute and are using the interpreter when interpretation is imperitive, for example for meetings. They have asked social services to identify an interpretation service but this has not yet been done. This leaves the service user without an interpreter. The inspector feels that she has been disadvantaged. The manager must ensure that an interpretation service is identified for the service user, if necessary broadening the search beyond the local area. The previous inspection required that tenants meetings are held regularly. The manager stated that service users now have tenants meetings every two weeks but that this frequency is newly started. The inspector found that the flat downstairs had had two meetings in January 2006 and the flat upstairs had had a meeting in April and before that in January 2006. As there in no evidence available that the requirement has been met it has been restated. The inspector viewed the risk assessments on the files of service users. There was evidence of extensive risk assessment and some evidence of review of risk assessments but this was not consistent. The manager said that they aim to review risk assessments yearly. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 12 The manager must ensure that all risk assessments are reviewed and updated regularly. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Lifestyle opportunities at the home are good. EVIDENCE: Four of the service users at Buxton Street attend day centres on some days during the week and the home works hard to support attendance. One service user refuses day centre but the manager stated that this happens much less frequently now. He is provided with activities at home on the days he chooses not to go to day centre. The service user who has no day centre chooses a programme of activities like shopping and attending social clubs. Service users participate in the local community in a variety of ways like visiting the cinema and shopping. Relationships with families and friends are encouraged and supported by the home. One service user has a friend who visits every day. She also has siblings in America and Holland and keeps in regular telephone contact with them. One has local family who she sees occasionally. Another service user has regular visits from family. Two service users have no family in contact. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 14 The inspector observed interaction between staff and service users and felt that service users are treated with respect. One service user told the inspector that the manager was a good man. One individual had decided to have a lay down in his room before supper and this was respected as his choice. The manager stated that one service user enjoys cleaning and takes a keen interest in her room. Other residents get involved in domestic tasks at the weekends. The inspector felt that independence is promoted in the home. The manager stated that there are basic menu plans but they are very flexible. Service users have the opportunity to shop with staff. One service user needs two to one support to do this. The manager said that the two service users in the downstairs flat eat together amicably. Whilst the inspector was on the premises one of the care staff was cooking supper upstairs and it smelled delicious. A service user told the inspector that he enjoys his meals. The manager was able to describe the particular dietary needs of two service users and how they are met. The inspector felt that meals and mealtimes are a positive aspect of life at the home. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Personal and healthcare needs are adequately met but arrangements for the administration of medication must be improved. EVIDENCE: The manager stated that the independence of individuals in personal care varies, ranging from total support needs to almost independent. The staff group at Buxton Street is very stable and carers know the service users well. Also service users are able to indicate preferences. However as previously mentioned support plans have not been reviewed and need to be updated including for personal care. Two of the service users have dual diagnosis of learning disability and mental health needs. One has autism. The manager described the changed mental health needs of one service user and said that they had involved the community nurse for learning difficulties (CNLD). He is working with the service user and might call a mental health review if he decides it is needed. The manager stated that service users see dentist, optician and chiropodist regularly. They visit their general practitioners whenever necessary. One Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 16 service user has borderline diabetes, controlled by diet. The inspector viewed the record of her blood sugar level testing, which appeared to be satisfactorily kept. The manager said that one service user gets anxious and needs reassurance that she is not going to be sent back to an institution where she used to live. This is indeed the case and the service user was delighted to be reassured by the inspector. The inspector viewed the arrangements for the administration of medication. The MAR sheets are kept in folders which have a photograph of the service user, and a list of their medications and the possible side effects of these. However these lists had not been kept up to date and in the case of one service user the list was missing. The manager must ensure that lists of medications in use are kept up to date. The home is now working with Boots pharmacy and medications in tablet form are being dispensed in bubble packs. These medications could be balanced as the MAR sheet indicated how many had been dispensed and from what date they were being used. The inspector balanced several but one medication had a tablet missing. The manager stated that this tablet had been missing for some time and he needed to write to the general practitioner to get a replacement. Liquid medications could not be balanced because there was no record on the MAR sheet of the quantity prescribed or when it started to be used. The manager must ensure that it is possible to balance all medications. The home keeps current medications in individual medicine cupboards in the rooms of service users. It keeps surplus stocks in a main cupboard. The stock control of medications in the home was very poor. There were large quantities of unused medication. If the home have been giving service users their medications regularly then they must have over ordered on several occasions. There were medications which were no longer in use and medication which was out of date. The manager must dispose of unused and out of date medication. The manager stated that he had not done a stock audit for several months and acknowledged that the responsibility for the poor stock control lay with him. The manager must undertake a stock control audit. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 17 The staff had adopted a practice of writing on the packets of medications when they had been administered to service users, in addition to writing on the MAR sheet. The inspector told them that this was an unnecessary duplication which was more likely to lead to error than prevent it. The manager must ensure that MAR sheets only are used for the recording of the administration of medication. At the previous inspection the manager stated that there was a book for recording incoming medication and a book for recording medication returned to the pharmacy. At this inspection the inspector saw such a book but it had not been used. She also saw some loose sheets which listed medications returned to the pharmacy. The manager must ensure that the book recording medications in and out of the home is properly used and signed off by the pharmacist when medications are returned to him. The inspector formed the view that the staff at the home need retraining in the administration of medication. The manager must ensure that all staff who administer medication update their medication training. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 18 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 and 23. The outcomes for service users in this area are adequate. However there are a number of improvements needed. EVIDENCE: The inspector saw a guide to complaining for service users but there was little evidence of an active complaints procedure in operation at the home. The manager was not able to show the inspector an up to date complaints folder and it was also not possible to locate the Outward complaints policy. The policy and procedures manual was wrongly numbered so the policy which was listed in the index as being about complaints was actually about something else. The manager must ensure that the home has a copy of the current corporate complaints policy. The manager must ensure that he has a folder for filing complaints and recording progress towards their resolution. The inspector was shown a Listening Book. The purpose of this book is to record comments made by service users so that they can be shared with staff and actions can be taken before the service user feels it necessary to make a complaint. The book was empty of recording. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 19 The manager must ensure that if the home is keeping a Listening Book, they do actually write in it. The inspector viewed the organisational policy for adult protection, although this too was wrongly numbered in the manual. The inspector is aware that an incident has occurred since the last inspection where an adult protection investigation was undertaken. The inspector has been kept informed of the progress of the investigation and the steps taken to protect a vulnerable individual, all of which appeared satisfactory. The inspector was told that the records relating to this investigation are held at head office. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 20 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 and 30. The environment is safe but in a poor decorative condition in the downstairs flat. The home is generally adequately clean and hygienic. EVIDENCE: The manager advised that the two flats are soon to be redecorated and given some refurbishment, starting with the ground floor flat. The inspector confirmed this by hearing the manager making some of the arrangements on the telephone. The ground floor flat is very shabby and in need of redecoration and refurbishment. The first floor flat is in better condition generally but still needs work. Two of the bedrooms which the inspector viewed on the first floor were very pleasant. A service user told the inspector she loves her room. The manager must ensure that the ground floor flat is redecorated and refurbished. There were no offensive odours in the home. Neither of the flats have utility rooms. The washing machines and driers, which are domestic in scale, are located in cupboards. The manager is aware that foul laundry must be washed at 65 degrees Celsius for not less than 10 minutes. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 21 Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 , 35 and 36. Based on the evidence available the outcome for this area is judged as adequate. EVIDENCE: There are ten permanent staff at Buxton Street in addition to the manager. Two are part time and one is on secondment from another home. One waking carer is responsible for all the service users at night. Currently the deputy manager post is vacant. There is a keyworking system in place but the inspector felt that keyworkers were not really taking responsibility for individual service users. The inspector felt that the poor condition of the service user files, described above, was evidence that the keyworker role at the home was not fully understood by staff. Furthermore the manager stated that the lack of use of the proper book for recording medication in and out of the home was the result of a particular worker not fulfilling a responsibility he had been given. The manager should consider how responsibilities, including keyworker responsibilities, at the home should be properly delegated, and how he is going to monitor staff performance. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 23 The service user and staff groups at Buxton Street reflect cultural diversity. The manager was clear that all staff have equal opportunities for personal development and said he tries to be as fair as possible when offering extra shifts to staff. The manager stated that there are three staff who have NVQ level 3, three are undertaking level 2 and one is undertaking Learning Disabilities Assessment Framework (LDAF). The records of recruitment are not retained at the home but the inspector is satisfied from discussions with a senior manager in the organisation that the recruitment procedure is robust. There was a requirement at the previous inspection that documentation be made available regarding an outstanding Criminal Records Bureau disclosure. The inspector was able to view CRB disclosure reference numbers for all the staff. The previous inspection required the manager to ensure that staff (including bank staff) receive adequate training. This was a restated requirement, a timescale of 01/07/05 not having been met. The inspector acknowledges that having permanent staff and not using bank staff is a positive development. However the manager was not able to produce staff training profiles for inspection so it was not possible to find out what training the staff have had. A staff member told the inspector that he had had adult protection training six months ago and four days mental health training. Another staff member said he had not had any training yet this year but had had manual handling last year, and medication training in December 2005 (from Boots). The experience of the inspector is that without proper record keeping it is not possible to determine staff training needs. The manager must ensure that staff (including bank staff) receive adequate training. The manager must ensure that staff training profiles are available for inspection. The inspector noted that the three staff whose records she viewed had all had supervision three times since September 2005. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 41 and 42 Currently the home is only adequately run and a number of requirements have been made to address leadership, management and safety issues. EVIDENCE: The manager was appointed to his post a month ago. He was deputy manager and has been acting up on and off for three and a half years whilst several managers have spent short periods of time in post. The post of deputy manager is now being advertised within the organisation. The manager has a degree in management and is starting the registered managers award. He has sent his application for registration to the Commission for Social Care Inspection (CSCI). The manager must become registered to manage the service. The appointment of the present manager had been well received by the two staff who were interviewed by the inspector. They have confidence in him. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 25 Staff interviewed also felt that the home benefited from a stable team and good teamwork. The inspector felt that the manager had started at a difficult time with no deputy in post and the legacy of three and a half years of disrupted management. The inspector recommends that: Senior management prioritise the appointment of a deputy manager, consider allocating temporary administrative assistance to the manager, and as mentioned elsewhere in this report take a pro-active approach to providing additional record storage space. The manager advised that the home has a threeyear plan and he monitors the progress of the home towards the goals. The inspector viewed the 2006-6 section. The manager stated that there are central forums which service users attend. The mother of one of the service users attends the residents meetings. The organisation employs a participation and development officer and she sent out questionnaires in February 2006. She is currently compiling the feedback. The inspector viewed three service user files and various other documentation. The service user files were too large and very difficult to audit. Information was filed in the wrong categories and some of the information was years old. There is an urgent need for new files to be started with current information and for old information to be archived. Other records in the home appeared rather tatty and in need of relabelling. Records need to be sorted, with unnecessary paperwork being destroyed or archived. The manager stated that there has been no archiving space available to him and he has had to resort to using an outside shed to store old records. He said that senior managers are going to be requested to rent some storage space. The office facilities at Buxton Street are tiny with very little space to store files. In the view of the inspector there is a direct link between the lack of storage space and archiving facilities, and the condition of the service user files. The staff have continued to use the files beyond their capacity because if they start new ones there is nowhere to store the old ones. The manager must ensure that new current files are started for service users with properly updated information (see standard 6 and 9). Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 26 The inspector noted records which were inappropriately placed. A sheet to record whether a service user attended his day centre and a behaviour monitoring chart were kept in a medication folder. Neither were fully completed. The manager must ensure that if a record is started it is consistently completed or else discontinued. Records relating to individuals should be kept in their files. The previous inspection required the manager to make available for inspection the electrical wiring certificate, a previous timescale of 01/07/05 had not been met. The inspector saw evidence that the work had been undertaken in April this year but the certificate was not available for inspection. The requirement has therefore been restated. The manager must make available for inspection the electrical wiring certificate. The previous inspection required the manager to ensure that magnetic door closers are put in place on all bedroom doors, to ensure fire protection. Two magnetic closers have been provided and there are three more to do. The requirement has therefore been repeated. The manager must ensure that magnetic door closers are put in place on all bedroom doors, to ensure fire protection. The inspector noted in the upstairs kitchen that the chopping boards are very worn. This does not promote good health hygiene. The manager must ensure that new chopping boards are purchased for the upstairs kitchen. The inspector viewed the contents of the two kitchen refrigerators. There was little food in them and the manager said it was the weekly shopping day on the day of the inspection. It was however obvious, and the manager agreed, that the practice of labelling food with the date of opening, was not being followed. The manager must ensure that opened food in the refrigerators is labelled with the date of opening. The inspector viewed the fire risk assessment, and evidence of weekly fire alarm testing. The manager stated that quarterly fire drills take place. The last fire drill had taken place in December 2005 and although the manager had put the drill in the diary for 9th April 2006 it had not been carried out by staff. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 27 The inspector saw evidence of a boiler check by an outside contractor in April this year. She also saw evidence of weekly fridge and freezer temperature and water temperature checks. Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 x 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 x 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 2 x 2 x 3 x 2 2 x Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 5 Requirement The service user guide must be expanded to include all the necessary information to comply with the regulations (previous timescales of 1st September 2004 and 1st December 2004, 1st August 2005, 1st October 2005 not met). The manager must ensure that each individual service user has a written contract or statement of terms and conditions with the home (previous timescale of 01/12/05 not met). The manager must ensure that service user plans are updated to reflect the current needs of service users. Notwithstanding this the manager must ensure that service users who need them, have arranged, a review of their placement, and an invitation is sent to social services for a social worker to attend. The review must go ahead whether a social worker attends or not. The manager must ensure that an interpretation service is identified for the service user, if DS0000010293.V290156.R01.S.doc Timescale for action 01/07/06 2. YA5 5 01/07/06 3. YA6 15 01/09/06 4. YA6 15 01/09/06 5. YA7 12 01/07/06 Buxton Street (131-133) Version 5.1 Page 30 6. YA8 12 7. 8. 9. 10. 11. 12. YA9 YA20 YA20 YA20 YA20 YA20 14 13 13 13 13 13 13. YA20 13 14. YA20 13 15. YA22 22 16. YA22 22 17. YA22 12 (3) necessary broadening the search beyond the local area. The manager must ensure that tenants meetings are held regularly even if it is only for one service user (previous timescale of 01/09/05 not met) The manager must ensure that all risk assessments are reviewed and updated regularly. The manager must ensure that lists of medications in use are kept up to date. The manager must ensure that it is possible to balance all medications. The manager must dispose of unused and out of date medication. The manager must undertake a stock control audit. The manager must ensure that MAR sheets only are used for the recording of the administration of medication. The manager must ensure that the book recording medications in and out of the home is properly used and signed off by the pharmacist when medications are returned to him. The manager must ensure that all staff who administer medication update their medication training. The manager must ensure that the home has a copy of the current organisational complaints policy. The manager must ensure that he has a folder for filing complaints and recording progress towards their resolution. The manager must ensure that if the home is keeping a Listening Book, they do actually write in it. DS0000010293.V290156.R01.S.doc 01/06/06 01/09/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 01/09/06 01/06/06 01/06/06 01/06/06 Buxton Street (131-133) Version 5.1 Page 31 18. 19. YA24 YA35 23 18 20. 21. 22. YA35 YA37 YA41 18 8 17 23. YA41 17 24. YA42 23 25. YA42 23 26. YA42 16 27. YA42 16 The manager must ensure that the ground floor flat is redecorated and refurbished. The manager must ensure that staff (including bank staff) receive adequate training (previous timescale of 01/07/05 and 01/12/05 not met). The manager must ensure that staff training profiles are available for inspection. The manager must become registered to manage the service. The manager must ensure that new current files are started for service users with properly updated information (see standard 6 and 9). The manager must ensure that if a record is started it is consistently completed or else discontinued. Records relating to individuals should be kept in their files. The manager must make available for inspection the electrical wiring certificate (previous timescales of 01/07/05 and 01/09/05 not met). The manager must ensure that magnetic door closers are put in place on all bedroom doors, to ensure fire protection (previous timescale 01/10/05 not met). The manager must ensure that new chopping boards are purchased for the upstairs kitchen. The manager must ensure that opened food in the refrigerators is labelled with the date of opening. 01/07/06 01/07/06 01/07/06 01/09/06 01/09/06 01/06/06 01/06/06 01/06/06 01/06/06 01/06/06 Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 32 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 YA31 Good Practice Recommendations The manager should consider how responsibilities, including keyworker responsibilities, at the home should be properly delegated, and how he is going to monitor staff performance. Senior management prioritise the appointment of a deputy manager, consider allocating temporary administrative assistance to the manager, and as mentioned elsewhere in this report take a pro-active approach to providing additional record storage space. 2 YA38 Buxton Street (131-133) DS0000010293.V290156.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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