Inspection on 19/04/07 for Carlingford Road, 181

This inspection was carried out on 19th April 2007.

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 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlingford Road, 181 02/07/08

Carlingford Road, 181 14/11/07

Carlingford Road, 181 03/10/06

Carlingford Road, 181 24/11/05

Carlingford Road, 181 17/05/05

Carlingford Road, 181 16/09/04

Carlingford Road, 181 20/05/04

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 Carlingford Road, 181 181 Carlingford Road South Tottenham London N15 3ET Lead Inspector Jackie Izzard Unannounced Inspection 19th April 2007 09:30 Carlingford Road, 181 DS0000060630.V333381.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 Carlingford Road, 181 DS0000060630.V333381.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. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlingford Road, 181 Address 181 Carlingford Road South Tottenham London N15 3ET 020 8693 6088 020 8299 4818 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) www.choicesupport.org.uk Choice Support No registered manager Care Home 4 Category(ies) of Learning disability (0) registration, with number of places Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2006 Brief Description of the Service: 181 Carlingford Road is a residential care home registered to provide personal care to up to four people over the age of eighteen and who have a learning disability. The home is situated in a residential area of Tottenham in North London, with good public transport links and close to Wood Green shopping and leisure facilities. The home is a converted mid-terrace house, arranged over three storeys, with four bedrooms, two bathrooms, a garden, lounge and kitchen. On the 1st April 2004, Choice Support took over the registration of the home, and Sanctuary Housing Association provides the housing support. Choice Support is a charitable organisation that has been in business for 20 years supporting people with learning disabilities in the community. The home provides 24 hour care and its stated aim is to provide the people living there with a secure, relaxed and homely environment in which their care, well being and comfort is of the prime importance. Placements at the home costs £1411.16 for each person per week. People living at the home are expected to pay separately for some items and activities, such as holidays, transport, activities, eating out, take away meals and rental of a water cooler. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. At the time of this inspection, there were three men and one woman living at the home. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 19 April 2007. The inspector did not tell anyone she was coming. She stayed at the home for seven hours. During the day, the inspector: • • • • • Talked to three staff Talked to three of the people who live at the home and watched how they got on with each other and staff Looked at all the rooms in the house Looked at the files in the office Checked up on all the requirements made at the last inspection to see if they had been completed (these were improvements that Choice Support and the manager had to do to make sure the home is being run properly and to make life better for the people who live in the home). The inspector also used information provided by the manager in a questionnaire to help with the inspection. • What the service does well: What has improved since the last inspection? One of the bathrooms has been redecorated . New carpets have been provided on the landing and stairs. New permanent staff have been employed. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 5 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at this home do not understand the charges they are paying, the contract is not accessible to them and does not contain all the charges. There is no evidence that their representatives have agreed to additional charges as they have not signed up to date contracts. EVIDENCE: Service user guides were seen at the last inspection and were said to be of a good standard, but on this occasion, the service user guides were not available for inspection as the manager was not on duty and the staff did not know where they were. A requirement was made at the last inspection of the home in October 2006 that the total cost and charges for the service are updated in the individual service user guides, and reflect the total cost for the service and who is responsible for payment and that any additional cost associated with a water cooler must also be clearly reflected. The inspector saw updated contracts regarding charges but these had not been seen nor signed by representatives of the people who live at the home. These contracts did not mention a charge for the home’s water cooler. Due to the nature of their disability, the people living at the home are unable to give informed consent regarding financial matters, and there was no written Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 9 evidence in their files that their representatives, ie family members or Haringey, had agreed to this financial arrangement. People pay £62.35 per week contribution to heir fees. £29.50 of this is for food and paid from their money into the food budget. In addition, people pay for any takeaway meal they eat. The requirement to clarify all charges in writing is restated in this report. No new people have moved into the home in the last year and all assessments are in the process of being updated due to the introduction of person centred planning so it was not possible to assess the quality of assessments at this inspection. The inspector did see the new assessment documents, including an assessment of cultural needs, were of a good standard though not yet completed. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Until the new person centred planning assessment and care plan is completed for everybody, it is not possible to judge whether their needs are being fully met. From the evidence available at the time of this inspection, there was an inadequate risk assessment process which means that people may be inadvertently put at risk by staff who may not be sufficiently well informed. EVIDENCE: Staff told the inspector that they are in the process of introducing a person centred planning approach in home. For this reason , people’s assessments are being undertaken using new formats, including a comprehensive assessment of cultural needs. Unfortunately, these were not complete so could not be inspected . A requirement was made at the previous inspection that the person centred plans were completed by 30 January 2007. The inspector looked at the files for Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 11 all four people living at the home and saw that none are yet completed. Staff have attended training and showed the inspector the health book and support book which comprise the person centred plan. This requirement is restated. The inspector asked to see the risk assessments for all four of the people living at the home. One risk assessment was seen which addressed aggressive behaviour. This was not comprehensive and did not fully inform staff on what to do to protect others if one of the residents was behaving in an aggressive way. Two staff said that none of the others had a risk assessment. The inspector discussed this with the manager a few days after the inspection by telephone. The manager said that all four people have risk assessments in place. However, if this is the case staff are not aware of them. This puts people in the home at risk. A requirement is made to ensure that all four people have risk assessments in place which all staff have read and understand. These must include risks associated with epilepsy, challenging behaviour and health risks. The inspector had received reports of one of the people assaulting staff and other residents in the home. This was addressed in detail by reading the records relating to that person and discussing with staff. Two staff told the inspector that there had been a reduction in the number of violent incidents recently since the person in question had a change of medication. There were currently no concerns about the risk of violence. The inspector was able to send some time with this person who was calm and contented on the day of the inspection. Staff showed a good awareness of the situations which might lead to violence. None of the people living in the home talk or sign very much and so were not able to tell the inspector their views. Staff said that they involve people as much as possible in day to day decisions about their lives; for example, what to eat, what to wear and whether or not to go out to a planned activity. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to take part in leisure activities and to maintain their relationships with family and friends. Although there are some restrictions to their freedom these are in the interests of their personal safety. Their individual lifestyle preferences are respected and they are provided with healthy food which meets their cultural and dietary needs and preferences. EVIDENCE: All four people who live at this home attend a day service for people with learning difficulties or people with autism five days a week. They attend different dayservives according to their individual needs. Inspection of records and discussion with staff members indicated that they are supported to attend up to three social clubs each week for people with learning difficulties. In addition, on a Tuesday evening, they attend a trampoline session at a sports centre in Islington. Staff told the inspector that Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 13 people have a choice whether to go to the planned activity and that one person often chooses to stay at home rather than go trampolining. An extra staff member was seen to be on the rota for each evening that people have organised activities to support them. Individual interests are also supported. One person attends a weekly drama group. Records and discussion with staff showed that people enjoyed shopping, cinema, walking in the nearby park and going to a local pub. Due to the nature of their disability, some people had very strong preferences for particular daily routines in the house and could be distressed if their routine is not respected. The inspector saw that staff respected people’s wishes to do things in a very specific way and supported them in this. Staff also showed a good understanding of each person’s preferred routine when they get home from their day service and supported them with their individual needs. There was evidence to show that staff support people in maintaining their relationships with family and friends. Staff escort one person to visit his/her parent each week and another person is visited by his/her family every weekend. One person has a friend with whom s/he stays for holidays once or twice a year. Staff support this relationship by taking this person to his/her friend, encouraging telephone contact, etc. The inspector saw that s/he has a large photograph of their friend on his/her bedroom wall, which is very positive. None of the people living at the home are able to go out without support. They meet up with people who they know from their day services at social clubs. The inspector saw photographs of a holiday which everybody went on last year. People are encouraged to take some responsibility for day to day chores, such as tidying bedrooms, helping with preparing meals. There are restrictions as there is a keypad on the door so that people cannot leave the building unless they know the code. This is for the safety of the residents who would be at risk if they went out alone. The menu was inspected along with the record of food actually served each day. The food was varied, nutritious and well balanced. Different cultural preferences were catered for. One person is Muslim but chooses not to follow a Muslim diet. Inspection of the fridge showed a good supply of healthy foods. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 14 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 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive personal support tailored to their individual needs and preferences. Although health records were not all up to date, staff were aware of people’s health needs. Staff have not yet attended accredited medication training which needs to be urgently addressed to minimise risks to residents, but records indicated that medication was being given appropriately. EVIDENCE: The inspector looked at a selection of medication records (MAR sheets), medication cabinet, discussed medication training with two staff and looked at the health assessments , records of health appointments and daily records relating to health and personal care for three people. Medication was stored safely and the temperature of the medication cabinet was recorded daily and had not exceeded 25 degrees which is positive. Each person had an individual daily log and personal care log which details for staff the person’s specific personal care needs, which was very good. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 15 Observation of the people at the home showed a good level of personal care. Everybody was dressed in clean well fitting clothes. One person had recently had a health review and his/her medication was changed which staff report to be having a positive effect on the person’s wellbeing. The inspector saw from a letter in one person’s file that a health need had been identified in 2004 which stated that this would be followed up “in a couple of months”. Although from discussion, it was clear staff were aware of this person’s condition, there were no records available to show that the person had received any follow up care or treatment. Staff said that no treatment had been prescribed and that the person had recently been supported to see the GP about this health need. However there were no records available for inspection as evidence of this. A requirement is made to ensure this health need is addressed. The inspector looked at the records kept by staff of one person’s weight. The weight records between November 2006 and Januruary 2007 were clearly inaccurate as weight gains of 7 to 14lbs were recorded in one week. All four residents were seen to be registered with a GP. Staff told the inspector that three people will not cooperate with blood tests but no work had been undertaken with them to help them overcome their fears. Records of dental and optician appointments were seen for three and found to be up to date. None of the residents can look after their own medication. Medication records were completed properly and there were no concerns about the recording of medication. Two staff told the inspector that the manager had assessed them as competent to give medication. They did not have a copy of this assessment and the staff files were locked away because the manager was not on duty. Neither had yet attended accredited medication training but were administering medication. A requirement is made to ensure there is always a trained staff member on duty to give out medication. The manager said that this training would be prioritised and she would request it is moved forward to May 2007 to ensure the requirement is complied with. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 16 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): People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although complaints appear to be dealt with appropriately the home needs to make improvements in order to protect people from abuse. Some staff have had training in safeguarding adults but have been supplied with incorrect details of who to contact in the event of abuse. This, along with insufficiently robust recording and reporting practices means people are not fully protected from risk of abuse. EVIDENCE: The home has a pictorial complaints procedure to help people understand how to complain. The home had received one complaint in the last twelve months. This had been recorded and was resolved appropriately. A requirement was made by a CSCI inspector in October 2006 that Choice Support inform the CSCI when a referral of an ex staff member had been made to the Protection of Vulnerable Adults (POVA) list giving a timescale of 30 October 2006 for compliance. This requirement was not complied with and the service manager informed the inspector by telephone during the inspection that this referral had still not been made. She said she would ensure this was carried out within a few days. This requirement is therefore restated in this report. As a result of alleged theft by a staff member from the account of a person living at the home, a requirement was made to update the financial assessments for each person. One was seen to have been updated in January 2007 but the other three could not be located on the day of the inspection so this is also restated. A recommendation for staff to receive refresher training in adult protection has been acted on and the inspector saw written evidence Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 17 that this training is booked. The inspector discussed adult protection procedures with one staff member who had recently attended training. The inspector saw that this staff member had been provided with written information which was inaccurate and gave details of the wrong local authority. This must be addressed as a matter of urgency as it is essential that all staff know what to do and who to contact if they suspected abuse. The inspector looked at financial records and noted that the manager is signatory to each resident’s account. Two people have a family member who can act as signatory and two have another manager form a Choice Support project as the second signatory. A requirement is made for Choice Support to inform the CSCI as to why the company is not complying with Regulation 20 of the Care Homes Regulations 2001 which requires them to ensure that employees at the home do not act as agent where practicable. Other unsatisfactory financial practice seen in records included one person being loaned £2 from another person who is unable to give informed consent (the loan was repaid) and insufficient records relating to paying towardsa water cooler, nor evidence of their representatives’ consent to this unusual arrangement . CSCI have not been informed of the outcome of a recent adult protection investigation affecting somebody ho lives at this home. A verbal account was given to the inspector by staff during the inspection but a written report is required. The preinspection questionnaire submitted by the manager reported that three staff had their contracts terminated by Choice Support since the last inspection six months ago. One of these was in connection with the alleged theft of money. The inspector spoke with the manager on the phone to ask about the other two staff members and was informed that they were dismissed for gross misconduct. It was explained to the manager that this should have been reported to the CSCI under Regulation 37 of the Care Homes Regulations 2001 as an event affecting the wellbeing of people living at the home and a report requested. It was not clear from the risk assessment given to the inspector, as to what safeguards were in place to protect those living at the home from the risk of assault by one resident. This is addressed in a previous section of this report and a requirement made. Staff told the inspector that the violent incidents have ceased and currently there is little risk of anybody being assaulted. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 18 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, 26, 27, 28, 30 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The general condition of the home’s furniture, décor and hygiene was adequate to meet people’s needs but there was room for improvement in all areas. It is of concern that improvements to the building regarding refurbishment and decoration appear to be driven by CSCI requirements rather than Choice Support’s planned programme of improvements. EVIDENCE: The inspector looked around the house and garden. New landing and stair carpets and refurbishment of the ground floor bathroom have improved the appearance of the home since the last inspection. The home has still to meet requirements to provide new carpets and curtains in bedrooms as only two people have new curtains. Requirements to refurbish the first floor bathroom , redecorate the lounge and replace the carpet and curtains are outstanding. The manager informed the inspector that the Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 19 bathroom would be completed by 30 May 2007 along with the carpets and curtains for the bedrooms. The inspector noted that two people’s chest of drawers were broken and need replacing. Bedrooms were personalised with people’s own belongings and pictures/photographs on the walls which was positive. The sofas in the lounge needed cleaning along with two chairs. A dirty garden chair was also in this room. This indicated a lack of attention to providing a clean and homely room. The kitchen was cleaned to a high standard and the rest of the house was cleaned to a satisfactory standard. There is a small laundry area. No soap or towel was provided in the bathrooms until the inspector requested it. There was broken furniture in the garden which was a potential hazard and this needs to be removed. It is of concern that the CSCI have required these improvements as it is expected that Choice Support take responsibility for ensuring people have a well maintained homely envirment to live in. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 20 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, 33, 35 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels are adequate with room for improvement if people are to receive one to one support whenever they wish to. People will benefit from a better understanding of their needs once staff have been sufficiently trained. EVIDENCE: Six weeks’ staff rotas were inspected as part of this inspection. These show the home has to use bank staff every week as there are insufficient permanent staff employed to cover the rota. As the people living at the home prefer and benefit from being supported by staff they know, this should be addressed. Staffing levels on Sundays are minimal at two staff per shift. The inspector did not check daily activity records on this occasion to see if this staffing level impacts upon people’s opportunities to access community activities. The inspector was unable to inspect staff records as the manager was not on duty and these were locked away for reasons of confidentiality. These will be inspected at another inspection in 2007. It was not therefore possible to confirm that a requirement to ensure staff files were up to date had been Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 21 complied with. The manager assured the inspector by telephone that staff files contained all the required information. The pre- inspection questionnaire completed by the manager reported that none of the staff have NVQ level 2. The national minimum standard for a home of this type is that 50 of staff have this training by 2005. In a conversation after this inspection visit the manager said that one staff does have this training. She said that Choice Support enrol staff on NVQ 2 once they have passed their six month probation and the majority of staff at this home have been working less than six months. A requirement is therefore made to ensure Choice Support inform CSCI of their plans to ensure people living at this home are looked after by a staff team of whom 50 have NVQ 2 as required. The inspector advised that no further unqualified staff be employed at the home until this standard is met. Recruitment practices could not be inspected due to lack of availability of staff file s but this will be inspected at a later date. Choice Support offer a comprehensive training programme and the inspector saw written evidence and heard from the manager that staff were booked onto various courses in the near future, although two staff had not been told they were to attend training in June. Three staff told the inspector they felt they had been provided with a good level of training and records were in place to show the training programme. There is only one staff on duty sleeping in at night which is unusual in home for people with high care needs. The inspector discussed this with staff who said that all the residents slept well and there were rarely night time incidents. The last incident at night was said to be in January 2007and the on call manger attended the home to support the staff member when called. A recommendation was made in October 2006 that the night staffing reduction is discussed at people’s reviews. It was not possible to check at this inspection whether this had taken place so the recommendation is repeated. Two staff told the inspector that staff meetings happen on a regular basis and offered the minutes to the meetings as evidence. These were not inspected on this occasion. The staff team reflects both gender and the cultural backgrounds of the people living there. Two staff explained to the inspector the importance the people at this home place on having consistent staff team whom they know well. The inspector observed good quality interaction between staff and residents and staff showed a caring attitude when supporting people with their daily routines of getting changed, making a drink and snack etc. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 22 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, 40, 42 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff report a positive management approach within the home but Choice Support do not appear to be monitoring this home sufficiently to ensure compliance with inspection requirements, national minimum standards and the best outcomes for people living there. EVIDENCE: The three staff spoken to by the inspector, spoke very positively about the manager and how they enjoyed working with her. The manager has attended relevant management training in the last year. The manager has still not applied to the CSCI to be registered as the manager for this home. It is of concern that Choice Support did not know that this was the case and provide her with the support needed to make the application. The original timescale required by CSCI was one year ago and it is unacceptable that Choice Support Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 23 have allowed this home to run without a registered manager for this length of time. The annual development plan and any quality assurance information could not be located in the home. The manager was not present so a requirement is made to send this to the CSCI. There were no Regulation 26 reports carried out by Choice Support available for inspection at the home since 2005. A requirement is made to ensure these are in the home every month and a copy sent to the CSCI. A requirement is also made to ensure that there is always someone on duty trained in medication administration, first aid and food hygiene as this is not currently the case. Staff on duty in the morning of the inspection had not attended training in some of these areas. The inspector was provided with written information indicating staff will be attending training in food hygiene, health and safety, medication and first aid in the next two months if they have not attended this training already. The pre inspection questionnaire did not record the dates of the last inspection of the gas appliances and electrical wiring and this information could not be located by staff during the inspection so a requirement is made to forward this information to the CSCI. Fire equipment was inspected on 16 April 2007. The policy in place regarding what to do if somebody goes missing, as seen in one person’s personal file, were old (written prior to 2002) and need to be reviewed and dated to ensure they reflect current needs. The manager said she has still not completed a food safety hazard analysis as required at an Environmental Health inspection last year. It is of concern that Choice Support are not addressing outstanding inspection requirements as part of a monthly monitoring of the home as required by Regulation 26. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 2 29 x 30 2 STAFFING Standard No Score 31 X 32 1 33 3 34 X 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 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 2 2 x 1 X 2 2 x 2 x Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15, 12 The registered persons must ensure that all service user plans are completed in the new PCP format. This requirement is restated. An assessment of each person’s cultural needs must also be completed. 2. YA5 5(b) The registered persons must 30/06/07 ensure that the total cost and charges for the service are updated in the individual service user guides, and reflect the total cost for the service and who is responsible for payment and that any additional cost associated with a water cooler must also be clearly reflected. This requirement is restated. Contracts must be dated and signed by each person’s representative. 18/06/07 Requirement Timescale for action Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 26 3. YA9 13(4) The registered person must ensure that every person living in the home has a risk assessment, which must include risks associated with health, epilepsy and challenging behaviour, which all staff have read and understand. The registered persons must ensure that the individual health profiles are updated for each person living at the home. 15/05/07 4. YA19 12 30/05/07 5. YA19 12 This requirement is restated. The registered person must ensure that people’s health needs are addressed and records kept of all appointments. The registered person must ensure that all staff administering medication have undertaken accredited medication training. There must be one person on duty who is trained in medication, food hygiene and first aid at all times. 30/05/07 6. YA20 13 (2) 30/05/07 7. YA23 20 17 The registered person must ensure that a report regarding the theft of a resident’s money and the outcome is sent to the CSCI. This requirement has been amended and restated. 30/05/07 Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 27 8. YA23 37 The registered person must ensure that the Commission is informed when the referral of one staff member is made to the POVA list. This requirement has been restated. 30/05/07 9. YA23 20 17 The registered person must ensure that the individual financial assessments are updated for each person resident at this home. 30/05/07 10. YA23 37 11. YA23 20(3) 12. YA23 13(6) This requirement has been restated. The registered person must 30/05/07 notify the CSCI of an event which led to the dismissal of two staff members. The registered person must 30/06/07 advise the CSCI as to the reasons why employees of the home act as agent for the residents’ finances and what safeguards have been put in place to prevent further financial abuse. The registered person must 30/05/07 provide all staff with information on what to do in the event of suspected abuse of a resident of the home. The registered person must ensure that new floor coverings and curtains are provided in all bedroom. This requirement has been restated. 30/05/07 13. YA26 23 Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 28 14. YA27 23 The registered person must ensure that the bathroom on the first floor is redecorated throughout. The previous timescales of 30/09/05 & 30/05/06 were not met. This requirement has been restated. 30/05/07 15. YA28 23 The registered person must ensure that the lounge is redecorated and that the carpet and curtains are replaced. This requirement has been restated. The registered person must ensure there are steps taken to ensure there are no hazards in the home and ensure broken furniture is removed from the garden. The registered person must ensure all care staff personnel records contain all information as set out in the National Minimum Standards and as required by regulation. The previous timescale of 30/08/05 & 30/03/06 were not met. This requirement was not checked at this inspection. The registered person must advise the CSCI of how Choice Support intend to meet the requirement for 50 of staff to be trained to NVQ 2. 30/06/07 16. YA24 13(4)(a) 30/05/07 17. YA33 17(2) 30/05/07 18. YA32 18 30/06/07 Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 29 19. YA37 9 The registered persons must 30/06/07 ensure that the manager applies to the Commission to be registered. The previous timescale of 30/05/06 was not met. This requirement has been restated. The registered persons must 30/06/07 provide the CSCI with a copy of the most recent quality assurance exercise and annual development plan for this home. The registered person must 30/06/07 ensure the policy regarding people going missing from the home is reviewed to ensure it is up to date. The responsible individual must undertake visits to the care home on a monthly basis as required by Regulation 26, provide a copy of the written reports of these visits to the manager (to be kept in the home) and to the CSCI. This requirement has been restated. 30/05/07 20. YA39 24 21. YA40 13(4) 22. YA39 26 23. YA42 23 (5) The registered person must comply with the recommendation made by the Environmental Health officer that a food safety hazard analysis be undertaken. This requirement has been restated. The registered person must provide evidence that the home’s gas and electrical inspections are up to date. 30/06/07 24. YA42 13(4)(a) 30/06/07 Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 30 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 YA33 Good Practice Recommendations It is recommended that the registered person ensures that the service users’ pending placement reviews include discussion with the placing authority regarding the current levels of support that are provided to service users at night. This recommendation has been restated. Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 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 Carlingford Road, 181 DS0000060630.V333381.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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