Inspection on 03/10/06 for Carlingford Road, 181

This inspection was carried out on 3rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlingford Road, 181 02/07/08

Carlingford Road, 181 14/11/07

Carlingford Road, 181 19/04/07

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 Caroline Mitchell Key Unannounced Inspection 3rd October 2006 10:50 Carlingford Road, 181 DS0000060630.V295876.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.V295876.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.V295876.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) Choice Support Mr John Philip Parsonage Care Home 4 Category(ies) of Learning disability (0) registration, with number of places Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th November 2005 Brief Description of the Service: 181 Carlingford Road is a residential home that is registered to provide personal care to up to four service users who are over the age of eighteen and who have a learning disability. Service users can be of either gender. The home is situated in a residential area of Tottenham 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, a garden, lounge and kitchen/diner. The accommodation is suitable for the needs of the service users but is not suitable for those requiring assistance with mobility or who use mobility aids. On the 1st April 2004 the management of the home was transferred from Care Providers Haringey Adult Independent Living Association (HAIL) to Choice Support, and Sanctuary Housing Association provides the housing support. Choice Support is a charity organisation that has been in business for 20 years supporting people with learning disabilities in the community. The homes provide 24 hour care and it’s stated aim is to provide the service users 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 £1,133.44 for each person per week. Service users are expected to pay separately for some items and activities, such as eating out. Following “Inspecting for Better Lives” the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection and took around six hours to complete. During this time the inspector spoke to the manager, who arrived in the afternoon, as she was rota’d on the late shift, and briefly to two members of staff. The inspector was shown around the home and a number of written records were also examined. The inspector also took into account data provided to the Commission by the registered person, in the form of a preinspection questionnaire. Due to the nature of the disability of the service users it is difficult to gain their opinions. However, the inspector was able to speak to three service users and spend some time with them. They appeared relaxed and well cared for. What the service does well: What has improved since the last inspection? What they could do better: It is necessary to continue to address the issue of the repair and refurbishment of the home, as although progress has been made, there is still some way to go before the home can be termed comfortable throughout, and some requirements have been restated on more than one occasion in relation to this. Again, although progress has been made, there is also some work to do in updating the service users’ personal plans, financial assessments and health assessments. The staff records still need some work and a requirement is restated in relation to this. There is also some room for improvement in relation to adult protection records and processes, and reporting to the Commission under Regulations 26 and 38. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 6 There are twenty one requirements and three recommendations made as part of this report. Four of these requirements are restated, as the previous timescales for compliance have not been met. Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the timescale given will lead the Commission to consider enforcement action to ensure compliance. 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. Carlingford Road, 181 DS0000060630.V295876.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.V295876.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&5 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The information needed to make an informed choice about where they live, is available to prospective service users. The details of the charges for the service need to be updated and expanded. EVIDENCE: The inspector saw the service user guide for one services user. It was noted to be of a good quality in that it was individualised, written in accessible language and illustrated will real photographs of the people living and working in the home. The guide doubles as a contract, as it sets out the charge for the service, how to complain and what care and support the service user can expect in the home. It included the assured shared tenancy agreement with Sanctuary Housing Association. The inspector noted that the details of the cost and charges for the service, that were included in the individual service user guide, were out of date and did not reflect the total cost of each placement and who is responsible for payment. A requirement is made in respect of this. It is clear that service users need to pay separately, on top of their weekly charge for rent and food, for things such as sweets, alcohol or eating out. In addition, a new water cooler is installed in the kitchen and, if the service users decide to keep it, any additional cost must be clearly reflected as part of their written contract. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service users are encouraged to make decisions about their lives and supported to take risks as part of an independent lifestyle. A Person Centered Planning format is being introduced. However, due to staff changes, this is taking some time to complete. EVIDENCE: The inspector reviewed the written records for three service users and case tracked two in some detail. There were plans in place for all three service users, and one of the three service users had an additional plan completed in the new PCP (Person Centered Planning) format. The manager explained that, there being a number of new staff, there is a need for them to complete the relevant training, that is being provided by Choice. There is still some work to be undertaken to ensure that everyone’s’ plans are properly completed in the PCP format and a requirement is made in respect of this. The inspector noted that the written guidance for staff in relation to how to work with each individual service user was very detailed and the emphasis was very much on supporting service users to be as independent as possible, and Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 10 to support them in making choices that are relevant to their lives. The manager told the inspector that there is a co-key working system being introduced as new staff come into post. She added that she wants to establish a system of regular meetings between the key workers, co-key workers and the key workers in the day services to ensure that there is a better coordinated approach to service users’ needs. The risk assessments that were in place covered the risks that were relevant to the needs and lifestyles of individual service users, and were noted to be very clear and comprehensive. The manager had reviewed them recently. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides opportunities for personal development and service users do take part in a good range of social and leisure activities, both in the home and in their local community. Service users’ rights are recognised and their families have involvement in their lives. The service users are provided with a varied and balanced diet. EVIDENCE: All of the service users were out at their various day services at the time of the inspection and the inspector was able to spend a little time with them when they returned. Due to the nature of their learning disabilities and autism, the service users do not communicate in conventional ways, so it is a challenge to gain their opinions about life in the home. However, the inspector observed that they seemed to be relaxed, well cared for, and well groomed. The service users who were going to trampolining after their evening meal indicated that they were looking forward to it. One service user said they didn’t like trampolining, so they had chosen to stay at home instead. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 12 Each service user has a schedule of activities, setting out the individual activities that they are to undertake each week and include social, leisure and skills based activities, both in the home, and in the local community. The inspector case tracked the records for one service user, for the period of one month, in order to monitor the kinds of community and social activities that the service user was recorded as being involved in during the evenings and at weekends. During that period the service user went to the pub twice, to a party, out shopping four times, for a walk and to drama class once. The manager explained that the social clubs that service users usually attend are not on during the summer month’s school break. This particular service user had also been on a week’s activities holiday with Mencap and a weekend visit to her befriender during the summer. The service user was noted as enjoying being involved in cooking and domestic tasks around the house with staff, and records reflected that they had been involved in cooking, cleaning, ironing and setting the table on a number of occasions. This particular service user was encouraged by staff to help with making the evening meal at the time of the inspection, and seemed to be enjoying being involved. There was a lot of evidence that service users are encouraged and facilitated to be involved with their families, and family members are welcomed in the home and that their opinions are taken into account. The manager described an instance where one parent raised an issue regarding the cultural balance in the staff team in relation to the service users’ cultural make up, and this had been born in mind in the recruitment process. The inspector noted that the guidance for staff placed emphasis on ensuring that the service users’ right were upheld. Due to the nature of their disability, service users are subject to some restrictions to their personal freedom, these restrictions are in the interests of their safety, and are reviewed regularly as part of their individual risk assessments. The manager told the inspector that a new menu is being introduced, that works on a four weekly rotation, so as to provide more variety, and to help with forward planning. The inspector saw the record that had been kept of what service users had actually eaten, and this showed that they had been receiving a reasonably well balanced diet. However, staff had stopped completing this record recently, and a requirement is made for it to be continued. During the tour of the home the inspector noted that the fridge and freezer were well stocked and there was plenty of fresh fruit and vegetables. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users receive personal support to suit their needs and preferences and their health needs are met generally. However, there is room for improvement in tracking service users’ health care needs, and in communication with specialist learning disabilities health care professional in order to ensure that ongoing heath care issues are followed through. The arrangements for the administration of medication in the home were generally acceptable, with some room for improvement, primarily with regard to record keeping. EVIDENCE: The inspector reviewed the records of the personal and health care needs of two service users in some detail, and noted that the guidance for staff in relation to the personal care needs of these services users was very detailed. It included guidance regarding service users’ specific cultural needs and preferences, and the emphasis was very much on ensuring that they were encouraged to be as independent as possible, and their dignity maintained. The written records of the two service users reflected that they have access to a range of services in relation to their health care needs. The service users weight was monitored monthly and records reflected that their weight remained stable. One service user’s records showed that they had recently Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 14 visited their GP, and regularly visited the dentist, had been to the optician and the foot health clinic, and was on the waiting list for an OT assessment. However, the inspector formed the opinion that there is room for improvement in terms of communication with the specialist learning disabilities health care team. In separate incidents, service users had refused to co-operate in simple medical procedures, but no evidence was available that this had been followed up by the learning disabilities health care professionals involved. Each of the service users had an individual health profile in their records. These were very comprehensive and helpful documents, and as they were completed in 2004, a requirement is made for them to be updated. The manager showed the inspector evidence that this process had been started for one service user, and explained that they are to be improved upon by the addition of pictures, so that the profiles are more accessible to the service users. It is also hoped that as part of this process, closer links may be developed with the learning disabilities health care professionals. The inspector reviewed the records in relation to medication in the home. The Boots system has recently been introduced and this is an improvement on the previous arrangements. Boots had provided a number of staff with training in the administration of medication using the Boots system. The temperature that the medication was being stored at was being monitored and a record was kept of this. At the time of the inspection the temperature was below 25 C. There were gaps in the record of the administration of medication in April, May, June and July 2006. The manager was asked to address this with the staff responsible, and a requirement is made in relation to this issue. The record of staff who had been assessed as being competent was somewhat out of date, as was the sample of signatures, as there have been a lot of staff changes. Requirements are made in respect of these issues. The inspector saw that a record was kept on each service users’ medication record sheet of the medication that came into the home. A separate record was also kept of any medication returned to the pharmacist. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service users and their representatives can feel their views are listened to and will be acted on. Service users are generally protected from abuse, neglect and selfharm, although there is room for improvement in the context of a recent adult protection issue. EVIDENCE: Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 16 The home’s complaints policy and procedure was in place, which is titled ‘How to complain’, and is in pictorial style for the service users. Since the previous inspection there have been no complaints recorded in the record kept in the home. It was discovered by the manager in June 2006; that one service user has had a large amount of money stolen from their post office account. The inspector saw the written account of the action taken by the manager. The inspector has been informed by the responsible individual for the home that the placing authority were informed, and that review meetings did take place in relation to this issue. However, the minutes of these meetings were not available as part of the records kept in the home and a requirement is made in respect of this. The responsible individual has undertaken to make a referral of the staff member who is under suspicion, to the POVA list. However, there was a delay in this, and a requirement is made for the Commission to be notified as soon as the referral has been made. It is the opinion of the inspector that this is an opportune moment to provide staff with refresher training regarding the protection of vulnerable adults, particularly in relation to London Borough of Haringey’s adult protection procedures and a recommendation is made in respect of this. The inspector noted that the financial assessments that were completed for each service user in 2004 were out of date, and would benefit from review in the context of this theft. A requirement is made in respect of this. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27, 28 & 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home provides an environment that service users can regard as their home and their bedrooms are personalised to reflect this. The home is kept clean and real progress has been made with the refurbishment, which has improved the environment. There remains room for improvement, to make the home a nice place for the service users to live in. EVIDENCE: At the previous inspection the registered person was required to redecorate the service users’ bedrooms, and this had been achieved. It was also required that the hall stairs and landing be redecorated and recarpeted. This had not been achieved within the given timescales and this requirement is restated as part of this report. The inspector was very pleased to note that the kitchen/ dining area has been redecorated, and new kitchen cupboard fronts and work surface have been installed. This is a vast improvement, and the manager said that the service users like to spend time in their kitchen since it has been refurbished. It just remains for a new extractor to be provided above the hob, as the existing extractor is broken. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 18 At the previous inspection the registered person was required to redecorate one of the bathrooms, at this visit, although they were clean, both bathrooms were noted to very stark, and sorely in need of refurbishment. The service users’ bedrooms have been redecorated, and it is necessary to continue to make improvement, as service users now need new carpets and curtains in their rooms. The lounge has not been redecorated for some considerable time and the carpet and curtains were quite dirty and worn. A number of requirements are made in respect of these issues. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service users are supported by sufficient numbers of staff. Service users are generally protected by the home’s recruitment practices, although there is still some work necessary to improve the information available in staff files. Staff benefit from a reasonable level of supervision support and are provided with an induction and relevant ongoing training. EVIDENCE: There were two staff on duty on the early shift when the inspector arrived and two staff arrived in the afternoon to cover the late shift. The manager was also rota’d on the late shift and aided the inspector when she arrived. Choice support have a well established and reasonably thorough recruitment process and the appropriate pre-employment checks are obtained regarding applicants prior to them being engaged to work in the home. At the previous inspection a requirement was made regarding including all information in the staff personnel files that are kept in the home. The manager has made some progress with establishing personnel files for the new staff and bank staff. She said that she has further work to do, organising the files. The inspector looked at the files for five staff and the majority of the necessary information was available for inspection. However, they did not include a recent photograph of the staff member or a copy of their current job description. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 20 It was also difficult to be sure of the actual date that each staff member began work in the home, and one staff member’s written records did not include references sought by Choice Support. As completed files were not available for all staff working in the home the previous requirement is restated as part of this report. In addition, the inspector noted that as part of their application, one staff member had included details of one previous post, working in a care setting. However, the staff member had not offered a reference from this employer, but two references from other employment in non-care settings. It is recommended that where applicants have limited experience in care, references be sought regarding their performance in that setting, particularly if this experience is within the last five years. Only one permanent staff member remains in the team since the previous inspection. The care team has been through a period of considerable disruption over the past months, and the majority of the staff are permanent bank staff or relatively new, although some of the bank staff do have longer term experience with the service users. The manager explained there is still one or two new staff waiting to join the team, when their recruitment checks have been completed. Communication between staff includes a message book and a handover between each shift; a written shift plan is used to ensure people are clear about their responsibilities. The manager explained that as a new team is being established she had arranged a team building day that took place recently and that this had been a very positive exercise. The inspector revisited the change in staffing arrangements, from two staff on duty at night, to one staff member sleeping-in. This arrangement has been in operation for around eighteen months at the time of this inspection. The inspector reviewed the monitoring records kept by staff at night, and these reflected that apart from the minor and periodic sleeplessness of one service user, the service users has settled well to this arrangement. There had been no incidents and no cause for concern. It remains relevant to ensure that service users’ placement reviews include discussion regarding this change in the support provided to them and the recommendation to this effect is carried forward. There was evidence that one to one staff supervision and support is being provided to staff and the manager showed the inspector the training records for each staff member, that had recently been updated. She explained that Choice as an organisation, take seriously their responsibuility to provide good quality training to their staff and have a good range of training available. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 21 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, 41 & 42 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. There is now a permanent full time manager in place and she is making steady progress with improvements in a number of areas in the home. She must now apply for registration with the Commission. In order to comply with the Care Home Regulations, there is a need for the registered persons to properly report changes in management in the home, and to provide reports of monthly visits to the Commission. Service users can be reasonably confident that the home protects their physical safety and security through a proactive approach to health and safety, although there is a need for a food safety analysis. EVIDENCE: At the previous inspection there was no manager in post, things have moved on as a permanent manager has been running the home since December last year, is committed to improving the service, and there is evidence that she is making some progress in this. She told the inspector that she was unwell earlier this year, but is now fully recovered, and very positive about the direction that the service is going in. There have been some difficult issues to Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 22 manage, but she feels that, with the new staff team behind her, progress will continue. It is now necessary for her to apply to be registered by the Commission, and the previous requirement in relation to this is restated. A requirement is also made for the registered person to ensure that all absences of the manager over 28 days in duration are reported to the Commission, as this was an omission at the time of the manager’s illness. The responsible individual has not provided the Commission with a report of their monthly visits undertaken under Regulation 26 for some months and no copies of these reports were available in the home at the time of the inspection, although there was evidence that the responsible person had undertaken some visits during this period, having attended service user meetings. A requirement is made in respect of this. In terms of health and safety, the staff are provided with the core training as part of their induction. The inspector saw the records of the water temperature check undertaken in the home to ensure that the water temperature in the baths stays around the safe temperature of 48C. The inspector also saw evidence that PAT (portable electrical appliance testing) had recently been undertaken to ensure that the electrical equipment in the home was safe. The inspector also noted that an Environmental Health officer had visited the home, and had recommended that a food safety hazard analysis be undertaken and a requirement is made in respect of this. Records reflect that there is careful monitoring of all accidents and incident in the home in order to minimise repeated risks. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 23 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 3 2 X 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 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 2 27 1 28 1 29 30 2 3 X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X X X 2 2 X Version 5.2 Page 24 Carlingford Road, 181 DS0000060630.V295876.R01.S.doc 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 YA5 Regulation 5(b) The registered person must ensure that the total cost and charges for the service are updated in the individual service users guides, and reflect the total cost for the service and who is responsible for payment. Any additional cost associated with the water cooler must also be clearly reflected. 2. YA6 15 The registered persons must ensure that all service users plans are completed in the new PCP format. 3. YA17 17 Schedule 4 (13) The registered persons must ensure that a record is kept of the food provided for service users. The registered persons must ensure that the individual health profiles are updated for each service user. 30/10/06 30/01/07 Requirement Timescale for action 30/11/06 4. YA19 12 30/11/06 Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 25 5. YA20 13 (2) The registered person must ensure that the record of specimen signatures for staff administrating medication are updated and include the shortened signature that is entered on the medication administration records. 30/10/06 6. YA20 13 (2) The manger must address the issue of the gaps in the medication administration records with the staff on duty at the time to ensure that that the medication administration record sheets are completed at the time that the medication is administered, and that no gaps are left in the medication administration records. 30/10/06 7. YA20 13 (2) The registered person must ensure that all staff administering medication have undertaken an assessment and are assessed as competent. 30/10/06 8. YA23 20 17 30/10/06 The registered person must ensure that all records that are relevant the issue of the theft of one service user’s money, including the minutes of all meetings held, be kept appropriately in the home and available for inspection. 30/10/06 The registered person must ensure that the Commission is informed when the referral of one staff member is made to the POVA list. 9. YA23 37 Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 26 10. YA23 20 17 30/11/06 The registered person must ensure that the individual financial assessments are updated for each service user. 30/12/06 The registered person must ensure that new floor coverings and curtains are provided in all service user’s bedroom. 11. YA26 23 12. YA27 23 The registered person must ensure that in the bathroom on the ground floor The room is redecorated throughout. 30/01/07 13. YA27 23 The registered person must ensure that in the bathroom on the first floor The room is redecorated throughout. The previous timescales of 30/09/05 & 30/05/06 were not met. 30/01/07 14. YA28 23 The registered person must ensure that in the hallway, stairs and landing All carpeted areas are refitted with new floor coverings. The previous timescales of 30/09/05 & 30/05/06 were not met. 30/01/07 15. YA28 23 The registered person must ensure that the kitchen extractor above the cooker hob is replaced. 30/12/06 16. YA28 23 The registered person must ensure that the lounge is 30/01/07 Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 27 redecorated and that the capet and curtains are replaced. 17. YA33 17(2) 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. 18. YA37 9 The registered persons must ensure that the manager applies to the Commission to be registered. The previous timescale of 30/05/06 was not met. 19. YA37 38 The registered person must ensure that all absences of the manager of 28 days or more are reported to the Commission as require under Regulation 38 of the Care Homes Regulations. 20. YA41 26 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. 21. 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. 30/11/06 30/10/06 30/10/06 30/10/06 30/11/06 Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 28 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 YA23 Good Practice Recommendations It is recommended that all staff be provided with refresher training regarding the protection of vulnerable adults, particularly in relation to London Borough of Haringey’s adult protection procedures. 2. YA33 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. 3. YA34 It is recommended that where applicants have limited experience in care, references be sought regarding their performance in that setting, particularly if this experience is within the last five years. Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Carlingford Road, 181 DS0000060630.V295876.R01.S.doc Version 5.2 Page 30 - 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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