Inspection on 28/07/06 for Cascade Care Ltd (Cascade 1)

This inspection was carried out on 28th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cascade Care Ltd (Cascade 1) 03/10/07

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Cascade Care Ltd (Cascade 1) 16 Bergholt Crescent London N16 5JE Lead Inspector Robert Sobotka Key Unannounced Inspection 28th July 2006 10:00 Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cascade Care Ltd (Cascade 1) Address 16 Bergholt Crescent London N16 5JE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8802 7167 020 8211 7791 Cascade Care Ltd Mr Bandele Otuwehinmi Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 07/02/2005 Brief Description of the Service: Cascade House is a care home for five male service users with mental health needs. The home is situated in a residential street in Stamford Hill, within walking distance from an overground train station, shopping facilities and other local amenities. The home is located in a domestic property that blends in with other houses on the street. The premises are not wheelchair accessible. At the time of this inspection visit, there were 4 service users accommodated in the home and one place was vacant. The company has recently been bought as a going concern and subsequently re-registered with the Commission for Social Care Inspection on 20/07/06 with the new name of Cascade Care Ltd. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 over one day (morning and early afternoon) and was unannounced. As part of the visit, the inspector spoke to some of the service users and staff working in the home, as well the new Responsible Individual. He also conducted a tour of the premises and viewed various records. The aim of this unannounced inspection was to check the home’s compliance with the National Minimum Standards for Care Homes for Adults (18-65) and The Care Homes Regulations 2001. What the service does well: What has improved since the last inspection? The home has met all requirements and recommendations from the last visit. Each service user has now got an up-to-date care plan in place. Appropriate risk assessments were also now in place. The home maintained a record of all medication brought into the home. The registered manager has ensured that the Commission is informed in any occurrences listed in Regulation 37 of the Care Homes Regulations. Staff personnel files have now been brought up to date and included all information required by law. Previous recommendation that refusals from the service users to participate in keyworking sessions be documented has now been met. The home also kept a log of outgoing correspondence and faxes sent, to demonstrate that appropriate authorities have been informed of any important issues in the home. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s statement of purpose required minor amendment. Appropriate admission systems were in place. The home was meeting the needs of those accommodated there. Prospective service users have an opportunity to “test drive” the home, prior to moving in. EVIDENCE: The home’s statement of purpose has recently been amended to reflect the recent change of ownership of the business. It however required further minor amendment, as at the time of this inspection, it stated that the home provided services to “men with past or present history of drug and alcohol abuse”. This statement must be removed, as the home is not registered under this category. The service user’s guide was also in place and it gave potential residents useful information about the home. There has been one admission to the home since the last inspection. The inspector viewed a care plan of the most recently admitted service user. His file contained a comprehensive assessment. There was also evidence that appropriate and relevant information had been obtained from the placing authority. Following a discussion with the service users, staff working in the home and review of the documentation, the inspector was satisfied that the home was Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 9 meeting the needs of the service users accommodated there. In cases where the home experienced any difficulties in meeting the assessed needs, any concerns were being promptly passed onto the relevant professionals. At the time of the inspection, one of the service users was staying on a trial basis. There was evidence in his file that he visited the home over a period of 9 weeks, during which he had several overnight stays. All permanent service users had their contracts/statements of terms and conditions in place. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had an appropriate care planning process in place. Those using the service are encouraged to take part in decision-making about the care they needed. Confidentiality is maintained. EVIDENCE: As part of this visit, the inspector viewed care plans of all service users accommodated in the home at the time of the inspection. Care plans viewed were up-to-date and there was evidence that they were being reviewed on a regular basis. The Responsible Individual and the Registered Manager informed the inspector that for the foreseeable future service users care plans would be reviewed on a monthly basis. They also showed the inspector a new format, which would be used for care planning. It was noted that in some cases there were delays in service users signing their care plans. The inspector was informed that this was due to some of the service users feeling that care plans were being reviewed too often. The home operates a keyworking system. Each keyworker is responsible for supporting and coordinating care for their assigned service user. Keyworking Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 11 sessions were organised, during which individual goals, progress and areas needed further support were discussed. Some service users were sometimes refusing to attend/participate in those sessions. This was clearly recorded in individual service user’s files, as previously recommended. During the course of this visit, service users were observed making choices about their activities and other aspects of daily living during the course of this inspection. Regular service user meetings were organised and all service users were encouraged to attend them. The purpose of those meetings was to allow service users to contribute as to how the home should be run and to make any suggestions about care offered in the home, as well as activities on offer etc. Service users spoken to confirmed that felt appropriately supported and consulted about the way the home should be run. The inspector also viewed risk assessments in respect of each service users. These were up-to-date and well maintained. Confidentiality was maintained. All confidential information was kept in the staff or administrator’s offices, which were locked when not in use. Those working in the home shared information with the inspector on a need-to-know basis. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users continue to take part in appropriate leisure activities. They are encouraged and supported to develop and maintain friendships and family links. Service users enjoyed food in the home. EVIDENCE: Documentation viewed and conversations with the service users confirmed that those who use the service are encouraged to take part in the local community and to maintain and develop social, emotional and communication skills. Records viewed showed that service users visit their families and friends, attend cultural centres, do some of their own shopping and go out to cinemas, theatres and pubs. Some of these events are organised and facilitated by the home. Individual file of the most recently admitted service user showed that the home has researched for appropriate leisure and further education facilities for him and there was evidence that he was in the process of joining various places that were of interest to him. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 13 Since the new organisation purchased the home, new documentation has been introduced and implemented. This included recording one to one activity support and resident house daily support. Families and visitors are welcome to the home. The home had a visitor’s policy in place. Visitor’s book was also maintained. Service users said that they were able to invite their friends and families into the home. Meals offered by the home can be eaten in the dining room with other service users. Record of food offered to service users was kept. Fridge and freezer temperatures were recorded. There were appropriate food supplies in the home and service users spoken to said that they enjoyed food in the home. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 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 good. This judgement has been made using available evidence including a visit to this service. The home was appropriately meeting the physical and emotional needs of the service users. Appropriate medication systems were in place. EVIDENCE: The inspector was informed that all service users who lived in the home at the time of this inspection attended their own personal care and staff only offered verbal prompts as and when required. There was evidence of an input from Psychiatrist, Community Psychiatric Nurses and Social Workers. The majority of the psychiatric reviews were carried out promptly. The majority of the service users choose to attend their GP surgeries and hospital appointments independently. In some cases staff accompanied service users to appointments. Appropriate medication systems were in place. The registered manager informed the inspector that the home was in the process of implementing the new blister pack dosage system, which would be fully operational from late August. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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 good. This judgement has been made using available evidence including a visit to this service. The home had a good complaints system in place and any concerns are dealt with without delay. Those living in the home were protected from abuse, neglect and self-harm. EVIDENCE: The inspector viewed the complaints record. There has been one complaint since the last inspection. There was evidence that it was appropriately investigated and dealt with and resolved on the same day. One of the service users who spoke to the inspector said that he felt comfortable raising any concerns with the registered manager or a member of staff. Service users manage their finances, however support and guidance is offered to those service users who may require help in managing their finances, due to risk of substance abuse or money mismanagement. Records of accidents/incidents were also reviewed. These showed that appropriate action is taken following any incident/accident to prevent further incidents. The inspector was also satisfied that the registered manager ensured that all “notifiable” incidents have been reported to the Commission, as previously required. The requirement in relation to reporting any occurrences listed in Regulation 37 of the Care Homes Regulations is therefore met. Appropriate adult protection policy and procedure was in place. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 16 Following the discussion with staff working in the home, service users and review of documentation, the inspector was satisfied that those living in the home were protected from abuse, neglect and self-harm. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.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, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users continue to benefit from a homely, comfortable and safe environment. EVIDENCE: The premises were found to be maintained to a good standard. The home is an ordinary domestic property situated in a residential street. Those service users who spoke to the inspector stated that they were happy with the condition of the home and their bedrooms and communal areas. There have been no changes to the premises since the last inspection, with the exception of one of the vacant bedroom, which has been redecorated. The premises were well maintained, clean and hygienic at the time of this unannounced visit. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those who use the service are supported by staff who are committed to providing good quality of care, however some staff required additional training. EVIDENCE: The Responsible Person stated that there have been no changes to the staffing levels since the last inspection and the change of the provider. She also said that the organisation was currently in the process of carrying out an assessment/audit of staff training needs and that refresher training courses were being organised for the existing staff. The inspector viewed duty rosters, which showed that there were sufficient numbers of staff on duty. There are two members on each shift, including nights. Night staff remain awake throughout the night. Staff spoken to stated that they felt that staffing levels were sufficient. The inspector was informed that 50 of staff working in the home have obtained NVQ Level 2 qualification or above. As part of this visit, staff personnel files were inspected. The inspector viewed 4 files, all of which contained information listed in Schedule 2 of the Care Homes Regulations. The inspector was satisfied the previous requirement that the registered person does not employ a person to work at the care home Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 19 unless the person is fit to work at the care home and all information listed in Schedule 2 of the Care Homes Regulations has been obtained, has now been met. Regular team meetings were taking place, minutes from which were available for inspection. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 20 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, 40, 41, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriately managed by a competent manager, however he must obtain his management qualification within set timescale. Good progress has been made in ensuring that service user’s rights and best interests are safeguarded by the home’s record keeping. Some of the home’s policies and procedures required reviewing. Appropriate health and safety checks were in place. EVIDENCE: The home has a new registered manager in place, who has been approved by the Commission as fit to manage a residential home. He is a qualified Social Worker and has previously worked in the home as a deputy manager. In order to meet the standard 37 fully, the registered manager must obtain a relevant qualification in management. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 21 During the course of the visit, the inspector received positive comments from both service users and staff about the registered manager’s performance and capabilities. One of the service users said that the registered manager was “a very good man”. The new Responsible Individual has been carrying out “the Regulation 26 visits”, reports from which were being forwarded to the Commission. There has been an overall improvement in relation to the record keeping and care plans were being updated on a regular basis. Risk assessments have also been reviewed. The recommendation that a log of outgoing correspondence and faxes sent be kept to demonstrate that appropriate authorities are informed of any important issues in the home was now being maintained, as previously recommended. The Responsible Individual informed the inspector that the new company was in the process of reviewing all policies and procedures. The responsible individual must ensure that all policies and procedures are up-to-date and kept under review. Appropriate health and safety checks were in place. The home was adequately insured for its purpose. Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 22 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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 2 3 3 x Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 Requirement Timescale for action 15/09/06 2. 3. YA37 YA40 4. YA35 The home’s statement of purpose requires amendment. The statement that the home provides services to “men who have past or present history of drug dependence or alcohol abuse” must be removed. 9(2)(b)(i) The registered manager must obtain a relevant qualification in management. 22 (1), The responsible individual must Appendix ensure that all policies and procedures listed in Appendix 2 2 of the National of the National Minimum Minimum Standards are up-to-date and Standards. kept under review. 19(5)(b), The responsible person must 23(4)(d) ensure that all care staff receive all mandatory training, as required by law. 01/03/07 01/10/06 01/12/06 Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 25 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. Extracts may not be used or reproduced without the express permission of CSCI Cascade Care Ltd (Cascade 1) DS0000067294.V305440.R01.S.doc Version 5.2 Page 26 - 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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