Inspection on 30/07/06 for Cascade Care Ltd (Cascade III)

This inspection was carried out on 30th July 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cascade Care Ltd (Cascade III) 22/11/07

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 III) Cascade III 74 Linthorpe Road London N16 5RF Lead Inspector Robert Sobotka Key Unannounced Inspection 30th July 2006 09:30 Cascade Care Ltd (Cascade III) DS0000067296.V305472.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 III) DS0000067296.V305472.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 III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cascade Care Ltd (Cascade III) Address Cascade III 74 Linthorpe Road London N16 5RF 020 8800 8530 020 8221 7981 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) Cascade Care Ltd Mr Casper Viriri Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29/08/05 Brief Description of the Service: Cascade III is a registered care home, which provides care, support and accommodation for maximum of five male service users within a community setting, who have mental health needs. The premises are situated in Linthorpe Road, which is situated in Stamford Hill, N16, within a walking distance from Stamford Hill British Rail Station. Access to buses and underground trains (Victoria Line) from Seven Sisters and Picadilly Line from Manor House Station are approximately 10 minutes away from the home and the 235 bus stop is two minutes away. Further buses with routes to Tottenham, London Bridge, Aldgate and Euston are also within walking distance. The property is a large Victorian terraced house, which consists of five single bedrooms, a large communal lounge with cable TV and a music centre, separate laundry facilities with a dryer, bathroom and WC, separate WC, large dining room, fully equipped kitchen and a large garden at the rear of the house. The premises are not suitable for those with complex mobility needs and are not wheelchair accessible. At the time of this inspection, there were 2 service service users accommodated in the home and 3 places were 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 III) DS0000067296.V305472.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. It was carried out on Sunday. As part of the visit, the inspector spoke to some of the service users and two care staff working in the home. He also conducted a tour of the premises and viewed various records. The inspector also met the new Responsible Person two days prior to this inspection, whilst undertaking an unannounced inspection at the sister home. Some information given by the Responsible Individual, such as plans in relation to care planning process, staff training and review of policies and procedures, which applied across all projects, have been used in this inspection reports 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? What they could do better: Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 6 There was one outstanding requirement, since the last inspection, which was made in relation to the home’s Adult Protection Policy, which required updating. In addition, 6 new requirements made during this inspection visit. These included: - 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. - The registered manager must obtain a relevant qualification in management. - The responsible individual must ensure that all policies and procedures listed in Appendix 2 of the National Minimum Standards are up-to-date and kept under review. - The responsible person must ensure that all care staff receive all mandatory training, as required by law. - It is required that an application for minor variation is made to the Commission, in respect of the service user whose placement is funded by the learning disability team. - The responsible person must ensure that records of the food provided for service users are kept. These must be sufficient in detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition or otherwise, and any special diets prepared for service users. 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 III) DS0000067296.V305472.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 III) DS0000067296.V305472.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. It was noted, however that the service user’s placement was funded by the Learning Disability Team, as the service user had a mild learning disability. This required for the Responsible Person to apply to the Commission Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 9 for a minor variation to the home’s registration. This process was explained to the registered manager during the inspection feedback. It is required that an application for minor variation is made to the Commission, in respect of the service user whose placement is funded by the learning disability team. Following a discussion with a service user, staff working in the home and review of the documentation, the inspector was satisfied that the home was meeting the needs of the current service user group. There was evidence that service users are offered to visit the home and have overnight stays in the home, before they make a decision to move to the home on a full time basis. Each service user had a contract, which included statement of terms and conditions in place. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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, 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 both service users. Both documents were well maintained and were reviewed of regular basis. Minutes from the Care Planning Approach meetings were also in place. There was evidence that service users are encouraged to participate in their care planning process and their views were taken into account. During the inspection visit at the sister home, the Responsible Individual 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. The home operates a keyworking system. Each person had a designated keyworker, who was responsible for coordinating care of their keyclient. Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 11 Keyworking sessions were also organised, during which any individual goals, progress and areas that needed further support were discussed. Regular service users’ meetings were also held, during which service users could make any comments and suggestions as to how the home should be run. Appropriate risk assessments were in place. Confidentiality was being maintained. All confidential information was kept in the office, which was kept locked when not in use. Staff working in the home shared information about the service users with the inspector on a need-toknow basis. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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. Those who live in the home were encouraged to lead active lifestyles within local community and develop and maintain friendships and family links. Service users enjoyed food offered in the home, however records in relation to food offered to service users required improvement. EVIDENCE: Documentation viewed confirmed that staff working in the home encourage and support service users to become a part of the local community and to attend local college courses and day centres. They are also offered assistance in seeking paid and/or voluntary employment. Those who lived in the home were offered a holiday to Butlins and one of the service users chose to go on it. Service users are allowed to receive visitors in the home. They were encouraged to maintain family contact and to have appropriate relationships. Care plans for both of the service users evidenced that those who live in the home are encouraged and supported to maintain appropriate family contacts and develop appropriate friendships. Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 13 There were appropriate food supplies in the home. Some of the meals offered in the home were prepared some staff and also prepared by the service users. Fridge freezer temperatures were taken and recorded daily. Food was now appropriate labelled once opened, as required at the last inspection. Record of food offered to the service users was kept, however it required improvement, as some entries were not made in some cases recoding was very brief. The responsible person must ensure that records of the food provided for service users are kept. These must be sufficient in detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition or otherwise, and any special diets prepared for service users. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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: At the time of this inspection, none of the service users required support with personal care. There was evidence in care plans viewed that verbal prompts to service users were sometimes required. Care plans viewed showed that those who live in the service received appropriate care from the healthcare professionals. Those who use the service received regular psychiatric reviews. Each person was registered with the General Practitioner and any other healthcare professional who would be beneficial to meeting their needs. Appropriate medication systems were in place. The inspector was informed 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 III) DS0000067296.V305472.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, however the home’s adult protection policy required review. 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. Those who lived in the home were also given opportunities to raise their concerns about the way the home is run, during resident’s meetings and their keyworking sessions. 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. As previously required, the home’s Adult Protection Policy requires further development/updating to include information on the Protection of Vulnerable Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 16 Adults List and what action should be taken should abuse be suspected. This is a repeated requirement and must be met without further delay. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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. Those who live in the home benefit from a homely, comfortable and safe environment. EVIDENCE: At the time of this inspection, the premises were well maintained. It was noted, however, that the garden was becoming overgrown and required weeding. As previously mentioned, the home’s security arrangements required review. Service user who spoke to the inspector said that he was happy with the communal areas and his bedroom. The premises were found to be clean and hygienic at the time of the inspection. Appropriate laundry facilities were in place. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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, 35. 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 majority of staff either have obtained the NVQ qualification or were in the process of obtaining one. The inspector was unable to access staff personnel records, as the manager who holds the key was not working on the day of the inspection. Staff Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 19 personnel files, were however checked during the inspection visit, where a copy of the files of staff working in this home are kept by the organisations administrator, and that documentation audit was satisfactory. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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 adequate. 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. Some of the records required improvement. Some of the home’s policies and procedures required reviewing. Appropriate health and safety checks were in place. EVIDENCE: The home has got a new registered manager in place. Although he was not present during this inspection visit, the inspector had an opportunity to meet him on previous occasions, as he used to work as a deputy manager in a sister home. Staff spoken to and one of the service users provided the inspector with a positive feedback about the manager and his managerial skills. They said that the manager was fair and approachable. The registered manager has obtained the NVQ Registered Managers Award; he must however also obtain the relevant management qualification. Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 21 The new Responsible Individual has been carrying out “the Regulation 26 visits”, reports from which were being forwarded to the Commission. 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. The majority of the required records were in place, however as previously stated, better recording of food offered/served to the service users is required. Appropriate health and safety checks were in place. The home was adequately insured for its purpose. Cascade Care Ltd (Cascade III) DS0000067296.V305472.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 2 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 2 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 x 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 2 2 3 x Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(6) Requirement The home’s Adult Protection Policy requires further development/updating to include information on the Protection of Vulnerable Adults List and what action should be taken should abuse be suspected. (Previous timescale of 01/11/05 was not met.) 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. The registered manager must obtain a relevant qualification in management. The responsible individual must ensure that all policies and procedures listed in Appendix 2 of the National Minimum Standards are up-to-date and kept under review. The responsible person must ensure that all care staff receive all mandatory training, as required by law. Timescale for action 01/10/06 2. YA1 4 15/09/06 3. 4. YA37 YA40 9(2)(b)(i) 22(1) Appendix 2 of the National Minimum Standards 19(5)(b), 23(4)(d) 01/03/07 01/10/06 5. YA35 01/12/06 Cascade Care Ltd (Cascade III) DS0000067296.V305472.R01.S.doc Version 5.2 Page 24 6. YA2 Care Standards Act 2000 7. YA17 17(2) Sch 4.13 It is required that an application for minor variation is made to the Commission, in respect of the service user whose placement is funded by the learning disability team. The responsible person must ensure that records of the food provided for service users are kept. These must be sufficient in detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition or otherwise, and any special diets prepared for service users. 15/09/06 01/09/06 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 III) DS0000067296.V305472.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. 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