Inspection on 14/04/08 for Cascade II

This inspection was carried out on 14th April 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Cascade II 06/10/08

Cascade II 17/09/07

Cascade II 15/08/06

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 II 37 Gladesmore Road Haringey London N15 6TA Lead Inspector Susan Shamash Unannounced Inspection 14th April 2008 1:30 Cascade II DS0000067295.V362987.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 II DS0000067295.V362987.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 II DS0000067295.V362987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cascade II Address 37 Gladesmore Road Haringey London N15 6TA 020 8800 0760 020 8809 4900 cascade2@cascade-care.co.uk 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 Maximus Chifamba Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated: 5 Date of last inspection 17th September 2007 Brief Description of the Service: Cascade II is a residential care home providing personal care to five male younger adults who fall within the category of mental disorder. The home specialises in offering a supportive environment for men with a history of mental health difficulties, who may also have a forensic history. This may involve being discharged from more structured institutions under provision of one of the sections of the mental health legislation. The home is privately run by a provider who also runs a number of similar residential care homes. The home is a large three-storey terrace house that is well decorated and maintained. The ground floor contains the communal kitchen/diner, the first floor contains the communal lounge, and residents’ bedrooms are located on all three floors. There is a bath/shower room with toilet on the first floor and a separate toilet as well as the laundry area on the ground floor. There is a rear garden that has been covered in decking. The home is situated in a quiet residential area off of Green Lanes in South Tottenham, which is near to Stamford Hill, with local shops and with access to various forms of public transport. The weekly fees as of April 2008 remain £1100 to £1500 depending on assessment of need. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 5 CSCI inspection reports are available from the office at the home or from the CSCI website - www.csci.org.uk The overall aim of the home is to provide the highest quality of care, in a homely and safe environment, for men with a history of mental illness who may also have a forensic history. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took approximately six hours. The acting manager (not yet registered with the CSCI) was on duty throughout the inspection, although he accompanied a resident to a meeting shortly after my arrival. I was therefore assisted by a member of staff from another care home at the beginning of the inspection. The clinical manager for the provider organisation and the responsible individual for the provider organisation also came to the home to assist me with the inspection whilst the manager was out. The manager provided every assistance with the remainder of the inspection, and towards the end of the inspection I met briefly with two staff members who work regularly within the home. Five people were resident in the home on the day of my visit, including two new residents admitted since my previous inspection. I was able to talk to one new resident at length, and spoke to the other briefly prior to them going out of the home. I spoke to one other resident during the inspection, totalling three residents in all. Other residents did not wish to speak to me during the visit. I also conducted a tour of the premises and inspected a range of documentation kept in the home. What the service does well: The home continues to provide quality care and support to residents with complex mental health needs some of whom have restrictions imposed on them through the legal system. Residents are generally well served in the home by committed staff and competent managers. One person living at the home told me ‘they’re very nice to you here.‘ A high standard of training is provided to staff and the home exceeds the national minimum standard for the proportion of appropriately qualified staff. Care documentation in the home is generally current and detailed and demonstrates a significant amount of positive joint work with referring agencies and mental health professionals. The home is appropriately decorated and generally well equipped providing a pleasant environment to live and work in. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 7 The home has been successful in supporting a number of residents to move on to more independent accommodation. One resident told me that they were hoping to move into their own flat shortly, and this was confirmed by the home’s management. The home supports people to carry out their own shopping and cooking in order to develop the skills necessary for more independent living. The home also supports residents who wish to carry out some painting/decorating work or gardening within the home with nominal payments made. What has improved since the last inspection? What they could do better: Residents’ statements of terms and conditions with the home still need to be updated to ensure that their rights are fully protected. More detail should be recorded on risk assessments for residents, to ensure that all areas are addressed in detail including self-medication, collecting prescriptions, cooking etc. A weekly budget should be provided to residents who carry out their own shopping and cooking, in order to prepare them for more independent living. Clearer recording is needed to demonstrate that people are reminded and supported to attend regular healthcare appointments. All prescribed medicines must be signed into the home and surplus stock must be returned, to ensure the safe administration of medicines to residents. Details of how complaints are addressed, must be recorded in the complaints book, alongside timescales for all actions, to evidence that these are addressed appropriately. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 8 It remains required that a new hi fi system be provided to replace the system which is not working, in the lounge. A small number of other improvements to the home environment are also needed as specified in the report. All staff must be given current training in Adult Protection, Medication Administration and Infection Control to ensure the safety of people living at the home. It remains required that all staff are supervised at least two-monthly, including an annual appraisal, to ensure that they work in line with best practice. The quality assurance system for the home must be upgraded, so that the views of people living at the home are taken into account. More frequent staff meetings and resident meetings should be arranged, unless an alternative format for seeking residents’ views about the home can be found. The recording monies held by the home for safeguarding on behalf of residents needs to be improved for the protection of residents from financial abuse. Copies of the evacuation plan need to be readily available in the home for the protection of staff and residents in the event of a fire. Finally better labelling is needed of perishable items stored in the refrigerator or freezer to ensure that people living at the home are protected by appropriate food hygiene procedures. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 9 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 II DS0000067295.V362987.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents have their needs assessed and agreed with them prior to admission to the home to ensure that the home can address them effectively. They are given adequate and current information about the home prior to moving in but their rights could be further protected by amendments to their contracts of terms and conditions with the home. EVIDENCE: Two new residents had been admitted to the home since the previous inspection, so that the home is now fully occupied. I met one of the new residents on their way to a healthcare appointment with staff support, as I arrived at the home. I spoke to the other new resident in their room during the inspection. Both spoke highly about the support provided by staff and the facilities provided within the home. I inspected three residents’ files in detail, including those of the newer residents. All contained a range of comprehensive assessment information from both health and social care professionals as well as from in-house assessments. There was evidence that this information was kept up to date with care planning approach (CPA) review meetings in place. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 11 The manager advised that the home continued to have good working relationships with the mental health professionals involved with the residents. Records indicated that these professionals kept in touch with their respective clients on a regular basis and this was confirmed by two of the residents spoken to. The statement of purpose and service users guide provide a range of relevant information for prospective residents to the home. However the service users guide had not been updated as recommended at a previous inspection, and it remains recommended that this document include more detailed information about the complaints procedure and information about how the home carries out quality monitoring including obtaining feedback from individual residents. Statements of terms and conditions with the home. As recommended at the previous inspection a new format had been produced for these documents including the individual Cascade home at which each person would reside and the individual room to be occupied. However the new statements of terms and conditions had not yet been signed on behalf of the provider organisation and by residents. They should be further updated to include the responsible individual for the home and current CSCI details, and must then be signed by all relevant parties. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ needs and aspirations are recorded within their care plans. The plans are reviewed regularly with the individual residents to ensure that their changing needs continue to be met. Residents are supported to retain and maximise their independence by making as many decisions as possible for themselves and taking responsible risks. EVIDENCE: The three residents’ files inspected all contained current care plans that were based on detailed assessments of each resident’s needs including cultural and social needs. The plans were clearly laid out and detailed the individual needs as well as giving clear guidance to staff on how to address these needs. There was also documented evidence that the plans were regularly reviewed with individual residents, and this was confirmed by staff and residents spoken to. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 13 Some agreed restrictions had been placed on people’s freedoms, with documented evidence that these had been discussed with residents as appropriate. Confirmation of this was given by one resident that I spoke to. Restrictions included the use of alcohol, illegal substances and where people may smoke. Three people living at the home advised that they received a high level of support from staff, enabling them to make progress with their identified goals. The home has a satisfactory risk management policy and the assistant manager described how this is implemented in a number of situations. Risk assessments were available for all residents whose files were inspected, and these were being reviewed regularly as appropriate, with signatures recorded to evidence that residents had been consulted about these. At the previous inspection I noted that whilst these generally did contain satisfactory risk assessment information for each person, I remained concerned that the strategies to address a number of different risk areas identified, were being recorded together, rather than individually so that there is potential for some key risk strategies to be lost (particularly when dealing with as many a large number of risks). On this occasion I noted that more information was available about how each risk would be addressed. However further detail needs to be provided regarding how individual risk areas will be addressed such as self-medication, cooking etc. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home take part in a range of activities both at home and within the local community. They are also supported to develop and maintain relationships with relatives and friends to the extent that they wish to. People are supported to make decisions for themselves regarding their daily lives. They enjoy balanced and varied meals of their choice that are culturally appropriate. EVIDENCE: The manager and staff advised that residents are encouraged to participate in activities both inside and outside of the home, however, given their complex needs, structured day activities are taken up on an intermittent basis. One person was working part-time as a volunteer at a charity shop and another had previously been involved in voluntary work. Apart from this, the manager advised that people living at the home chose not to pursue Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 15 employment or training opportunities and this was confirmed by those spoken to. One person told me that they find college courses to be very stressful. Participation in daily activities was documented and was being monitored by the home. I had the opportunity to speak to the Clinical Manager for the provider organisation, and he advised that he is providing regular one-to-one sessions to at least two of the residents living at the home. Discussion with staff and residents and recording within care plans indicated that residents were encouraged and supported to express their different cultural, social, intellectual, emotional and sexual needs as appropriate. The manager and inspection of files and the visitor’s book indicated that people living at the home continue to have positive contact with relatives or friends, and this was confirmed by residents spoken to. I was advised that all residents are able to travel independently and have freedom passes to access public transport. The manager advised that residents access a range of community facilities including local sports facilities, shops, clubs and pubs and that the home continues to offer outings to local restaurants, pubs and other community facilities, although these are usually taken up on a one-to-one basis. Residents confirmed that they were encouraged to be involved in the local community, but advised that they rarely participated in group activities with the home, out of personal choice. One resident advised that they continue to play table tennis in a local league and also attend a local gym regularly as well as attending a mental health drop-in service. Another resident enjoys cycling and going out for walks regularly. The assistant manager advised that residents had had the opportunity to go on holiday with residents from other homes belonging to the provider organisation, since the previous inspection. However none of the residents at Cascade II had chosen to be involved in this. However one resident had been supported to go on holidays to Birmingham and Wales semi-independently. One resident told me that they were hoping to move out into their own accommodation, and the manager and provider confirmed that this was the case, once a vacancy becomes available at another service run by the provider organisation. The manager advised that all the residents had their own bedroom and front door keys and had unrestricted access to the home and garden. Residents confirmed this. Staff on duty during the inspection were seen to treat the residents with courtesy and respect. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 16 The home has a three monthly specimen menu, however as residents’ meetings are no longer being held regularly, it was not clear whether food preference options are discussed with residents. Some residents self cater with staff supporting them with shopping for food, cooking and giving advice on healthy options. The result of this is that many of the meals cooked in the home differ from the menu given the current preference of the residents at the time. Residents are from a variety of ethnic backgrounds and stated that the meals they ate met their cultural preferences. One resident is vegetarian and there were a variety of vegetarian foods stocked within the home. As required at the previous inspection, records of food served included details of vegetarian alternatives for this person. The home was well stocked with food including fresh vegetables and fruit. The manager confirmed that residents continue to be encouraged to join staff for the weekly food shop for the home. One resident told me that they shopped for their own food and received money from the home for this purpose, however they felt that they would benefit from having a weekly budget for food shopping. It is recommended that a weekly budget should be provided to residents who carry out their own shopping and cooking, in order to prepare them for more independent living. It is also recommended that the records of meals provided to residents should be clearer about which residents ate which meals, to demonstrate that people’s preferences are catered for. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive appropriate personal support in accordance with their needs and preferences. However there is insufficient evidence that they receive reminders and encouragement to attend routine healthcare appointments to ensure that their health needs are fully met. More rigorous recording is needed to ensure that residents are given prescribed medicines safely. EVIDENCE: The manager confirmed that all the current residents are physically independent in respect of their personal care needs although they may need verbal prompting with certain areas of personal hygiene to varying degrees. Residents spoken to indicated that this was undertaken in a sensitive manner. People are supported with their emotional needs, particularly through support from their key workers and notes of some key worker sessions were seen on the files inspected. Staff had undertaken training in counselling skills to further promote their ability to support residents with their emotional needs. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 18 Case files still did not include sufficient evidence that residents are supported with their physical health needs such as appointments with their GP, local hospital outpatient departments, opticians, dentists etc. Previously there had been a separate section relating to healthcare needs on each residents’ file, giving an overview of medical appointments or healthcare checks that residents had attended. However these had not been maintained up to date. When residents refuse to attend routine healthcare appointments, this must be recorded, to evidence that they are being prompted and encouraged to attend these routine check-ups. Medication was stored appropriately within the home with the storage temperature recorded daily. Records of medication administration were maintained to a high standard with no gaps in the medication administration records. However not all medicines had been signed into the home and there were a number of medicines that needed to be returned to the pharmacy. Residents spoken to confirmed that they were supported to collect their own prescriptions for medicines and take their medicines at the times prescribed. I was concerned that one resident had missed one dose of their medication because they had not taken their prescription to the pharmacy in time. Whilst the value of residents collecting their own medication is appreciated, it is of concern that the risks associated with this must be assessed as far as possible and minimised. At the previous inspection a requirement was made regarding the need for a policy regarding the administration of homely remedies to people living at the home. The manager advised that following consultation with the registered provider, it was decided that no homely remedies would be kept at the home, and that each person would seek medical advice if necessary. It is recommended that this decision should be reviewed regularly in the light of current residents’ needs. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to express their views and any concerns they may have and can be confident that these will be recorded, however there is insufficient evidence that these will be handled effectively and promptly. Appropriate procedures are in place, however there is insufficient staff training to ensure that residents are protected from abuse as far as possible. EVIDENCE: The home has a clear and satisfactory complaints procedure that was seen displayed in the kitchen and the office. Inspection of the complaint’s record indicated that the record is also being used by staff to reflect their concerns about individual residents’ behaviour. Residents spoken to told me that they felt able to raise any concerns or complaints they might have with staff, but were not always sure as to whether these would be acted on appropriately. For one complaint recorded since the previous inspection, the actions taken by management to address the issue had been recorded on the complaints record, demonstrating that this was dealt with within the set timescales. However other complaints recorded by staff members did not include a record of action taken or timescales, although the manager advised that they had been addressed. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 20 Only one out of the three staff members’ files that I inspected had current certificates for undertaken training in the protection of vulnerable adults. Staff members that I spoke to were confident about the action to be taken in the event of a disclosure or allegation of abuse. The home also has a detailed adult protection policy as appropriate to protect residents from abuse. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is generally clean, comfortable and well decorated and that meets their needs. Whilst improvements had been made, there remain a number of small issues to be addressed within the home to better meet peoples’ needs. EVIDENCE: The home is a three-storey house, with five bedrooms, a bath and shower room with toilet, a separate toilet under the stairs, a kitchen and dining area and a large lounge area on the second floor. The home was generally clean and well decorated throughout. Three residents allowed me to see their bedrooms. The home has satisfactory bath, shower and toilet facilities, and paper towels and soap were being provided in these facilities as appropriate. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 22 The home’s communal areas were decorated to a reasonable standard, and as required at the previous inspection, the damaged sofa in the lounge had been replaced. The remaining sofas also appeared to have been cleaned effectively. The registered provider told me that they had attempted to replace all of the sofas in the lounge, however it was not possible to do this without removing the lounge windows in order to move the existing furniture. She advised that instead this was planned for when residents go on their annual holiday over the summer, when it is also planned to repaint large areas of the home. At the previous inspection staff and residents told me that the hi fi system in the lounge was not working. However this had not yet been replaced. The provider and manager advised that a new hi fi system was now on order. The home is commended for encouraging residents (who express an interest) to be involved in carrying out some redecoration work and gardening maintenance for the home and thus further developing their independence skills. All residents spoken to were generally happy with the facilities provided. One person told me that the home’s iron was faulty and requested that a new iron be purchased. A new mirror should also be provided in the ground floor bathroom, and cracks in several walls on the stairways within the home must also be addressed. The rear garden area was looking unkempt, and this must be maintained appropriately for the comfort of people living in the home. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a well qualified and experienced staff team, in sufficient numbers, to support residents and to assist in meeting their assessed needs. All staff have the satisfactory clearances required to evidence a robust recruitment procedure designed to ensure that residents remain adequately protected. Staff are generally well supported to effectively address residents’ needs, but further training and more frequent staff supervision sessions are needed to ensure that residents are supported in line with best practice at all times. EVIDENCE: On arrival at the home a bank member of staff was on duty (from another home) and the manager was supporting one resident to attend a healthcare appointment. The staff rota was seen and showed that a minimum of two staff were on duty for twenty four hours each day and this included two waking night staff. The shifts worked during the day remain: 9.00 am to 5.00 pm; 5.00 pm to 9.00 pm and 9.00 pm to 9.00 am although the manager advised Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 24 that there is some flexibility in providing extra staffing to support residents with particular activities outside of the home. Staff on duty matched those recorded on the rota. Three staff files were inspected. Copies of identity documents, references and enhanced Criminal Records Bureau disclosures were available for all staff as appropriate, and the manager confirmed that all staff also completed new Cascade application forms. Although one staff member had left since the previous inspection, the manager advised that it had not been possible to give residents notice of this, as recommended at the previous inspection, as this had occurred quite suddenly for that staff member’s personal reasons. There was evidence of appropriate induction training, from staff files sampled. Staff training summaries were also available for staff, indicating the training they had undertaken. Since the last inspection training had been undertaken in health and safety, first aid, fire safety and food hygiene. Other certificates maintained on staff files indicated that staff members had current training in breakaway techniques and managing aggression. Only one of the three staff whose files were inspected had completed training in the protection of vulnerable adults and a requirement is made accordingly under Standard 23. One was in the process of undertaking a national vocational qualification (NVQ) level 2 in care, and one was due to commence this training shortly. The manager advised that current NVQ training exceeds the national minumum standard of 50 staff trained to NVQ level 2 or above in care. He noted that other staff members had also completed training in HIV, risk assessment and counselling. I was concerned that that inspection of staff files showed that not all staff had current training in Adult Protection, Medication Administration and Infection Control. This training must be provided to all members of the staff team without delay to ensure the safety of people living at the home. Two support workers who work in the home on a regular basis were spoken to briefly, (as they commenced work at the end of my inspection visit) and both confirmed that they had undertaken a full induction program and had participated in a range of core skills training. Records within staff files indicated that staff members were not having supervision sessions on a regular basis. Staff advised that they felt well supported by the manager on a day-to-day basis. However all staff members must be supervised at least two-monthly to ensure that they work in line with best practice. An annual appraisal must also be carried out for each staff members. Records of staff meetings also indicated that they were not as frequent as they had been previously. The manager advised that he was due Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 25 to undertake appraisals shortly. He noted that a deputy manager had not yet been appointed to the home, but an individual had been identified, and this was due to be undertaken shortly. It may be that this is part of the reason for the insufficiently regular provision of supervision and staff meetings. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that is competently managed. Although the home has an internal quality monitoring system there is room for improvement in this area to ensure that the views of residents are taken into account and standards of care are consistently high. More rigorous procedures are needed to ensure that residents are protected from financial abuse. Health and safety of staff and residents is generally protected, however further attention is required in identified areas, to ensure that safety precautions remain as robust as possible. EVIDENCE: At the previous inspection evidence was provided that the manager has significant care and sufficient management experience and is in the process of completing the registered Managers’ Award at NVQ level 4. He advised that he Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 27 has submitted a CRB disclosure through the Commission, as required to commence the process to be registered as manager with the CSCI. He was reminded that a letter needs to be sent to the CSCI to remove the name of the previous registered manager from the home’s registration certificate. From discussion with residents, the manager, responsible individual for the provider organisation and two support workers, as well as from documentation seen, I was confident that there are competent management arrangements in the home. The home has a quality assurance system in place as described by the manager at previous inspections. However last year there was only one response from a person living at the home. Records indicated that there are less frequent staff meetings held at the home and there had not been a residents meeting for some time, this was confirmed by staff and residents spoken to. The manager noted that residents had been reluctant to get together for meetings of late, and this was the reason for the recent lack of meetings. At the previous inspection it was noted that requests made by residents at meetings were often slow to be addressed. It remains required that the quality assurance system for the home be upgraded, so that the views of people living at the home are taken into account and the home is responsive to residents’ choices and requests as raised at resident meetings. Feedback should also be sought from health care professionals and relatives in contact with the home. It was noted that a completed Annual Quality Assurance Assessment has not yet been returned to the CSCI as required. This must be completed and returned without delay. Reports of unannounced Regulation 26 visits undertaken by the responsible individual were being sent to the local CSCI area office and to the home. The responsible individual and staff also confirmed that the visits were being undertaken monthly. The deputy manager advised that few people living at the home were currently being supported by the home to manage their finances, although occasionally some residents might ask for monies to be kept in the home’s safe for safekeeping. Examination of records for recording monies deposited for safekeeping, did not state clearly when the monies were returned to residents. This places residents at risk of financial abuse and must be addressed without delay, including signatures of the staff member responsible and relevant staff member. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 28 A range of satisfactory health and safety documentation was seen including legionella, gas, electrical and portable appliances testing, accident and incident forms. Fire doors in the home were self closing at the time of the inspection as appropriate. As required at the previous inspection, records indicated that weekly fire alarm tests were being carried out regularly and more frequent fire drills were also being arranged. Records of when the fire alarm system is tested still need to identify which call points are tested on each occasion (e.g. by numbering the points). More details should also be recorded for fire drills including the time of the drill (varied between drills and including a night drill at least annually) and names of staff and residents involved, to ensure the safety of people living and working at the home. Risk assessments were available for the home environment and these were found to be appropriate. As required at a previous inspection the home’s fire risk assessment had been reviewed following consultation with a fire officer in relation to the fire exit door in the kitchen, and more secure arrangements had been put in place. As this could not be located during the inspection, a copy of the evacuation plan for the home must be sent to the CSCI area office, and posted in relevant places throughout the home. Inspection of the home’s building indicated that some perishable items were being stored in the refrigerator or freezer without clear labelling as to the date on which they were opened or first made, and the date on which they should be discarded. This is required to ensure that people living at the home are protected by appropriate food hygiene procedures. Finally environment risk assessment audits were being undertaken regularly for the home and recorded as appropriate, to ensure the safety of people living and working at the home. Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X 2 2 X Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 30 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 YA5 Regulation 5(1b) Requirement The registered person must ensure that service users’ statements of terms and conditions with the home indicate the individual Cascade home at which each service user will reside and the individual room to be occupied, to protect the rights of people living at the home. (Previous timescales of 13/10/06 and 09/11/07 partially met). The new documents must be further updated to include the responsible individual for the home and current CSCI details, and must then be signed by all relevant parties. The registered person must ensure that service users are reminded and supported to attend regular healthcare appointments, and that these are recorded. In cases where residents refuse to attend an appointment, this must be recorded, to ensure that people receive appropriate support to safeguard their DS0000067295.V362987.R01.S.doc Timescale for action 06/06/08 2. YA19 12 30/05/08 Cascade II Version 5.2 Page 31 3. YA20 13(2) 4. YA22 22 5. YA24 23(4bd) health. (Previous timescale of 19/10/07 not met). The registered person must ensure that all prescribed medicines are signed into the home and surplus stock is returned, and that this is recorded to ensure the safe administration of medicines to residents. The registered person must ensure that details of how complaints are addressed, are recorded in the complaints book, alongside timescales for all actions, to evidence that these are addressed appropriately. (Previous timescale of 12/10/07 not met). The registered person must ensure that a new hi fi system is provided to replace the system which is not working, in the lounge. (Previous timescale of 23/11/07 not met). A new iron must also be provided for residents’ use without delay, and a new mirror should be provided in the ground floor bathroom. The cracks in a number of walls in the home must be investigated and addressed as appropriate, and The garden area must be maintained appropriately for the comfort of people living in the home. The registered person must ensure that training in Adult Protection, Medication Administration and Infection Control is provided to all DS0000067295.V362987.R01.S.doc 09/05/08 16/05/08 30/05/08 6. YA35 18(1ci) 04/07/08 Cascade II Version 5.2 Page 32 7. YA36 18(2) 8. YA39 24 members of the staff team to ensure the safety of people living at the home. The registered person must 20/06/08 ensure that all staff are supervised at least twomonthly, including an annual appraisal, to ensure that they work in line with best practice. (Previous timescale of 09/11/07 not met). The registered person must 04/07/08 ensure that the quality assurance system for the home is upgraded, so that the views of people living at the home are taken into account and the home is responsive to residents’ choices and requests as raised at resident meetings. Feedback should also be sought from health care professionals and relatives in contact with the home. (Previous timescale of 23/11/07 not met). More frequent staff meetings and resident meetings should be arranged, unless an alternative format for seeking residents’ views about the home can be found. The Annual Quality Assurance Assessment must also be returned for the home. The registered person must ensure that the record of monies held by the home for safeguarding on behalf of residents, clearly states when money is returned to them, including signatures of the staff member responsible and relevant staff member, for the protection of residents from DS0000067295.V362987.R01.S.doc 9. YA41 17(2) Schd 4(9) 09/05/08 Cascade II Version 5.2 Page 33 financial abuse. 10. YA42 23(4ce) The registered person must ensure that records of when the fire alarm system is tested identify which call points are tested on each occasion (e.g. by numbering the points). More details should also be recorded for fire drills including the time of the drill (varied between drills and including a night drill at least annually) to ensure the safety of people living and working at the home. A copy of the evacuation plan for the home must be sent to the CSCI area office and this must be made readily available thoughout the home. 23/05/08 Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 34 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 YA1 Good Practice Recommendations It remains recommended that the service users guide be further updated to include more detailed information about the complaints procedure and information about how the home carries out quality monitoring including obtaining feedback from individual service users. It is recommended that strategies to address individual risk areas should be recorded individually rather than together on risk assessments, to ensure that all areas are addressed in detail including self-medication, cooking etc. It is recommended that the records of meals provided to residents need to be clearer about which residents ate which meals, to demonstrate that peoples preferences are catered for. A weekly budget should also be provided to residents who carry out their own shopping and cooking, in order to prepare them for more independent living. It is recommended that staff and residents be encouraged to ensure that all perishable items stored in the refrigerator or freezer are clearly labelled with the date on which they are opened or first made, and then date on which they should be discarded to ensure that people living at the home are protected by appropriate food hygiene procedures. 2. YA9 3. YA17 4. YA42 Cascade II DS0000067295.V362987.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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