Inspection on 15/08/06 for Cascade II

This inspection was carried out on 15th August 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 5 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 14/04/08

Cascade II 17/09/07

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 II 37 Gladesmore Road Haringey London N15 6TA Lead Inspector Susan Shamash Key Announced Inspection 15th August 2006 01:45 Cascade II DS0000067295.V303284.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.V303284.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.V303284.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 8889 4900 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.V303284.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 August 2006 are £1000 to £1500 depending on assessment of need. 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.V303284.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately seven hours. The registered manager was not on duty having worked the previous night. The inspector was therefore assisted by the assistant manager for the majority of the inspection. Since the previous inspection a new provider had purchased the home however the management and staffing of the home had not changed. There were five residents accommodated and no vacancies. One resident had been discharged from the home and a new resident accommodated since the last inspection. The inspection consisted of meeting with and talking to three of the residents independently (one only wished for a very brief chat), discussion with the assistant manager and independent discussion with two support workers. Further information was obtained from a tour of the premises and a range of documentation kept in the home. What the service does well: The home continues to provide high 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 well served in the home by committed staff and competent managers. Those spoken to were clear that the support they received was provided in a positive and personal way that they appreciated. Staff are well supervised and supported to work with residents in line with best practice. A high standard of training is also provided to staff and the home exceeds the national minimum standard for the proportion of appropriately qualified staff. 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 well decorated and maintained and provides a pleasant environment to live and work in. A range of appropriate quality control procedures are in place to ensure that the home continues to operate to a high standard. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Statements of terms and conditions with the home need to be improved to indicate the individual Cascade home at which each resident will reside and the individual room to be occupied. Risk assessments for individual residents must be reviewed at least sixmonthly and should detail strategies to address individual risk areas individually. The windows in an identified resident’s room need to be cleaned and the walls must be repainted. Soap and disposable towels should be provided in the laundry room and an identified shelf in the staff office must be repaired. Refresher training in food hygiene must be provided to all staff due for an update at the home. The fire alarm system must be serviced and fire doors must be tested to ensure that they are effectively self-closing on a weekly basis. The risk assessment for the lounge window must be reviewed with a window restrictor put in place if deemed necessary to protect residents from harm. It is 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 residents. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 7 It is recommended that at least one resident be encouraged to join staff for the weekly food shop for the home and that vegetarian alternatives be recorded on the record of food served daily. It is recommended that a small mirror, new wardrobe and new set of bed linen be provided for the identified resident’s room and that a bath mat be provided in the bathroom. Finally it is recommended that further storage facilities for files and a computer be provided in the staff office and that the key to the rear door from the kitchen be stored in a safe place to prevent it from going missing. 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 II DS0000067295.V303284.R01.S.doc Version 5.2 Page 8 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.V303284.R01.S.doc Version 5.2 Page 9 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 and 5. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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 appropriately address them. Residents’ needs are then regularly reviewed to ensure that their changing needs can continue to be addressed effectively. The statement of purpose and service users guide have been updated to ensure that prospective residents have current information about the home, and all residents have signed contracts of terms and conditions with the home so that they are aware of their rights and responsibilities. Slight amendment of the service users guide and contracts would further protect residents. EVIDENCE: Three residents’ files were inspected in detail, one of these related to a service user who had been admitted from another of the provider organisation’s registered residential care homes since the last inspection. 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. All three residents had had CPA review meetings since the last inspection. Written evidence was also seen that the home prepared its own re-assessment report for residents as a contribution to the Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 10 CPA meetings and that the individual residents were appropriately involved in this process. This was confirmed by staff and residents spoken to. The assistant 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. A new provider had purchased the home since the previous inspection and the statement of purpose and service users guide had been updated accordingly. These provide a wide range of relevant information for prospective residents to the home. However the service users guide could be further improved by including more detailed information about the complaints procedure and information about how the home carries out quality monitoring including obtaining feedback from individual residents. The assistant manager advised that each resident had a contract of terms and conditions with the home as appropriate. However these did not specify the individual Cascade home at which each resident would reside. It is required that this information be included on each contract in addition to the individual room to be occupied. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 11 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 and 9. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the 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 clear about restrictions imposed on them by the home and are supported to retain and maximise their independence by making as many decisions as possible for themselves. They are also supported to take responsible risks to develop and maintain their independence both inside and outside the home although a further improvement to the documentation relating to this is still needed. EVIDENCE: The three residents’ files inspected all contained current care plans that were based on detailed assessments of each resident’s 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 evidence that the plans were regularly reviewed with individual residents. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 12 There are agreed restrictions placed on residents that are documented, with evidence seen that these had been discussed with residents as appropriate. Confirmation of this was given by one of the residents spoken to independently. Restrictions included the use of alcohol, illegal substances and where residents may smoke. Two residents 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 was able to give specific examples of how this is implemented. At the last inspection it was noted that not all residents had a single risk assessment document identifying individual risks and giving specific guidance to staff on actions they may take to minimise identified risks. A requirement was made accordingly. During the current inspection, the inspector was unable to find risk assessment documents for the three residents whose files were inspected in detail. However these were sent to the local CSCI office shortly after the inspection. Whilst these generally did contain satisfactory risk assessment information for each resident, they had not all been reviewed within the last six months. The inspector was also concerned that the strategies to address a number of different risk areas identified, were recorded together, rather than individually so that there is potential for some key risk strategies to be lost (particularly when dealing with as many as ten individual risks together as in the case of one resident). This is particularly necessary given the forensic histories and the overall complex needs of the residents, and a requirement is made accordingly. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 13 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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents enjoy 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. Residents are supported to make decisions for themselves regarding their daily lives. They also enjoy balanced and varied meals of their choice that are culturally appropriate. The kitchen has been refurbished to ensure that this is a comfortable place to cook and eat in. EVIDENCE: Residents are encouraged to participate in activities both inside and outside of the home, however, given the complex needs of the residents, structured day activities are taken up on an intermittent basis. One resident was working part-time as a volunteer at a charity shop and another had been in paid parttime employment for a period since the last inspection. Apart from this there was evidence seen that other residents were choosing not to pursue employment or training opportunities at the time. This was documented and being monitored by the home and the various social and healthcare Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 14 professionals involved with the individual residents. 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 appropriately. The inspector was informed that all residents are able to travel independently and have freedom passes to access public transport. The assistant manager stated that residents access a range of community facilities including local sports facilities, shops, clubs and pubs and that the home continues to organise outings to local restaurants, pubs and other community facilities. Residents spoke positively about the encouragement they receive from staff generally. One resident is interested in computers and showed the inspector the computer they had set up in their bedroom. One resident told the inspector that they played table tennis in a local league and attended a local gym regularly as well as attending a mental health drop-in service. Another residents enjoys cycling and going out for walks regularly. They advised that they were intending to attend college in the autumn. Since the last inspection residents had had the opportunity to go on holiday with residents from other homes belonging to the provider organisation. However the inspector was informed that none of the residents at Cascade II had chosen to attend the holiday on this occasion. One resident advised that they were working towards moving into their own place in the community with support from staff. The assistant manager and inspection of files confirmed that four residents continue to have positive contact with relatives and/or friends. The assistant manager advised that all the residents had their own bedroom and front door keys and had unrestricted access to the home and garden. Residents spoken to confirmed this. The assistant manager and support workers on duty during the inspection were seen to treat the residents with courtesy and respect. The home has a three monthly specimen menu that was current and there was evidence in notes seen of a recent residents’ meeting that food preference options are discussed with residents. Four of the five 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 advised that sufficient choices are available for them. However vegetarian options are not always recorded on the record of food served at the home. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 15 As required at the last inspection, the kitchen had been refurbished and redecorated following a leak from the bathroom on the first floor above the kitchen. It presented a pleasant staff for residents to eat and cook in and residents were seen making use of the facilities as and when they chose to during the inspection. The home was well stocked with food including fresh vegetables and fruit. One resident told the inspector that they would like to be more involved in choosing the foods bought for the home during the main weekly shop. It is recommended that at least one resident be encouraged to join staff for the weekly food shop for the home and that vegetarian alternatives be recorded on the record of food served daily. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 16 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 and 20. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents receive appropriate personal support in accordance with their needs and preferences. Their emotional and physical healthcare needs are met on an individual basis and recording of health checks and appointments had been improved allowing staff to support residents effectively in this area. Residents are supported to take their prescribed medicines appropriately to ensure that their medication needs are met. EVIDENCE: The assistant 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. Residents are supported with their emotional needs including support from their key workers and satisfactory 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.V303284.R01.S.doc Version 5.2 Page 17 The support workers spoken to were positive about this training and discussed the ways in which they were able to support residents effectively. Evidence was seen that residents are supported with their physical health needs. This included appointments with their GP, local hospital outpatient departments and other specialist health appointments. As required at the previous inspection there was a separate section relating to healthcare needs on the residents’ files inspected, giving an overview of medical appointments or healthcare checks that residents had attended. 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. The contents of the medication cabinet matched the inventory of medicines brought into the home as appropriate, and records of medicines returned to the pharmacy were also available as appropriate. Residents spoken to confirmed that they were supported to collect their own prescriptions for medicines and take their medicines at the times prescribed. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 18 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 and 23. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are able to express their views and any concerns they may have and can be confident that the home will deal with these effectively. Appropriate procedures and staff training are in place 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. The inspector was informed that three complaints had been received by the home since the last inspection. Residents spoken to told the inspector that they felt able to raise any concerns or complaints they may have with staff and indicated that they were confident that they would be acted on appropriately. As appropriate the actions taken by management to address each complaint were recorded on the complaints record, demonstrating that these were dealt with within the set timescales. A complaint was received on the day of the inspection, and feedback from management following the inspection indicated that this had been addressed appropriately. All staff had undertaken training in the protection of vulnerable adults and the two staff members spoken to were confident about the action to be taken in the event of a disclosure of allegation of abuse. The home also has a detailed adult protection policy as appropriate to protect residents from abuse. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 19 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 and 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a home that is clean, comfortable, well decorated and maintained and that meets their needs. This includes pleasant toilet/washing facilities, bedrooms and communal spaces that are appropriate to meet their needs. A programme of redecoration is in place to further improve facilities for residents. There is room for improvement in the furnishings and equipment in the staff office within the home to better meet residents’ needs. EVIDENCE: The home is a three-storey house, with five bedrooms, a bath/shower room with toilet, a separate toilet under the stairs, a kitchen/diner and a large lounge area on the second floor. The home was clean, well decorated, equipped and maintained throughout. The communal areas of the home are furnished to a high standard. Two residents showed the inspector their bedrooms. One resident was concerned that their bedroom was too small for the number of possessions that they owned. The inspector was told that were a vacancy to arise in a larger room this would be offered to this resident as a priority. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 20 The home has satisfactory bath, shower and toilet facilities. As stated under Standard 17, the home had suffered ongoing difficulty with water leaking from the first floor bathroom directly over the kitchen. This had now been fitted with a second new bath and had been partially retiled. The assistant manager advised that redecoration of the bathroom was due to be completed shortly after the inspection. The kitchen had been refurbished and redecorated appropriately following the damage from the leak. The home’s communal areas are decorated and equipped to a high standard with the sofa and chairs in the lounge having been replaced prior to the last inspection as part of the home’s ongoing redecoration and replacement schedule. The home is commended for encouraging residents (who express an interest) to be involved in carrying out some of the redecoration work within the home and thus further developing their independence skills. One resident asked that they be provided with a small mirror, new wardrobe and new set of bed linen for their room and that a bath mat be provided in the bathroom. The windows in one resident’s room were in need of cleaning and the paint on the walls of the room was peeling. It is required that the windows in the identified resident’s room be cleaned and the walls must be repainted. The assistant manager advised that soap and hand towel dispensers were to be fitted in the downstairs toilet room. Soap and disposable towels should also be provided in the laundry room. The assistant manager advised that at the time of the inspection all typed documents had to be handwritten and then sent up to the head office for the home for typing, often after a delay of several days. A shelf in the staff office was broken and therefore resident files were being stored on the floor. This shelf must be repaired and it is recommended that further storage facilities for files and a computer be provided in the staff office. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a well qualified and trained staff team, in sufficient numbers, to support residents and to assist in meeting their assessed needs. Staff in turn are well supervised and supported in effectively addressing residents’ needs as well as to contribute to their own professional development. All staff have the satisfactory clearances required to evidence a robust recruitment procedure designed to ensure that residents remain adequately protected. EVIDENCE: The home employs seven support workers in addition to the registered manager and the assistant manager. Four of the seven have achieved the national vocational qualification (NVQ) level 3 in care, and a total of 71 of the staff team have a relevant qualification of at least NVQ level 2. This exceeds the national minumum standard of 50 staff trained to NVQ level 2 or above in care. 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 Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 22 and 9.00 pm to 9.00 am although the assistant manager advised 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. Two new staff had been recruited since the last inspection. Four staff files were inspected including the files of the two new staff members. Application forms, copies of identity documents, references and enhanced Criminal Records Bureau disclosures were available for all staff as appropriate. There was evidence from staff files sampled of appropriate induction training. The inspector was also shown a staff training summary that listed all staff employed and the training they had undertaken. Since the last inspection training had been undertaken in Protection of Vulnerable Adults and HIV. Other certificates maintained on staff files indicated that staff members had current training in health and safety, infection control, managing aggression, fire safety and counselling. The assistant manager advised that further training in first aid, fire safety, managing agression, keyworking and careplanning and working with forensic clients was planned for later in the year. However refresher training in food hygiene was also now due for a number of staff members. A requirement is made accordingly. Two support workers were spoken to and both confirmed that they had undertaken a full induction program and had participated in a range of core skills training. They said that they found the training relevant and useful. The assistant manager showed the inspector an employer’s award in relation to a learners award 2005 issued to the provider organisation by the College of North East London (CONEL). Records within staff files indicated that staff received regular formal supervision. At the previous inspection it was required that the assistant manager advised that new staff were supervised monthly with more experienced staff receiving supervision every two months. The staff members spoken to confirmed that they received regular and recorded supervision. They advised that they felt well supported by the registered manager and assistant manager on a day to day basis as well as through regular formal supervision. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents benefit from a home that is competently managed. The home has an effective internal quality monitoring system that includes seeking the views of residents accommodated. However, as part of the overall monitoring system evidence of the provider organisation’s own ongoing monitoring of the home must be sent to the CSCI on a regular basis. The home is committed to the health and safety of residents, staff and visitors to the home although further attention is required in identified areas to ensure that safety precautions remain as robust as possible. EVIDENCE: Evidence that the registered manager has significant care and management experience as well as completing the registered managers award was previously made available to the Commission. The registered manager had also completed a diploma in mental health studies in 2005. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 24 From discussion with residents, the assistant manager and two support workers as well as from documentation seen and a telephone conversation with the registered provider shortly after the inspection, the inspector is confident that there are competent management arrangements in the home. The inspector saw a letter to the home’s manager from a resident thanking them for all their support in securing a grant to purchase a guitar. The home has an effective quality assurance system that was inspected prior to the last inspection. Three feedback forms had been received from residents and these were generally very positive about the way the home is run. Records indicated that regular staff meetings and residents meetings were being held at the home and this was confirmed by staff and residents spoken to . This included regular unannounced monthly visits to the home by the provider organisation. As required at the previous inspection copies of the reports of these visits were being sent to the CSCI after each visit is made. The inspector checked the financial records for one resident who is supported by the home to manage their finances. These were found to be accurate as appropriate and the resident confirmed that they were able to access their finances when needed. A range of satisfactory health and safety documentation was seen including legionella, gas, electrical and portable appliances testing certificates, accident and incident forms. Records indicated that weekly fire alarm tests were being carried out as appropriate as well as regular fire drills. At the previous inspection it was noted that not all the fire doors closed and remained shut when released and part of a smoke seal was missing on the edge of the internal lobby door leading to the kitchen. As required these issues had been addressed, however there is no record evidencing that fire doors are tested on a regular basis. It is required that fire doors must be tested to ensure that they are effectively selfclosing on a weekly basis and that this be recorded. The fire alarm system was also due for an annual service, and a requirement is made accordingly. Risk assessments were available fro the home environment and these were found to be appropriate. The inspector was also concerned about the safety of the lounge window which may present a health and safety risk to residents. The home’s risk assessment regarding the lounge window must be reviewed and window restrictors should be put in place if deemed necessary to protect residents from harm. A recent visit from the environmental health officer had indicated that the home has strong infection control procedures. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 25 At the previous inspection it was noted that two bolts that needed a key to release them secured the exterior door in the kitchen that leads to the rear garden. The key is kept unprotected on the kitchen counter by that door. A requirement was made that the home’s fire risk assessment be reviewed and the fire officer consulted in relation to the fire exit door in the kitchen. Following consultation with the local Fire Authority, the inspector was able to confirm that this door is not considered to be a formal exit in the event of a fire. It remains recommended that the key be stored in a safe place to prevent it from going missing. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 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 3 23 3 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 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 3 X 2 X Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 27 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 YA5 Regulation 5(1b) Requirement The registered persons 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. The registered persons must ensure that risk assessments for individual service users are reviewed at least six-monthly. Timescale for action 13/10/06 2. YA9 13(4) 15(2) 13/10/06 3. YA24 13(3) 23(2cd) Strategies to address individual risk areas should be recorded individually rather than together, to ensure that all areas are addressed in detail. The registered persons must 27/10/06 ensure that the windows in the identified service user’s room are cleaned and the walls are repainted. Soap and disposable towels should be provided in the laundry room and an identified shelf in the staff office must be repaired. The registered persons must DS0000067295.V303284.R01.S.doc 4. YA35 18(1ci) 08/12/06 Page 28 Cascade II Version 5.2 5. YA42 13(4a) 23(4c) ensure that refresher training in food hygiene is provided to all staff due for an update at the home (Refresher training should be provided at least every three years). The registered persons must ensure that the following health and safety issues are addressed: - The fire alarm system must be serviced. - Fire doors must be tested to ensure that they are effectively self-closing on a weekly basis and this must be recorded. - The risk assessment for the lounge window must be reviewed with a window restrictor put in place if deemed necessary to protect service users from harm. 22/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations It is 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 at least one service user be encouraged to join staff for the weekly food shop for the home and that vegetarian alternatives be recorded on the record of food served daily. It is recommended that a small mirror, new wardrobe and new set of bed linen be provided for the identified service user’s room and that a bath mat be provided in the bathroom. It is recommended that further storage facilities for files and a computer be provided in the staff office. It is recommended that the key to the rear door from the DS0000067295.V303284.R01.S.doc Version 5.2 Page 29 2. YA17 3. YA24 4. 5. YA24 YA42 Cascade II kitchen be stored in a safe place to prevent it from going missing. Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cascade II DS0000067295.V303284.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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