Inspection on 17/09/07 for Cascade II

This inspection was carried out on 17th September 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 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 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 Key Unannounced Inspection 17th September 2007 12:30 Cascade II DS0000067295.V343055.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.V343055.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.V343055.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 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.V343055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 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 September 2007 are £1100 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.V343055.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 on duty for the beginning of the inspection, and I was assisted by the deputy manager and two staff members for the remainder of the visit. I also had the opportunity to meet with the responsible individual for the provider organisation who arrived at the home to undertake a routine unannounced visit, although this was postponed due to my presence. A new deputy manager was in place since the previous inspection, and examination of the rota and discussion with staff and people living at the home indicated that there had been some turnover of staff since the previous inspection. Three people were resident in the home on the day of my visit, and one prospective resident had been visiting the home for some time as part of the admission procedure for the home. They were not present in the home at the time of the inspection and it was therefore not possible to talk to them about their experiences of the home. One person had moved on to more independent accommodation living with their partner, and one had recently been discharged from the home following several difficult incidents. The inspection consisted of meeting with and talking to two of the residents independently (one did not wish to speak to an inspector), discussion with the manager, assistant manager, responsible individual and two staff members individually. 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 that staff were always around to talk to if you wanted to, adding ‘It’s reassuring, I’ll miss that when I leave.’ 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. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 6 The home is well decorated and generally well equipped providing a pleasant environment to live and work in. What has improved since the last inspection? What they could do better: Residents’ contracts with the home still need to be updated to ensure that their rights are protected as far as possible. Food records must specify food served or available to the identified person who is vegetarian, to ensure that the home provides them with a nutritionally balanced diet. All people living at the home must be reminded and supported to attend regular healthcare appointments and a clear policy is needed regarding the use of homely remedies within the home, to protect residents’ health. Details must be recorded regarding how complaints are addressed, to evidence that these are addressed appropriately. Identified furniture in the home’s lounge must be repaired or replaced. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 7 All staff must be supervised at least two-monthly to ensure that they work in line with best practice, and the home’s quality assurance system must be upgraded to ensure that the home is responsive to residents’ choices and requests and ensures their safety at all times. A current gas safety test, weekly fire alarm system tests and more frequent fire drills must be undertaken at the home to ensure the safety of people living and working at the home. It remains recommended that the home’s brochure be updated to include more detailed information and that strategies to address individual risk areas be recorded individually rather than together on risk assessments. It is recommended that more regular risk audits be undertaken for the building to ensure the safety of people living and working at the home. It is also recommended that management ensure that people living at the home are given some notice when staff members are intending to leave, and have an opportunity to mark their departure in some way. 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.V343055.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.V343055.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. 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: Four residents’ files were inspected in detail, including the care plan of one person who was still conducting visits of varying lengths to the home, prior to admission. 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. 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. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 10 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 the 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 were available for each person as appropriate. However these still did not specify the individual Cascade home at which each person would reside. It remains required that this information be included on each contract in addition to the individual room to be occupied. It was not possible to speak to the prospective resident who was still undertaking planned visits to the home, as they did not arrive for a visit until the evening following the inspection, however documents and discussion with staff members indicated that the home’s admission process was being undertaken thoroughly and at the prospective resident’s own pace. Cascade II DS0000067295.V343055.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. 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 permanent 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 also documented evidence that the plans were regularly reviewed with individual residents, and this was confirmed by staff and residents spoken to. Some agreed restrictions had been placed on people’s freedoms, with documented evidence that these had been discussed with residents as Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 12 appropriate. Confirmation of this was given by one of the residents spoken to independently. Restrictions included the use of alcohol, illegal substances and where people may smoke. Two 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. 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). It remains recommended that these strategies be recorded separately for each risk. Cascade II DS0000067295.V343055.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. 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 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. People 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. EVIDENCE: The managers 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.V343055.R01.S.doc Version 5.2 Page 14 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. 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 assistant manager and inspection of files and the visitor’s book indicated that people living at the home continue to have positive contact with relatives and/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 assistant manager advised 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 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 had moved out into their own place in the community with a partner, since the last inspection. 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. 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 Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 15 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. However records of food served, tended to note only ‘vegetarian meal’ rather than specifying what meals consisted of, for this person. This is required to aid adequate monitoring to ensure that the home provides them with a nutritionally balanced diet. The home was well stocked with food including fresh vegetables and fruit. As required at the previous inspection, the assistant manager confirmed that residents were being encouraged to join staff for the weekly food shop for the home. Residents spoken to confirmed that this was the case. Cascade II DS0000067295.V343055.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. 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. Residents receive appropriate personal support in accordance with their needs and preferences. However there is insufficient evidence that their emotional and physical healthcare needs are fully met. Residents are supported to take their prescribed medicines appropriately to ensure that their medication needs are met, but further safeguards are needed to ensure that they are given homely remedies safely, when needed. 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. People are supported with their emotional needs, particularly through 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.V343055.R01.S.doc Version 5.2 Page 17 Case files did not include sufficient evidence that residents are supported with their physical health needs such as appointments with their GP, local hospital outpatient departments and other specialist health appointments. At the previous inspection there was 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. 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. Although a small number of homely remedies were stored within the medication cabinet, the home did not have a policy regarding the use of homely remedies, nor were staff spoken to sure about where such administration would be documented. This must be addressed. Cascade II DS0000067295.V343055.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. 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 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. Inspection of the complaint’s record indicated that two complaints had been received by the home since the last inspection. Residents spoken to told me that they felt able to raise any concerns or complaints they might have with staff, but were unsure as to whether these would be acted on appropriately. For one complaint recorded, 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 the other complaint did not include a record of action taken or timescales, although the assistant manager advised that the complaint had been addressed. All staff had undertaken training in the protection of vulnerable adults and the staff members spoken to were confident about the action to be taken in the Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 19 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.V343055.R01.S.doc Version 5.2 Page 20 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. There is room for improvement in the provision of a small number of furniture and equipment in the home to better meet peoples’ 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 generally clean and well decorated throughout. Two 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. Although the home’s communal areas were decorated to a high standard, one of the sofas in the lounge was damaged, so that it was not comfortable to sit on, and the remaining sofas were discoloured. Staff and residents also told Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 21 me that the hi fi system in the lounge was not working. Action should be taken to address these issues. 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. As required at the previous inspection one resident advised that they had been provided with a small mirror as requested, and a new set of bed linen for their room, and a bath mat had been provided in the bathroom. However people spoken to were concerned about the length of time they had had to wait for the bath mat to be purchased. As required at the previous inspection, the windows in an identified resident’s room had been cleaned. At the previous inspection the assistant manager advised that 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. I was pleased to note that a computer had now been purchased for the home, and staff are now able to print documents at the home. An identified shelf in the staff office had also been repaired as required. The responsible individual told me that redecoration of the kitchen area and further cupboard provision outside the staff office are planned for the next year. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 22 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 good 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 trained 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 consistently frequent staff supervision sessions are needed to ensure that residents are supported in line with best practice at all times. EVIDENCE: The home employs six permanent support workers in addition to the registered manager. The manager advised that the home was in the process of recruiting two further staff for the home, in the meantime shifts are covered by bank staff or staff doing overtime shifts. Four of the six have achieved the national vocational qualification (NVQ) level 3 in care, and two are in the process of undertaking a relevant NVQ level 2 qualification. This exceeds the national minumum standard of 50 staff trained to NVQ level 2 or above in care. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 23 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 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 had been a significant turnover in staff members since the previous inspection. Discussion with one person living at the home indicated that they had experienced this to be quite unsettling, and that this was made more difficult by there not having been an opportunity to say goodbye to staff members, in many cases. It is recommended that management ensure that people living at the home are given some notice when staff members are intending to leave, and have an opportunity to mark their departure in some way. 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 break away techniques and food hygiene. Other certificates maintained on staff files indicated that staff members had current training in health and safety, infection control, managing aggression, protection of vulnerable adults, fire safety, HIV, risk assessment, first aid and counselling. 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. Records within staff files indicated that some staff received regular formal supervision, however other staff members had not had supervision on a regular basis. Staff advised that they felt well supported by the registered manager and assistant manager on a day to day basis. All staff members must be supervised at least two-monthly to ensure that they work in line with best practice. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 24 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. The 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: 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.V343055.R01.S.doc Version 5.2 Page 25 From discussion with residents, the assistant manager, responsible individual for the provider organisation and two support workers, as well as from documentation seen and a telephone conversation with the registered provider shortly after the inspection, 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 and deputy manager. Last year three feedback forms were received from people living at the home, however this year there was only one response. 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. However two residents spoken to indicated that action agreed or requested at resident meetings, were slow to be implemented, and many were not implemented at all. Observation of the records confirmed that this was the case, and there was also an absence of feedback provided to residents at each new meeting regarding their requests from the previous meeting. It is therefore 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. Reports of some unannounced Regulation 26 visits undertaken by the responsible individual were being sent to the local CSCI area office and to the home, however the CSCI and home had not received sufficient reports to meet the national minimum standard of monthly visits. The responsible individual advised that the visits were being undertaken monthly and provided the CSCI with copies of the missing visit reports shortly after the inspection. All Regulation 26 reports should be sent to the home and CSCI on a monthly basis to monitor the standard of care and support provided at the home. The manager and deputy manager advised that no people living at the home were currently being supported by the home to manage their finances, although some advice was being provided to residents regarding budgeting. A range of satisfactory health and safety documentation was seen including legionella, electrical and portable appliances testing certificates, accident and incident forms. Fire doors in the home were self closing at the time of the inspection as appropriate. However records indicated that weekly fire alarm tests had not been carried out since May 2007 and only one fire drill had been undertaken in 2007. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 26 The deputy manager advised that the fire alarm system was currently not operational due to a recent fault and that an engineer was due to return to the home that evening to repair it. However this did not account for the absence of weekly fire alarm call point tests since May. The deputy manager advised that the weekly tests had previously been his responsibility, however he had been posted to work at another home run by the provider for several months, and this appeared to coincide with the cessation of testing. No gas safety certificate was available for the home since February 2006, although this must be undertaken annually. These are serious lapses in health and safety procedures, and I was concerned that the organisation’s own monitoring processes had not picked them up. A requirement is made accordingly. Risk assessments were available for the home environment and these were found to be appropriate. As required at the previous inspection, risk assessments had been undertaken regarding the safety of the lounge window and restrictors had been put in place to protect the safety of people living at the home. As required at the 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. Finally environment risk assessment audits were being undertaken annually for the home and recorded. However since examination of the checklists indicated that these are very basis health and safety checks e.g. whether fire exits are free from obstructions etc. it is recommended that these be undertaken on a far more regular basis to ensure the safety of people living and working at the home. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 27 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 2 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 3 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.V343055.R01.S.doc Version 5.2 Page 28 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 Timescale for action 09/11/07 2. YA17 16(2i) 3. YA19 12 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, to protect the rights of people living at the home. (Previous timescale of 13/10/06 not met). The registered persons must 12/10/07 ensure that food records include details of which meals are provided to the identified service user who is vegetarian, so that this can be monitored to ensure that the home provides them with a nutritionally balanced diet. The registered persons must 19/10/07 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 DS0000067295.V343055.R01.S.doc Version 5.2 Cascade II Page 29 4. YA20 13(2) 5. YA22 22 6. YA24 23(4bd) people receive appropriate support to safeguard their health. The registered persons must ensure that the home has a clear policy regarding the use of homely remedies within the home, including details of which remedies can be given, how often, and where administration should be recorded. The registered persons 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. The registered persons must ensure that the identified sofa in the lounge, which is damaged, is repaired, and that the remaining sofas are either cleaned thoroughly or replaced, for the comfort of people living at the home. 02/11/07 12/10/07 23/11/07 7. YA36 18(2) 8. YA39 24 A new hi fi system must also be provided to replace the system which is not working, in the lounge. The registered persons must 09/11/07 ensure that all staff are supervised at least twomonthly to ensure that they work in line with best practice. The registered persons must 23/11/07 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. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 30 9. YA41 26 10. YA42 13(4a) 23(4c) Feedback should also be sought from health care professionals and relatives in contact with the home. The registered person must ensure that reports of all unannounced Regulation 26 visits are sent to the local CSCI area office and to the home, and that these are undertaken monthly, to monitor the standard of care and support provided at the home. The registered persons must ensure that the fire alarm system for the home is tested at least weekly, and that this is recorded. More frequent fire drills must also be arranged at the home to ensure the safety of people living and working at the home. The registered persons must ensure that a current gas safety certificate is available for the home, for the protection of people living and working at the home. A copy must be sent to the local CSCI area office. 02/11/07 05/10/07 11. YA42 13(4a) 12/10/07 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 DS0000067295.V343055.R01.S.doc Version 5.2 Page 31 Cascade II 2. YA9 3. YA33 4. YA42 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. It is recommended that management ensure that people living at the home are given some notice when staff members are intending to leave, and have an opportunity to mark their departure in some way. It is recommended that more regular risk audits be undertaken for the building to ensure the safety of people living and working at the home. Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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. Extracts may not be used or reproduced without the express permission of CSCI Cascade II DS0000067295.V343055.R01.S.doc Version 5.2 Page 33 - 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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