Inspection on 06/10/08 for Cascade II

This inspection was carried out on 6th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cascade II 14/04/08

Cascade II 17/09/07

Cascade II 15/08/06

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Random inspection report Care homes for adults (18-65 years) Name: Address: Cascade II 37 Gladesmore Road Haringey London N15 6TA The quality rating for this care home is: The rating was made on: one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed inspection. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Susan Shamash Date: 0 6 1 0 2 0 0 8 Information about the care home Name of care home: Address: Cascade II 37 Gladesmore Road Haringey London N15 6TA 02088000760 02088094900 cascade2@cascade-care.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Cascade Care Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia 5 Over 65 0 Conditions of registration: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated: 5 Date of last inspection Brief description of the care home 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 Care Homes for Adults (18-65 years) Page 2 of 15 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. 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. Care Homes for Adults (18-65 years) Page 3 of 15 What we found: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took approximately six hours. The registered manager was on duty throughout the inspection, alongside the acting deputy manager, and both provided me with every assistance. The operations director for the provider organisation also phoned and spoke to me during the visit. I also spoke briefly with two staff members who commenced work towards the end of the visit. Five people were resident in the home on the day of my visit. I was able to talk to two residents, one at some length, and the other briefly according to their preferences. One resident was out throughout my visit, and the other two residents did not wish to speak to me during the visit. I also conducted a tour of the premises and inspected a range of documentation kept in the home. Both residents indicated that they were receiving appropriate support from staff. I inspected three residents files including those of the newer residents. All contained a range of comprehensive assessment information from both health and social care professionals as well as from in-house assessments. There was evidence that this information was kept up to date with care planning approach (CPA) review meetings in place. 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 those spoken to. The manager advised that no changes had been made to the statement of purpose or service users guide since the previous inspection. Statements of terms and conditions for each resident with the home, were sent to the CSCI shortly after the inspection, confirming that these had been updated to include the home at which residents live and the room to be occupied as required at the previous inspection. The three residents files inspected all contained current care plans that were based on detailed assessments of each residents needs including cultural and social needs. The plans were clearly laid out and detailed the individual needs as well as giving clear guidance to staff on how to address these needs. There was also documented evidence that the plans were reviewed with individual residents, and this was confirmed by staff and residents spoken to. Some agreed restrictions had been placed on peoples freedoms, with documented evidence that these had been discussed with residents as appropriate. Confirmation of this was given by one resident that I spoke to. Restrictions included the use of alcohol, illegal substances and where people may smoke. Care Homes for Adults (18-65 years) Page 4 of 15 Risk assessments were available for all residents whose files were inspected, however some of these had not been reviewed within the last six months. The manager and staff advised that residents are encouraged to participate in activities both inside and outside of the home, however, given their complex needs, structured day activities are taken up on an intermittent basis. One person was working part-time as a volunteer at a charity shop and another had previously been involved in voluntary work. Apart from this, the manager advised that people living at the home chose not to pursue employment or training opportunities and this was confirmed by those spoken to. Participation in daily activities was documented and was being monitored by the home. The organisation has a new equalities and diversity policy which I was shown during the visit. 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. However discussion with one person indicated that they would like to have regular counselling sessions. Staff advised that this resident had previously turned down the offer of counselling sessions offered by social services. The manager and inspection of files and the visitors book indicated that people living at the home continue to have positive contact with relatives or friends, and this was confirmed by residents spoken to. One resident has a girlfriend who visits the home regularly, and was with them at the time of the inspection. I was advised that all residents are able to travel independently and have freedom passes to access public transport. The manager advised that residents access a range of community facilities including local sports facilities, shops, clubs and pubs and that the home continues to offer outings to local restaurants, pubs and other community facilities, although these are usually taken up on a one-to-one basis. Residents confirmed that they were encouraged to be involved in the local community, but advised that they rarely participated in group activities with the home, out of personal choice. 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 a holiday to Wales and Birmingham over the summer, semi-independently. The manager advised that one resident was due to move out into their own accommodation shortly, once a vacancy becomes available at another service run by the provider organisation. Residents confirmed this. Staff on duty during the inspection were seen to treat the residents with courtesy and respect. The home has a three monthly specimen menu, however although residents advised that they are consulted about their preferences, this is not recorded as residents meetings are no longer being held regularly. Some residents self cater with staff supporting them with shopping for food, cooking and giving advice on healthy options. Care Homes for Adults (18-65 years) Page 5 of 15 The result of this is that many of the meals cooked in the home differ from the menu given the current preference of the residents at the time. Residents are from a variety of ethnic backgrounds and stated that the meals they ate met their cultural preferences. One resident is vegetarian and there were a variety of vegetarian foods stocked within the home. Records of food served included details of vegetarian alternatives for this person. The home was well stocked with food including fresh vegetables and fruit. The manager confirmed that residents continue to be encouraged to join staff for the weekly food shop for the home. The manager confirmed that all the current residents are physically independent in respect of their personal care needs although they may need verbal prompting with certain areas of personal hygiene to varying degrees. Residents spoken to indicated that this was undertaken in a sensitive manner. People are supported with their emotional needs, particularly through support from their key workers and notes of some key worker sessions were seen on the files inspected. Staff had undertaken training in counselling skills to further promote their ability to support residents with their emotional needs. Case files included improved evidence that residents are supported with their physical health needs such as appointments with their GP, dentist and local hospital outpatient departments, however they did not include sufficient evidence that they were prompted to attend opticians appointments etc. 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 and medicines signed into the home 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. I made a number of recommendations about medication administration to further protect people living at the home. The home has a clear and satisfactory complaints procedure that was seen displayed in the kitchen and the office. Inspection of the complaints record indicated that it is being completed appropriately. Residents spoken to told me that they felt able to raise any concerns or complaints they might have with staff. Only two out of the four staff members files that I inspected had current certificates for undertaken training in the protection of vulnerable adults. Staff members that I spoke to were confident about the action to be taken in the event of a disclosure or allegation of abuse. The home also has a detailed adult protection policy as appropriate to protect residents from abuse. The home is a three-storey house, with five bedrooms, a bath and shower room with toilet, a separate toilet under the stairs, a kitchen and dining area and a large lounge area on the second floor. The home was generally clean and well decorated Care Homes for Adults (18-65 years) Page 6 of 15 throughout. Three residents allowed me to see their bedrooms, and advised that they were satisfied with the facilities in the home. The home has satisfactory bath, shower and toilet facilities, and paper towels and soap were being provided in these facilities as appropriate. The homes communal areas were decorated to a reasonable standard, and as required at the previous inspection a new hi fi system, TV and DVD player had been provided in the lounge, the iron was replaced and cracks in a number of walls in the home were redecorated as appropriate. New pictures and a clock were also hanging in the lounge, with the carpet cleaned a new rug provided. A new mirror had also been provided in an identified bathroom, as required at the previous inspection. 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. A lockable bike store continues to be available for residents within the garden area. However on looking at the maintenance records for the home, I was concerned to see that repeated requests for maintenance issues from the homes manager had not yet been addressed, or took a number of repetitions prior to being addressed. These included the filling of some holes in the kitchen, as recommended by a pest control service, to help address a rodent problem - which had not yet been addressed despite being recorded for several weeks. A schedule is also needed for when the first floor bathroom ceiling and external paint work (particularly at the rear of the home) will be redecorated. The roof windows in the office and residents rooms are also in need of regular cleaning. The staff rota was seen and showed that a minimum of two staff were on duty for twenty four hours each day and this included two waking night staff. The shifts worked during the day remain 9.00 am to 5.00 pm; 5.00 pm to 9.00 pm and 9.00 pm to 9.00 am although the manager advised 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. Four staff files were inspected. Copies of identity documents, references and enhanced Criminal Records Bureau disclosures were available for all staff as appropriate, and the manager confirmed that all staff also completed new Cascade application forms. 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. Certificates indicated that training had been undertaken in health and safety, first aid, fire safety, breakaway training, and food hygiene. Some staff had undetaken medication, safeguarding adults, working with forensic clients, HIV, risk assessments, challenging behaviour, infection control and counselling skills. All four staff members had undertaken NVQ training in care at levels 2 or 3. Only two of the four staff whose files were inspected had completed training in the protection of vulnerable adults and a requirement is made accordingly. The manager advised that further training was to be provided in this area later in the year. I was concerned that that inspection of staff files showed that not all staff had current Care Homes for Adults (18-65 years) Page 7 of 15 training in Adult Protection, Medication Administration and Infection Control. This training must be provided to all members of the staff team without delay to ensure the safety of people living at the home, and avoid enforcement action being taken against the home. Records within staff files indicated that staff members were still not having supervision sessions on a sufficiently regular basis, although there had been some improvement in this area. Staff advised that they felt well supported by the manager on a day-to-day basis. However all staff members must be supervised at least two-monthly to ensure that they work in line with best practice. An annual appraisal must also be carried out for each staff member. The manager advised that he was due to undertake appraisals shortly. It is recommended that the manager undertake the local authoritys safeguarding adults training and that staff have training in mental health issues, and the Mental Capacity Act 2005. Since the previous inspection the manager had been registered with the CSCI providing evidence of sufficient management and social care experience, and has been undertaking the Registered Managers Award at NVQ level 4. He is supported by a temporary deputy manager who assists with supervision and deputises in his absence, and I was able to speak to her during the visit. From discussion with residents, the manager, operations manager for the provider organisation and two support workers, as well as from documentation seen, I was confident that there are competent management arrangements in the home. The home had not undertaken a quality assurance audit since the previous inspection, however the clinical director advised that she was looking at a major overhaul of the companys quality assurance systems, and would be choosing an appropriate system in time for the new year. She therefore requested an extension for this requirement made at the previous inspection. Records indicated that there are regular staff meetings held at the home, but there had not been a residents meeting for some time, this was confirmed by staff and residents spoken to. The manager noted that residents had been reluctant to get together for meetings of late, and this was the reason for the recent lack of meetings. The Annual Quality Assurance Assessment had been returned to the CSCI as required, and reports of unannounced Regulation 26 visits undertaken by the responsible individual were being sent to the local CSCI area office and to the home. The manager and staff also confirmed that the visits were being undertaken monthly, and that staff surveys had been distributed across the organisation. The manager advised that no people living at the home were currently being supported by the home to manage their finances. A range of satisfactory health and safety documentation was seen including legionella, gas, electrical and portable appliances testing, accident and incident forms. Fire doors in the home were self closing at the time of the inspection as appropriate. Records indicated that weekly fire alarm tests were being carried out regularly and more frequent fire drills were also being arranged. Records of when the fire alarm system is tested were now identifying which call points are tested on each occasion Care Homes for Adults (18-65 years) Page 8 of 15 (although a key should be available to indicate which call point is which). More details were being recorded for fire drills, although the time of the drill and names of staff and residents involved, should also be recorded, to ensure the safety of people living and working at the home. A new format including this information was provided to the CSCI shortly after the inspection. Risk assessments were available for the home environment and these were found to be appropriate. As required at a previous inspection the homes fire risk assessment had been reviewed following consultation with a fire officer and an appropriate evacuation plan was available. This should be reviewed at least six-monthly. There was appropriate storage and labelling of perishable items in the refrigerator and freezer to ensure that people living at the home are protected by appropriate food hygiene procedures. Finally environment risk assessment audits were being undertaken regularly for the home and recorded as appropriate, to ensure the safety of people living and working at the home. What the care home does well: What they could do better: Risk assessments should be reviewed at least on a six-monthly basis, and records must evidence that residents are prompted to attend routine opticians and other Care Homes for Adults (18-65 years) Page 9 of 15 healthcare appointments, to evidence that appropriate support is provided to people living at the home. A more effective system must be put in place for addressing maintenance issues reported by the homes management. Training is needed for remaining staff in the protection of vulnerable adults, infection control and medication administration. Failure to comply with the requirement may result in enforcement action being undertaken against the home. It is recommended that the manager undertake the local authoritys safeguarding adults training and that staff have training in mental health issues, and the Mental Capacity Act 2005. All staff members must be supervised at least two-monthly to ensure that they work in line with best practice. An annual appraisal must also be carried out for each staff member. An improved quality assurance system is needed for the home, including feedback from all relevant stakeholders. Fire risk assessments should be update at least six-monthly and some minor improvements could be made to fire safety records. It remains recommended that the service users guide be 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. A number of recommendations are made about improving medication administration records to further protect people living at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These requirements were set at the last inspection. They may not have been looked at during this inspection, as a random inspection is short and focussed. The registered person must take the necessary action to comply with these requirements within the timescales set. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 11 of 15 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered persons must 28/11/2008 ensure that peoples individual risk assessments should be reviewed at least on a six-monthly basis, to ensure that people are supported to take informed risks. . 2 19 12 The registered persons must 28/11/2008 ensure that records evidence that residents are prompted to attend routine opticians and other healthcare appointments, to evidence that appropriate healthcare support is provided to people living at the home. . 3 24 23 The registered persons must 12/12/2008 ensure that a more effective system is put in place for addressing maintenance issues reported by the homes management, so that these are addressed without undue delay. Roof windows must be kept clean, a schedule must be provided Care Homes for Adults (18-65 years) Page 12 of 15 for the redecoration of the first floor bathroom and external paintwork of the home, and the specified holes in the kitchen must be filled. . 4 35 18 The registered persons must 30/01/2009 ensure that training is provided to all remaining staff in the protection of vulnerable adults, infection control and medication administration. Failure to comply with the requirement may result in enforcement action being undertaken against the home. The registered persons must ensure that . 5 36 18 The registered persons must 19/12/2008 ensure that all staff members are supervised at least twomonthly to ensure that they work in line with best practice. An annual appraisal must also be carried out for each staff member. . 6 39 24 The registered persons must 27/02/2009 ensure that an improved quality assurance system is put in place for the home, including at least annual audits and feedback from all relevant stakeholders. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Adults (18-65 years) Page 13 of 15 improving their service. No. Refer to Standard Good Practice Recommendations 1 1 It remains recommended that the service users guide be 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. It is recommended that the identified person be referred for regular counselling sessions as discussed during the inspection. It is recommended that duplicate stickers be obtained from the pharmacy with all prescribed medicines, so that directions for administration do not need to be copied, thus reducing the risk of error. The year (and not just the month and day) should be recorded on non-compliance records, improved stock control measures should be adopted and clearer guidance must be sought on the administration of two PRN (as and when) medicines prescribed for the same person for one particular problem. It is recommended that the manager undertake the local authoritys safeguarding adults training and relay relevant information to the staff team and that staff members are provided with mental health training and training in the Mental Capacity Act 2005. It is recommended that fire risk assessments should be update at least six-monthly, a key should be produced to identify fire alarm call points tested and the time and staff involved in each fire drill should be recorded. 2 19 3 20 4 35 5 42 Care Homes for Adults (18-65 years) Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report CSCI General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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