Inspection on 05/08/08 for Chadwin Road (81-83)

This inspection was carried out on 5th August 2008.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chadwin Road (81-83) 06/12/06

Chadwin Road (81-83) 28/11/05

Chadwin Road (81-83) 30/06/05

Chadwin Road (81-83) 29/11/04

Chadwin Road (81-83) 19/07/04

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 08/11/2008.

CARE HOME ADULTS 18-65 Chadwin Road (81-83) 81-83 Chadwin Road Plaistow London E13 8ND Lead Inspector Sarah Greaves Unannounced Inspection 5 and 7 August 2008 10:00 th th Chadwin Road (81-83) DS0000058206.V369644.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 Chadwin Road (81-83) DS0000058206.V369644.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. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwin Road (81-83) Address 81-83 Chadwin Road Plaistow London E13 8ND 0207 474 8378 0207 474 8378 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) Consensa Care Limited Mrs Chipo Kiss Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 7 6th December 2006 Date of last inspection Brief Description of the Service: 81-83 Chadwin Road is one of a group of homes owned and managed by Consensa Care Limited and situated in a residential street off the A13 in the London Borough of Newham. It provides twenty-four hour support for seven people with severe or enduring mental illness who have high care support needs. Care staff support and facilitate individual service users in tasks associated with daily living, both within the house and in the community. Placements are permanent, however the aim is to encourage service users towards independent living. The service is not registered to provide a service for service users with organic brain disease, learning difficulties or dementia. The service also cannot cater for people with a history of serious risk to themselves or others or who require high levels of nursing care. There were six residents living at the care home at the time of this inspection and there was one vacancy. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over two days. We gathered information from speaking to residents, staff, the area manager and the proprietor. We read a randomly selected sample of the care plans and looked at the service’s storage and management of prescribed medications. Information was also obtained through touring the premises and checking a selection of documents including health and safety records, and staff recruitment, training and supervision files. The Commission for Social Care Inspection was informed that the registered manager had resigned; this information was received from the service provider prior to this inspection. The registered manager was no longer working at the care home and was working out their leave period. The service has been sent an Annual Quality Assurance Assessment (AQAA), which is a self-audit tool. We received an anonymous complaint prior to this inspection, which alleged that there was not sufficient staff at nighttime and that the Commission was not being informed of all notifiable events, as stipulated by the Care Homes Regulations. This complaint has been discussed with the proprietor and the views of staff has been sought. The end date for this inspection has been recorded as a week after the first visit to the care home, in order to enable staff to contact us after the inspection if they wished to. What the service does well: We observed that there was a good emphasis on encouraging people to participate in fulfilling activities, such as college courses, therapeutic employment and responsible duties within the community (such as providing practical help at a local church hall). It was noted that residents are encouraged to take part in the planning and preparation of their meals. The service demonstrated that it sought appointments for residents with their psychiatrists if any concerns were observed. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents (and their supporters) are assured that their needs and wishes will be suitably assessed prior to a trial admission; however, the service needs to ensure that documents about the care home are accurate and fully understood by staff. EVIDENCE: We read the Statement of Purpose and the Service Users’ Guide. It was noted that the Statement of Purpose had not been updated with the current address of the local office of the Commission for Social Care Inspection, which changed in September 2006. We noted that the Service User Guide stated that residents could use Elmbridge Park, which was described as a luxury sporting and leisure complex. However, we spoke to three members of staff on duty on the first day of the inspection and found that none of the staff had any knowledge about Elmbridge Park. We were of the opinion that staff should understand all aspects of the Service User Guide in order to properly advise prospective residents (and their representatives) about the service at 81-83 Chadwin Road. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 9 It was noted that the Service User Guide also stated that residents would be offered the opportunity to eat out at restaurants or have a take-away each Friday night although we were informed by staff that this was not occurring at the stated frequency reported within the Service User Guide. The Service User Guide stated that residents could use the computer in the main office. We were unclear as to how this was consistently feasible, as residents came to the office to request medication (taking into account that ‘give as required’ medications such as painkillers can be asked for at any time of the day or night). Both documents were otherwise satisfactorily presented in accordance to the National Minimum Standards for Care Homes for Younger Adults. Through reading four care plans at this inspection, we found that the needs of residents were fully assessed prior to admission. Assessments were provided by relevant medical, nursing and social care professionals prior to the admission of residents. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the service demonstrated that residents were offered opportunities to make choices about their lives, the quality of the individualised care plans and risk assessments needs to be improved upon. Although systems were in place to maintain the confidentiality of residents, staff need to consistently monitor whether this is being fully achieved. EVIDENCE: We read three care plans during this inspection. We noted in one care plan that the mother of a resident was recorded as the person’s appointee and it was stated the mother managed the individual’s finances; this care plan objective regarding personal budgeting was written on the 20/03/08. However, we noted that the resident’s mother was known to have passed away in April 2007. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 11 There was also an entry dated on the 20/03/08 within this care plan (in another care plan objective) that made no sense; “X has good relations with his mother but he mother died yesterday in May…” We found that a page within this care plan and other care plans read during the inspection referred to residents by an incorrect name (it was the same wrong name of a former resident). It was usual practice for the service to produce a monthly keyworking report; the report for July 2008 was not evidenced in the first care plan that we looked at. The second care plan that we looked at did not contain monthly key worker reports for June and July 2008. The ‘absence without authority policy’ stated that all residents should have a photograph of themselves within their file (to assist the police if required); we found that some files were missing a photograph. Through speaking to several of the residents and observing discussions at a birthday party on the second day of this inspection, we noted that residents were encouraged to make important choices about their lives. This process included daily planning sessions with staff; the purpose of these sessions were to plan activities for the next day, which might include a trip to the gym or shopping, attending to personal finances at the post office and cooking a meal. Residents participated in monthly meetings within the care home. We looked at the risk assessments within three care plans. We found that these assessments were up-to-date although we would have liked to see a more individualised approach; this finding was discussed with the proprietor and the area manager. The Commission for Social Care Inspection had received a written anonymous concern prior to this inspection visit that stated that there was insufficient staff to safely manage the needs of the residents at nighttime. We have issued a requirement for the service to produce specific risk assessments to address the needs of residents at nighttime, taking into account that there is only one member of staff on duty. We found that the service was displaying a notice in the entry corridor of the premises, which listed the activities that residents engaged in next to their names. We have advised that this is a breach of confidentiality as personal visitors for a resident should not be made aware of the activities (including therapeutic activities) that the other five residents were engaged in. This notice was removed during the inspection. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were supported to engage in meaningful activities, in accordance to individualised preferences and needs, although this good practice should be enhanced through staff organising activities to stimulate and motivate residents. Although a satisfactory selection of food and beverages was available, the service needs to demonstrate that residents are being advised about healthy eating protocols. EVIDENCE: Through speaking to residents and staff, and by reading a sample of the care plans, we found that the service supported people to undertake fulfilling activities at home and in the community. Residents stated that they were enjoying college courses in maths, literacy and communication skills, and had received certificates for their achievements. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 13 Residents described their involvement in activities at home such as attending to their laundry needs and working with staff with meal preparations, as well as utilising community resources such as gyms, shops, cafes and local health services. Staff reported that they have observed a decline in the scope of activities that were previously organised for residents; for example, it was stated that residents used to have frequent trips to the cinema and a swimming pool. This comment was discussed with the proprietor, who acknowledged that the service provider was aware of deterioration in the quality of the service, which has impacted upon arrangements to support residents to access community leisure facilities. Through speaking to residents and staff, and reading different documents (such as care plans and the minutes of staff supervision sessions), we found that residents were supported to maintain relationships with people outside of the care home, including relatives and friends. One resident stated that he regularly visited his girlfriend and another resident stated that they had contact with their child. Residents expressed that they were able to choose their own routines and staff demonstrated a good understanding of the entitlements of the residents, such as their rights to choose friendships and pursue their own interests. We were informed that each resident developed his or her own menu plan, although only one menu plan could be produced at the time of this inspection. We acknowledged that residents should demonstrate their preferences but we would like to see evidence that staff have encouraged individuals to consider healthy eating options. For example, we found that a resident was choosing to have cake and yoghurt for supper on a Thursday, although the supper choices on a Saturday and a Sunday evidenced a more substantial and balanced combination of protein and carbohydrate (egg sandwich and bacon sandwich). On another week the same resident had chosen to have soup with bread for a Saturday supper but a noticeably less nutritional toast with jam supper on a Thursday. We would like to see evidence of staff supporting residents to consider menu plans with a minimum of ‘5 a day’ fruit and vegetables, and more balanced choices. We found that the service offered a wide range of food items, including fresh fruits and vegetables, a choice of cereals, and sweet and savoury snacks. The service evidenced that opened food items were labelled with the date of opening; however we found two food items (fairy cakes and spaghetti) that would have benefited from being stored in airtight containers. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the service demonstrated that residents were supported with their personal care needs and some aspects of their health care needs, significant improvements are needed with the management of medication. EVIDENCE: Through reading a sample of the care plans and by speaking to residents, we found that people were offered the support that they needed to met their identified personal care needs such as maintaining personal hygiene, hair dressing, and purchasing new clothes and toiletries. We were informed during this inspection that one of the residents had recently been admitted to hospital. The Commission had not been informed of this hospital admission, as required by Regulation 37 of the Care Homes Regulations and staff had not filled in an accident form. We were concerned by the events that preceded this hospital admission, which were discussed in Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 15 detail with the proprietor and the area manager. It was known that a resident sustained a head injury outside of the care home and was brought home by a helpful member of the public. Staff recorded in the daily record for the resident that they bathed the wound site in order to assess the extent of the bleeding and then telephoned the General Practitioner (GP) for an appointment. The unescorted resident absconded on their way to an appointment at the GP and the hospital admission occurred a few days after the date of absconding. Although the service provider informed us that the staff-training list was not up-to-date it was noted that none of the care staff had a valid first aid certificate; we would have anticipated that the service would have demonstrated a more thorough approach to considering the potential neurological concerns that might arise following a head injury, if first aid training was occurring at the required frequency. We noted from one of the care plans that a resident needed to have their blood pressure recorded every day in accordance to the instructions of their GP; however, the care plan did not give any guidance regarding what blood pressure recordings were considered to be ‘within a normal range’ and whether staff should take any actions. The proprietor stated that the blood pressure recordings were given to the GP every three months as part of the GP’s monitoring of this person, and that the GP did not want any interventions other than this. However, we were aware that some staff did not fully understand why they were being asked to do the blood pressure recordings because it had not been explained to them. It was also noted that a resident was subject to monthly monitoring of their weight. The care plan did not state the recommended weight for the person (for example, a Body Mass Index calculation based upon a ratio of weight and height); hence the monthly recordings could not be evidenced to be of any particular significance. We noted from the staff training records that only two members of staff had received ‘Mental Health Awareness’ training, which we would expect to be a health care training course for all staff at 81-83 Chadwin Road. All of the residents were registered with a GP and were able to access community health care resources such as dentists and opticians. We found that residents were referred to psychiatry services when staff observed any concerns; most of the residents at this care home were not subject to regularly held Care Planning Approach meetings. We checked the service’s storage and administration of prescribed medications. We found the following concerns at this inspection: 1. A dosage box of medication had been prepared for a resident by a member of staff, following the person’s discharge from hospital. There was no information on the back of the dosage box so that staff were able Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 16 2. 3. 4. 5. 6. to identify which medications they were administering. Via discussion with the proprietor we were informed that staff were notified that they were not permitted to conduct ‘secondary administration’ of medication, hence these medications should have remained in the packaging provided by the hospital. We found three prescribed topical creams that were not on the medication administration records (E45, fucidin and aqueous cream). Although these creams had not expired we were unable to safely ascertain if the residents were still prescribed these treatments. Hydrocortisone cream was prescribed to a resident in September 2007 for five days treatment only. This prescribed medication was still in the medication cabinet. The directions on the pharmacy label did not correspond with the instructions on the medication administration record. Although this did not result in the resident receiving a wrong dose, we would have expected this mistake to have been promptly observed and reported to the pharmacist for advice. A prescribed painkiller in an ointment preparation (diclofenac gel) had no instructions for application on either that medication administration record or the pharmacy label. There was a gap on the medication administration record for a medication prescribed for administration on the morning of the first day of the inspection. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service needs to demonstrate improvements to the delivery of Adult Protection training. Although residents indicated that they were satisfied with the service’s management of complaints, this could not be properly assessed due to the lack of available evidence. EVIDENCE: We found that the complaints procedure was satisfactorily presented apart from the need to amend the address of the Commission for Social Care Inspection (as recorded within the Service User Guide). We asked to look at the complaints book on the first day of this inspection but it could not be found. Discussions with some of the residents indicated that they felt that their concerns and complaints would be suitably responded to. The Adult Protection procedure was appropriately written and staff were able to describe their understanding of the service’s whistle-blowing policy. Two members of staff informed us during the inspection that they had not received Adult Protection training. We looked at the training records for the service and noted that one member of staff was reported to have undertaken their Adult Protection training on 19/02/2007 but also received training for care planning and risk assessment, mental health awareness, communication, brain injury awareness, health and safety, and infection control on the same day. We Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 18 would therefore consider that this was an introduction to understanding and preventing abuse rather than a more in-depth course. It was also noted that two members of staff had received Adult Protection training in 2005 but had not received ‘refresher’ training since then. We would advise the service provider to investigate whether this training could be sought from an external source, such as through the local social services. Chadwin Road (81-83) DS0000058206.V369644.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27,28,and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents were not provided with a comfortable, welcoming and pleasant environment at the time of this inspection. EVIDENCE: The service occupies two ordinary style houses that have been joined to create one property. 81-83 Chadwin Road is situated in a residential street within walking distance from the shops and amenities in Canning Town. We toured the premises and made the following observations: The downstairs bathroom had a raised toilet seat on the floor. Staff were unaware of why a raised toilet seat was being provided and which residents needed this facility. Staff did not know if the toilet seat had been provided by an occupational therapist. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 20 We spoke to the proprietor about this finding on the second day of this inspection and were informed that the raised seat had been provided to a resident following a stroke but was no longer required. There were gloves on the floor, the toilet roll holder was broken and the hand towel was grubby. Nails were sticking out of the wall and there was a noticeable odour. Visible signs of rising damp were observed and the walls needed to be repainted. We looked at the upstairs bathroom on the first day of the inspection and viewed this room again on the second day of the inspection, with the proprietor present. It was noted that the shower attachment was broken and on the floor, and that any persons outside the bathroom could look in, as there was a gap when the door was closed. The wallpaper was coming off the walls and there was visible patches of mould. This toilet also had a raised toilet seat and staff did not why. The extractor fan in the smoking room did not work properly and the settee was in a torn condition. The quality of the reception on the television was poor. We were informed by the proprietor that a new settee had already been purchased and was due to be delivered. It was stated that residents used this television for watching videos, as attempts to improve the reception had been unsuccessful. The curtains in the communal lounge were too long and needed to be modified as they could be tripped over. It was noted that there was a calendar on display that promoted a particular church. We noted from the care plans that some residents were not members of this church, hence the calendar did not appear to be representative of the collective interests of the people that used the lounge. We noted that there was a jagged broken ashtray in the garden that residents were using. This was pointed out to staff as a potential danger and was removed during the first day of this inspection. There was also gym equipment in the garden; we advised that a cover for the equipment should be obtained so that it would be protected from rain and snow. Three residents invited us to look at their bedrooms, which were satisfactorily maintained and evidenced that people were encouraged to personalise their own space. We noted that one of the bedrooms contained an industrial style wire mesh bin; we have asked staff to offer the resident the opportunity to pick a more homely bin (unless they have a specific preference for the current item). We noticed the smell of cigarettes within communal corridors and found a cigarette butt in a toilet. Staff encouraged people to smoke within the designated areas. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 21 Chadwin Road (81-83) DS0000058206.V369644.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents were not presently receiving care from suitably qualified and supervised staff, although the recruitment practices were safe. EVIDENCE: At the time of this inspection the service did not have a registered manager working at the premises. Staff stated that they could seek advice by calling the Consensa Care Ltd head office, although findings within this report have demonstrated that this has not proven to be an effective approach to managing this service. We spoke to staff regarding the arrangements for lone working at nightime. Staff produced a safety policy that they were instructed to follow (which involved ‘checking in’ with other Consensa care homes at regular intervals during the night); we were informed that sometimes these calls were not answered. There was an identified senior person to contact during the night. This report has identified the need for the service to produce risk assessments Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 23 that address the nightime needs of the residents and it has also highlighted that staff would gain confidence from more training. The training records provided at this inspection indicated that less than 50 of the care staff had attained a minimum of National Vocational Qualification in Care at level 2. We looked at a sample of the recruitment files, which were found to be satisfactory. As previously stated within this report, we did not find satisfactory evidence regarding the delivery of first aid and refresher Adult Protection training, as well as some staff having not received ‘mental health awareness’. The proprietor acknowledged that there have been problems with the management of the service, which Consensa Care Ltd were addressing; these problems appear to include the sharing of information with staff regarding the daily management of the service. We noted that staff appeared to lack information that we would expect, for example, staff did not know if the raised toilet seats were for a particular resident and whether the seats had been provided via an occupational therapist’ s assessment. We were given a sample of the supervision records for staff. It was noted that the supervision notes for two members of staff (conducted by the registered manager) were confusingly presented as the employee name at the top of the supervision page stated, for example, ‘AB’ but the supervision constantly referred to ‘YZ’. We were unable to determine that staff were receiving individualised supervision. Chadwin Road (81-83) DS0000058206.V369644.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 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although residents voiced that they felt consulted about their experiences within the care home, the service needs to demonstrate that the welfare and safety people is promoted through effective management practices. EVIDENCE: At the time of this inspection the registered manager was no longer working at the service, although they were still in post (gardening leave). Through discussion with the proprietor and the area manager, we were informed that the service provider has had some concerns regarding the management of 8183 Chadwin Road for several months. We read a sample of the monthlyChadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 25 unannounced monitoring visits (Regulation 26) reports by the provider and have noted a pattern of concerns being detected. Issues found at this inspection have indicated the need for the service provider to implement more robust measures to ensure the safety and welfare of the residents at this care home until a new manager has been appointed and inducted; the Commission voiced this view during the inspection. We would expect that the proprietor or the area manager (or another individual identified by Consensa Care to have the appropriate qualifications and experience) would now undertake the daily management of the service until a permanent manager is in place. We were informed by staff that they could telephone senior people within Consensa Care for advice; however, the findings at this inspection have demonstrated that managerial input is needed in a much more intensive manner. We noted that the visitors’ book did not record the arrival and departure of a senior person to conduct the Regulation 26 visits. We noted that the service had not recently sought the views of the residents through questionnaires, although views were sought through individual discussions with residents and the residents meetings. We observed that residents approached the proprietor and area manager in a confident and relaxed manner during a birthday party and raised issues such as the forthcoming barbeque and their college courses. We felt that there was a clear and active approach to listening to and acting upon the views of the residents. We found that a bottle of multi-purpose cleaner had been left in the downstairs bathroom, which was an item that needed to be kept in a locked cupboard when not in use, in accordance to the Control of Substances Hazardous to Health legislation. The service produced evidence that the portable electrical appliances were tested this year; however, the electrical installations check by a competent person was overdue (June 2008), which was discussed with the proprietor. It was noted that staff signed a form to state that the first aid equipment was checked every month; however, we found that several items had expired in February 2006 and some sterile dressing packs were opened. The Landlord’s Gas Safety Certificate was valid and the service evidenced compliance with fire drills, fire alarm checks and professional maintenance of the fire extinguishers. Chadwin Road (81-83) DS0000058206.V369644.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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 1 27 X 28 1 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 1 X 2 X 3 X X 2 X Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 5 Requirement The registered person must ensure that amendments are made to the Statement of Purpose and the Service Users Guide, as indicated within this report. The registered person must ensure that there are detailed risk assessments in place to address the needs of each resident at night-time, taking into account that there is one member of staff working alone. The registered person must make safe arrangements for the management of medication. The registered person must ensure that the condition of the premises is improved, in accordance to the issues raised in this report. The registered person must ensure that the training needs of staff is addressed. The registered person must ensure that hazardous items are securely stored. The registered person must ensure that the first aid equipment is checked every DS0000058206.V369644.R01.S.doc Timescale for action 30/11/08 2. YA9 14 30/11/08 3. 4. YA20 YA24 13 (2) 23(2)(b) 31/10/08 30/11/08 5. 6. 7. YA35 YA42 YA42 18 13(4) (c) 13(4) (c) 31/12/08 31/10/08 31/10/08 Chadwin Road (81-83) Version 5.2 Page 28 month. 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. 2. Refer to Standard YA6 YA6 Good Practice Recommendations The service needs to demonstrate improvements to the accuracy and validity of information within the care plans. The service should maintain a recent photograph of each resident. Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chadwin Road (81-83) DS0000058206.V369644.R01.S.doc Version 5.2 Page 30 - 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. 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