Inspection on 01/11/05 for Chesterfield Gardens 44 & 60

This inspection was carried out on 1st November 2005.

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

Chesterfield Gardens 44 & 60 13/05/08

Chesterfield Gardens 44 & 60 11/10/07

Chesterfield Gardens 44 & 60 29/01/07

Chesterfield Gardens 44 & 60 25/04/05

Chesterfield Gardens 44 & 60 20/08/04

Chesterfield Gardens 44 & 60 11/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Chesterfield Gardens 44 & 60 London N4 1LP Lead Inspector Brian Bowie Unannounced Inspection 08.30 1 November 2005 st Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 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 Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 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. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Chesterfield Gardens 44 & 60 Address London N4 1LP 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) 020 8809 4933 020 8809 4933 PRA Services (Psychiatric Rehabilitation Association) Ms Norma Willis Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th April 2005 Brief Description of the Service: 44 & 60 Chesterfield Gardens are two terraced houses that operate as a single care home for seven adults with mental health needs. The home is run by the Psychiatric Rehabilitation Association (PRA) which provides a range of mental health services. The home is close to shops, pubs and public transport. 44 has three bedrooms for residents with a separate toilet and bath/shower room on the first floor and a lounge, kitchen/diner, toilet and staff office/sleeping-in room on the ground floor. 60 is similar in layout with a fourth resident bedroom on the ground floor instead of the staff accommodation. Both houses have an attractive rear garden. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted 6 hours. The manager was present and assisted with the inspection. A tour of both houses was made and all of the seven people resident in the home at the time of the inspection were spoken to. Both care staff on duty were also spoken to. A variety of records, including care plans, staff files and health & safety documents, were looked at. The overall impression from the inspection was of a home that is providing a good standard of care within a friendly, homely and supportive environment. What the service does well: What has improved since the last inspection? At the previous inspection there had been 6 areas which the home had to improve. The home had taken action on all of these areas and as a result these areas are now better than before. Plans setting out how residents’ needs are to be met have been put together as have risk assessments which describe how any risks in relation to each resident are dealt with and minimised. Care plans are now being reviewed and updated regularly. The communal areas in both houses have been redecorated, new flooring fitted in some rooms and the rear gardens tidied up. As a result both houses have Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 6 an attractive appearance, inside and outside, and give the impression of being well looked after. The manager is now regularly supervising all care staff so that they can be helped to support residents as effectively as possible. Several staff are undertaking appropriate further training such as NVQ qualifications in care. What they could do better: 7 new areas for improvement were identified at this inspection. These areas were discussed and agreed with the manager: • • • • • • • Risk assessments about residents to be kept updated Residents’ meetings to be held regularly Current local authority adult protection guidelines to be obtained Bedrooms to have a lockable drawer or cupboard The manager to have regular supervision meetings Monthly inspections of home by PRA Fire safety measures needed The manager at the home emphasised that she was keen to work closely with CSCI to raise standards at the home in order to be able to provide the best possible quality of life for residents. 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. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 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 Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People moving into the home have their needs and wishes assessed so that the home can be sure that it can meet these needs and wishes. EVIDENCE: All seven of the residents were spoken to. They said that they enjoyed living at the home and thought that their needs were being met. One resident who had recently moved in said: ‘I’ve had no problems-I’ve got no complaints. The staff are friendly.’ This resident had visited the home several times before moving in so that they could be sure it was the right place for them. The high satisfaction level of residents with the home indicated that the home is good at selecting residents who will benefit from what the home offers and that residents’ needs and wishes are being responded to. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8,9 The home is good at assessing and responding to the needs of residents and recording this in the individual’s care plan. Residents do not get the full benefit from having residents’ meetings which are held regularly nor from having their risk assessments regularly updated. EVIDENCE: Plans of care were looked at and indicated the main needs of residents and how these were to be met. As previously required these plans are now being reviewed and updated regularly. The keyworkers for each resident follow up the aims and objectives set out in the care plan. One member of care staff was interviewed and was able to show how he was assisting 2 residents to achieve the aims set out in their care plan. Care staff interviewed were aware of the need to provide guidance and support to residents where necessary, whilst letting them decide for themselves as much as possible how they led their life. The residents said they could decide when they wanted to have their meals and what they had to eat. They also said they had meetings where they discussed the running of the home and made suggestions about what they wanted to do, such as where to go on Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 10 holiday. However there had not been a recent residents’ meeting. It is important that these meetings are held regularly since they are a key part of the residents, as a group, being able to contribute their suggestions and views on how the home is run. Residents are being supported by staff to take risks as part of a more independent lifestyle. Some of the residents are now taking more responsibility over taking their medication. Staff discuss this with each resident and a plan is worked out with the risks weighed up. Feedback from the residents themselves showed that they were enjoying these opportunities to do more for themselves. In one case the risk assessment for a resident who was being taught how to go out safely on their own had not been updated to reflect this new initiative. It is important that all risk assessments are kept updated in order to safeguard the welfare of residents at all times. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,16 The home is good at enabling residents to get out and about and lead as ordinary a life as possible. Residents benefit by having staff who allow them to make choices for themselves and to have as much control over their life as possible. EVIDENCE: Residents take part in a variety of daytime activities, including day centres, and work projects. Residents get out and about in their local community, including going shopping, to the cinema and on outings. Most of the residents had recently gone on a short break to Blackpool which they had enjoyed. Cultural needs are responded to with one resident going to a temple to worship when he wished to, and when it is his turn to cook for other residents he will make a vegetable curry in line with his cultural needs and wishes. Another resident has few opportunities, other than with neighbours and local shopkeepers, to talk to people in his own language. It is recommended that in this case further efforts are made to respond to the cultural needs of this resident. Feedback from residents was positive about how staff respect their rights and give them responsibility. One resident said: ‘I need motivating so my Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 12 keyworker has taught me to cook some new dishes.’ Another said: ‘I can go to bed when I want.’ Another resident had not wished to go away with the others to Blackpool and this wish had been respected. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff are good at supporting the residents in a way that they are happy with. EVIDENCE: Staff were observed to interact appropriately with residents and in a way that recognised their individual needs and capabilities. A keyworker system is in place so that residents have a member of staff who takes a particular interest in supporting them. The keyworker for 2 of the residents was interviewed and was able to give a detailed account of their needs and interests. Residents comments included: ‘I like the company here- I don’t want to live on my own.’ ‘My keyworker’s alright- if I’ve got a problem I can talk to her.’ Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The residents do not get the full benefit of having staff that are aware of the local authority’s current adult protection procedures. EVIDENCE: There had been no incidents in relation to adult protection in the home in the last year. Staff had had training in this area and knew how to respond to incidents or allegations. However the home did not have a copy of the relevant local authority’s adult protection guidelines which it must obtain so that it knows how to respond appropriately to any allegations or incidents of abuse. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,30 Residents benefit from a home which is homely, comfortable, clean and hygienic. Residents must have the opportunity to have a lockable area in their room for valuable and/or personal items. EVIDENCE: Chesterfield Gardens provides a very homely and comfortable environment for residents, with improvements made since the last inspection in terms of the decoration and furnishings. Residents commented that it was a nice environment to live in. The home is kept clean with a cleaner coming into both houses regularly as well as residents taking responsibility to keep the houses tidy. Bedrooms seen were attractive and contained personal belongings of residents. However the bedrooms did not have a separate lockable space so that residents could store valuables and other personal items securely. Each bedroom must have a lockable area unless the resident has indicated they do not wish this to be provided. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Residents benefit from a committed and experienced team of staff at the home who have the skills and training needed to meet their needs. Residents are protected by the home having proper recruitment procedures for new staff. Residents however do not fully benefit from having a manager who herself is regularly supervised in order to improve further her skills in managing the home. EVIDENCE: Staff on duty throughout the inspection were observed and spoken to. Most staff at the home have worked there for a number of years and have built up a good knowledge and understanding of the needs of each resident. A good deal of positive feedback was received from the residents, including: ‘I like it herethey help me when I need it.’ One member of staff commented: ‘It’s a happy team- I like working here.’ Some staff files were looked at and contained the information needed to make sure that all staff in the home have had the appropriate checks made. These checks included written references and CRB disclosures. These procedures help to ensure that residents are protected from having unsuitable staff working in the home. A number of care staff have achieved NVQ Level 2 in caring for people, as well as attending relevant training courses when necessary. Staff files showed that Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 17 staff had done training in essential areas, such as food hygiene, health and safety, administering medication and first aid. Some staff are undertaking NVQ Level 2 training to improve their caring skills further. Staff had a good understanding of the individual needs of each resident. The staff files showed that staff are now having regular one-to-one supervision meetings with the manager to ensure staff are fully supported and guided on how to improve their practice. The manager herself was not having regular supervision meetings so that she could improve further the way in which the home is run. PRA must ensure that the manager has regular supervision meetings. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 The home runs well so that the residents really benefit by living at Chesterfield Gardens and by having their individual needs and wishes responded to. However PRA is failing to ensure that residents are fully protected through having regular visits by a senior member of staff from the organisation to check how the home is being run and to find ways of making it better. Residents are protected by current fire safety procedures, but need to have the full protection provided by the home having an up-to-date fire safety risk assessment of both premises together with an emergency plan for evacuation of the buildings. EVIDENCE: The manager is very experienced in the area of supporting people with mental health needs, and has been running this home for the past 3 years. She has completed the NVQ Level 4 course on being a manager in the care area. Staff said they felt supported by the manager, with one person saying: ’The door is Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 19 always open if I have a problem.’ Feedback from residents was positive about the way in which the home is run. Residents, individually and as a group, put forward their ideas and suggestions on how the home is run and these are then followed up by staff, such as organising a short break, the menu for the following week, which days people do their washing and cooking the evening meal. However PRA has failed to ensure that a senior member of staff visits the home monthly to check how it is doing and identify areas for improvement. PRA must make sure these visits take place monthly and a copy of the report is sent to CSCI. A wide range of records were looked at, including fire safety and accident reports. These records were up-to-date and accurate and confirmed that the home is being run responsibly with statutory checks being made and acted on. However in line with guidance from the LFEPA the home must have a fire safety risk assessment of the premises together with an emergency plan which sets out how the building is to be evacuated in the event of a fire. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 X X X Standard No 22 23 Score x 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 2 2 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 2 x X X 3 LIFESTYLES Standard No Score 11 x 12 2 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Chesterfield Gardens 44 & 60 Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 x DS0000010722.V253016.R01.S.doc Version 5.0 Page 21 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 2 3 Standard YA8 YA9 YA23 Regulation 24 13 18 Requirement Timescale for action 30/11/05 4 YA26 23 The registered persons must ensure that residents’ meetings are held regularly. The registered persons must 30/11/05 ensure that risk assessments are kept updated. The registered persons must 30/11/05 ensure that the home has a copy of the relevant local authority guidelines on dealing with abuse. The registered persons must 30/12/05 ensure that each bedroom has a lockable area unless the resident has indicated they do not wish this to be provided. The registered persons must ensure that the manager has regular supervision meetings. The registered persons must ensure that monthly visits to the home by a senior member of staff from the organisation are undertaken. The registered persons must ensure that the home has an upto-date fire safety risk assessment of both premises together with an emergency plan DS0000010722.V253016.R01.S.doc 5 YA36 18 30/11/05 6 YA39 26 30/11/05 7 YA42 23 30/11/05 Chesterfield Gardens 44 & 60 Version 5.0 Page 22 for evacuation of the buildings which have been approved by the LFEPA. 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 YA12 Good Practice Recommendations The registered persons should ensure that further efforts are made to respond to the cultural needs of the identified resident. Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chesterfield Gardens 44 & 60 DS0000010722.V253016.R01.S.doc Version 5.0 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!