Inspection on 11/10/07 for Chesterfield Gardens 44 & 60

This inspection was carried out on 11th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 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 29/01/07

Chesterfield Gardens 44 & 60 01/11/05

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 Susan Shamash Key Unannounced Inspection 11th October 2007 02:30 Chesterfield Gardens 44 & 60 DS0000010722.V345619.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 Chesterfield Gardens 44 & 60 DS0000010722.V345619.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. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 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 F/P 020 8809 4933 PRA Services (Psychiatric Rehabilitation Association) Marjorie Elaine McIntyre-Porter Care Home 7 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (7) of places Chesterfield Gardens 44 & 60 DS0000010722.V345619.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 category: 2. Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who can be accommodated is: 7 29th January 2007 Date of last inspection 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 Chesterfield Gardens 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 Chesterfield Gardens 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. The home aims to support individuals with mental health needs to live in the community as independently as possible. In October 2007 the fees charged are £547.79/week. Chesterfield Gardens makes inspection reports and other important information about the home available to residents, their families and professionals. Reports can also be viewed on www.csci.org.uk Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted approximately seven hours. The registered manager assisted with the majority of the inspection. A tour of both houses was undertaken and I had the opportunity to speak to all of the seven people living at the service at the time of the inspection. I also spoke to the member of care staff on duty and observed routines within the home. A variety of records, including care plans, staff files and health & safety documents, were examined. Information provided by the home in the Annual Quality Assurance Assessment, was also taken into account as part of the inspection process. What the service does well: A homely and relaxed atmosphere is provided with close attention paid to meeting the needs of each person living at the home. There is an experienced team of care staff who in most cases have worked at the home for a number of years. The overall impression is of a home that is providing an appropriate standard of care within a friendly, homely and supportive environment. People said that they enjoy living at Chesterfield Gardens and there was a very high level of satisfaction with the quality of care they receive. People living at the home are able to choose the content of the menus for the home, and take place in regular meetings during which they are consulted about the running of the home. Staff are continuing to find ways in which the residents can be encouraged to do as much as possible for themselves. For example in some cases residents are taking more control over taking their medication and others now cook more meals within the home. The home is good at treating people living at the home as individuals, with their own needs and wishes who, with support, can do many things for themselves. People living at the home go on holiday at least annually with support from staff living at the home. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: People living at the home must be prompted and supported to attend regular healthcare appointments including dentists and opticians, to safeguard their health and welfare. Guidance agreed by the GP must be put in place regarding the administration of a prescribed medicine to an identified person, and the storage temperature of medicines must be monitored. Work must be undertaken to address a number of minor shortfalls within the environment in the two homes. All members of staff must undertake appropriate induction training, current food hygiene training, and attend person-centred planning training to ensure that the needs and goals of people living at the home are supported in line with best practice. More frequent staff supervision sessions and appraisals must be undertaken to ensure that staff provide a high standard of care and support to people living at the home. More rigorous quality assurance procedures are needed for the home to ensure that people’s views about the home are taken into account. A log of property stored for safekeeping on behalf of people living at the home must be maintained to further protect people living at the home from financial abuse. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 7 A small number of health and safety records must be improved and a current detailed fire risk assessment must be recorded for the home, to ensure the safety of people living and working at the home. 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. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People moving into the home are provided with adequate information and their needs and wishes are assessed so that the home can be sure that it can meet their needs and preferences. EVIDENCE: I had the opportunity to speak with all seven people living at the home albeit only briefly to some of them. Those living in both houses told me that they enjoyed living at the home and thought that all their needs were being met. One person told me ‘It’s a nice place to live. We all help each other out.’ Detailed assessments were available in each person’s care file indicating that a comprehensive assessment is undertaken prior to any person being admitted to the home. The high satisfaction level described by people living at the home indicates that the home continues to be good at selecting people who will benefit from what the home offers, and that the needs and wishes of people living at the home are being responded to appropriately. No new people had been admitted to the home since the previous inspection. However, following the registration of the new manager for the home, the statement of purpose and service users guide had been updated to include current information as appropriate. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 10 In the Annual Quality Assurance Assessment for the home it stated that ordinarily, a desktop assessment is followed by a single informal visit, two meal visits and overnight/weekend stays. The statement of purpose indicates that the home is proactive at recognising the intrinsic value of people, regardless of circumstances, by respecting their uniqueness and their personal needs and treating them with respect at all times. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is effective at assessing and responding to the needs of residents and helping them to make decisions for themselves. People living at the home are supported to take appropriately calculated risks in order to develop their independence skills as far as possible. EVIDENCE: I looked at a selection of care plans, which identified the main needs of people living at the home and how these were being met. One member of care staff was interviewed and told me how they assisted residents to achieve the aims set out in their care plans. As required at the previous inspection all care files inspected contained an up to date care plan and risk assessment, although there remains more room for care plans to reflect person-centred approaches to supporting residents. Action needed in this area is detailed under the ‘Staffing’ section of this report. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 12 The manager advised that although the home wishes for all residents to have allocated social workers and to receive six-monthly Care Programme Approach & psychiatric reviews; in practice resource issues mean that a number of these review meetings have to be held at the home only, and several residents may not have an allocated worker, needing to be seen through the Community Mental Health Team duty system. 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 lead their lives. 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 holiday. Staff support residents to take risks as part of a more independent lifestyle. Some of the residents are now taking more responsibility over taking their medication. In the case of one resident arrangements had to be reviewed when it was noted that they were not taking the medicine appropriately. Feedback from residents indicated that they enjoyed opportunities to do more for themselves. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is good at enabling people to get out and about and lead lives of their choices. Residents enjoy a better quality of life because they have good links with the local community and close contact with friends and family. People are supported to make choices for themselves about how they spend their time, including a variety of leisure activities, educational and work opportunities. They are supported to have as much control over their lives as possible. They are encouraged to help prepare meals at the home and consulted about the menus so that their preferences are taken into account, and a varied and nutritious diet is provided to them. EVIDENCE: Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 14 ‘I help to keep the garden tidy’ one person told me. Others told me that they took part in a variety of daytime activities, including attending day centres, and work projects, as well as helping with the general running of both 44 & 60 Chesterfield Gardens, including cooking meals and cleaning bedrooms. Most people living at the home attend workshops run by the provider organisation during the week, and one attends a gardening project on two days a week. The manager advised that these placements help to maintain their ties to the community and to develop and maintain their social lives and functioning. People living at the home get out and about in their local community, including going shopping, to the cinema, pubs, parks and on outings. Cultural needs are responded to with one resident going to a temple to worship when they wish to (although they usually receive family support with this), and when it is their turn to cook for other residents they frequently make a vegetable curry in line with their cultural needs and wishes. The residents take it in turn to go out to the local shops to buy food for the home. In-house activities include playing board games, barbecues or having friends round. People said they could have visitors when they wanted and spoke positively about how staff members respect their rights and give them responsibility. They told me that they generally enjoyed their holidays, and were looking forward to a trip to Cornwall not long after the inspection. All residents have their own keys, and lockable cabinets within their rooms and staff have no access to personal/private space unless permission is received. Restrictions are kept to a minimum and where they are in place they are stated in the home’s brochure or the contract. I observed that residents and staff know each other well and interact in a relaxed way. As appropriate, since the 1st July 2007 ban the home has become a no-smoking zone. I was impressed to learn that one resident who had been smoking for many years, had managed to stop smoking altogether, not long before the inspection. People that I spoke to advised that they were consulted on menu choices and offered alternatives if they so wished. In the more independent home, residents choose to eat meals together, and these are an important social occasion of the day. The manager advised that staff spend time working with residents who have diabetes and high cholesterol, to encourage them to have a healthier diet. This was also documented in the care plans as appropriate. The manager advised that staff had worked intensively with two people living at the home, to support them to move out into more independent accommodation. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The staff team is good at providing physical and emotional support to residents in a way that they are comfortable with. However they do not receive sufficient support to attend regular healthcare appointments, so people’s healthcare needs are not fully met. Residents are generally protected by the medication arrangements in place in the home, however there is room for improvement in the records maintained to further protect them from harm. EVIDENCE: Staff were observed to interact appropriately with residents and in a way that recognised their individual needs and capabilities. A key worker system is in place so that residents have a member of staff who takes a particular interest in supporting them. Residents themselves commented that they thought their needs were being met and that staff were good at responding to their individual needs. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 16 However there was insufficient evidence that the people living at the home are prompted and supported to attend regular healthcare appointments including dentists and opticians. These must be clearly recorded in order to safeguard their health and welfare. The home encourages some residents to take more responsibility for taking their medication, so that they feel more independent and are better prepared if they move on to a more independent living situation. The records relating to the administration of medication to residents were up to date and accurate. However there was no clear written guidance available, agreed by the GP, regarding the administration of PRN (as and when) Chlorpromazine to an identified person living at the home. This is required to ensure that this person is safeguarded. The storage temperature of medicines stored at room temperature should also be monitored to ensure that it does not exceed 25°C, to ensure that the medication needs of people living at the home are met safely. Chesterfield Gardens 44 & 60 DS0000010722.V345619.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. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system so that people can be confident that their complaints and concerns will be listened to and acted on. People living at the home benefit from adult protection procedures that protect them from abusive practices. EVIDENCE: The home has policies and procedures in place in relation to reporting and investigating complaints with each resident given a copy of the complaint form. The complaint record showed that no complaint had been made since the previous inspection. Residents said they felt able to make complaints and raise issues if they needed to. It remains recommended that a record be kept of comments and suggestions made by residents on the running of the home so that the influence residents have on the service provided at Chesterfield Gardens can be measured more effectively. There had been no incidents in relation to adult protection in the home in the last year. Staff have had training in this area and the staff member on duty was aware of how to respond to incidents or allegations. Residents’ monies kept by the home are checked by two members of staff at the end of each shift to ensure that that there is a proper record kept, with any discrepancies identified quickly. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in homely, clean and comfortable environments and a number of improvements had been made since the previous inspection, improving facilities for people living at the home. A small number of improvements are needed to ensure the comfort and safety of people living at the home. EVIDENCE: The two houses on Chesterfield Gardens provide a 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. At the previous inspection an immediate requirement was made due to the hot water temperature in 44 Chesterfield Gardens being above the permitted range so that residents were at risk of scalding themselves when washing or having a Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 19 bath. As required action had been taken to address this issue, however I noted that records of the temperature of hot water temperature in this bathroom, indicated that the hot water temperature was still occasionally rising above a safe temperature, and this must be addressed without delay. As required, radiators in both 44 & 60 Chesterfield Gardens were fitted with thermostatic valves so that residents can adjust the temperature to their bedrooms. The upstairs bathroom at 60 Chesterfield Gardens had been redecorated so that residents benefit from a more attractive area for washing and showering. Both homes were kept clean with a cleaner coming into both houses regularly as well as residents taking responsibility to keep the houses tidy. Part of the banister at number 60 Chesterfield Gardens was in need of repair, as a railing was loose, and a freezer shelf also needed to be repaired or replaced, as it was broken leaving a sharp edge. The bathroom ceiling and identified windowsills at number 44 Chesterfield Gardens must also be redecorated, to ensure the comfort and safety of people living at the home. It is recommended that paper towels be provided in the bathrooms/toilets to improve hygiene for people living at the homes. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 20 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, 33, 34, 35 and 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a 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 are supported effectively by staff who attend regular training courses. However they do not have the benefit of staff trained in personcentred planning so that they respond more fully to the holistic needs and wishes of residents. Insufficient staff supervision may also place residents at risk of not receiving high quality support at all times. EVIDENCE: I had the opportunity to speak to one staff member and the registered manager. 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 residents. A good deal of positive feedback was received from the residents, indicating that they felt well supported by staff at the home. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 21 I inspected three staff files and these contained sufficient information to ensure that all staff in the home have had the appropriate checks made to ensure that residents are protected from having unsuitable staff working in the home. These checks included two written references and enhanced CRB disclosures. Discussion with the manager indicated that she is aware of the appropriate procedures to follow when recruiting staff. Certificates maintained in files indicated that a number of care staff have achieved NVQ Level 2, as well as attending relevant training courses when necessary. The manager advised that all staff had undertaken or were currently undertaking the NVQ level 2 qualification, and several staff were in the process of undertaking NVQ level 3. The staff member spoken to, advised that they had completed training in essential areas, such as food hygiene, health and safety, administering medication and first aid. Some staff are undertaking NVQ Level 3 training to improve their caring skills further. Staff have a good understanding of the individual needs of each resident but have not had training in person-centred planning which focuses on the individual needs and wishes of residents. This remains required. One person living at the home told me that they wished to have staff available in their home 24 hours daily, and I discussed this with the manager. She agreed that this would be raised in consultation with the person’s placing authority, to ensure that their views regarding their support package are taken into account. All new staff must undertake appropriate induction training this must be recorded. Identified staff members required updated food hygiene training and, inspection of records indicated that more frequent supervision sessions and appraisals must be undertaken to ensure that staff provide a high standard of care and support to people living at the home. In the Annual Quality Assurance Assessment the manager advised that the home’s recruitment practice is underpinned by an equal opportunities policy, and that the ethnic mix of staff members currently reflects the ethnicities faiths and gender of people living at the home. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is generally well run so that people living there benefit from having their individual needs and preferences responded to. Residents contribute to the way in which the home is run, however there is room for improvement in quality control procedures for the home to ensure that high standards of care and support are maintained at all times. Procedures in place to safeguard residents’ finances are generally appropriate to protect them from financial abuse, although this protection could be further improved. Although a large number of safeguards are in place, people living at the home would be better protected from harm by more rigorous health and safety record keeping. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 23 EVIDENCE: A new registered manager had been appointed for the home, and successfully completed the registration process with the CSCI. The new manager had taken over management of the home at a difficult time, following the death of the previous registered manager. The disruption in the running of the home had resulted in record keeping standards slipping with some documents not available or not kept up to date at the previous inspection. However there was a marked improvement in record keeping at the current inspection. The manager advised that regular staff and residents meetings are held at the home during which people can put forward their ideas and suggestions on how the home is run. Meeting minutes indicated that they were used for consultation about the way the home is run, such as organising a short break, the menu for the following week, which days people do their washing and cooking the evening meal. Although the manager advised that monthly quality assurance visits were being undertaken by a representative of the provider organisation, there were insufficient reports of these visits available, to evidence this. Nor had monthly reports been sent to the local CSCI area office, and this is required. More rigorous Quality Assurance procedures be undertaken within the home to ensure that people’s views about the home are taken into account, and the standard of care and support provision at the home meets a high measurable standard. A rigorous procedure was in place for checking residents’ monies, stored for safekeeping by the home. It is also required that a log of property stored should be maintained e.g. bank books. In the Annual Quality Assurance Assessment the manager advised that the home’s policy and practice aims to ensure equality and diversity are respected for all. A current equal opportunities policy was available for the home in addition to a code of practice and residents’ charter, which outlined people’s rights. Health and safety records were looked at, including fire safety and accident reports. These records were maintained up-to-date and accurate. Further action must be taken to ensure that the temperature of hot water is at a safe level at 44 Chesterfield Gardens for the protection of people living at the home from scalding. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 24 Although refrigerator temperatures were being recorded daily, the daily freezer temperatures must also be recorded. Fire drill records must include the time that drills are held and a current detailed fire risk assessment must be produced for the home (following consultation with the local fire prevention authority) to ensure the safety of people living and working at the home. It remains recommended that a record is kept of comments and suggestions made by residents on the running of the home so that the influence residents have on the service provided at Chesterfield Gardens can be measured more effectively. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 2 X 2 2 X Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA19 Regulation 12 Timescale for action The registered persons must 07/12/07 ensure that people living at the home are prompted and supported to attend regular healthcare appointments including dentists and opticians, and that these are recorded to safeguard their health and welfare. The registered persons must 07/12/07 ensure that guidance agreed by the GP is put in place regarding the administration of PRN (as and when) Chlorpromazine to an identified person living at the home. The storage temperature of medicines stored at room temperature should also be monitored to ensure that it does not exceed 25°C to ensure that the medication needs of people living at the home are met safely. The registered persons must 04/01/08 ensure that the broken part of the banister at number 60 Chesterfield Gardens is repaired and that the freezer shelf is DS0000010722.V345619.R01.S.doc Version 5.2 Page 27 Requirement 2. YA20 13(2) 3. YA24 23(2cd) Chesterfield Gardens 44 & 60 repaired or replaced, The bathroom ceiling and identified windowsills at number 44 Chesterfield Gardens must also be redecorated, to ensure the comfort and safety of people living at the home. The registered persons must 04/02/08 ensure that all members of staff attend person-centred planning training to ensure that the needs and goals of people living at the home are supported in line with best practice. (Previous timescale of 31/05/07 not met). The registered persons must 04/12/08 ensure that all new staff undertake appropriate induction training and that this is recorded. All staff must be provided with current food hygiene training and, more frequent supervision sessions and appraisals must be undertaken to ensure that staff provide a high standard of care and support to people living at the home. The registered persons must 04/01/08 ensure that more rigorous QA procedures are undertaken within the home to ensure that people’s views about the home are taken into account, and the standard of care and support provision at the home meets a high measurable standard. Reports of monthly unannounced visits to home on behalf of the provider organisation, must be sent to the local CSCI area office and to the home. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 28 4. YA35 18(1ci) 5. YA35 18(1ci2) 6. YA39 24 26 7. YA41 17(2) Schd 4(9) 8. YA42 13(4c) The registered persons must 07/12/07 maintain a log of property stored for safekeeping on behalf of people living at the home e.g. bank books, to ensure that they are further protected from financial abuse. The registered persons must 23/11/07 ensure that further action is taken to ensure that the temperature of hot water is at a safe level at 44 Chesterfield Gardens for the protection of people living at the home from scalding. (Previous timescale of 31/01/07 not fully met). The registered persons must 07/12/07 ensure that daily freezer temperatures are recorded, the time of day that fire drills begin must be recorded, and a current detailed fire risk assessment must be produced for the home (following consultation with the local fire prevention authority) to ensure the safety of people living and working at the home. 9. YA42 13(4) 17(3) 23(4ae) 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 YA22 Good Practice Recommendations It remains recommended that a record is kept of comments and suggestions made by residents on the running of the home so that the influence residents have on the service provided at Chesterfield Gardens can be measured more effectively. DS0000010722.V345619.R01.S.doc Version 5.2 Page 29 Chesterfield Gardens 44 & 60 2. YA30 It is recommended that paper towels be provided in the bathrooms/toilets to improve hygiene for people living at the homes. Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Chesterfield Gardens 44 & 60 DS0000010722.V345619.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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