Inspection on 13/05/08 for Chesterfield Gardens 44 & 60

This inspection was carried out on 13th May 2008.

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

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Chesterfield Gardens 44 & 60 11/10/07

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 Unannounced Inspection 13th May 2008 12:00 Chesterfield Gardens 44 & 60 DS0000010722.V363177.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.V363177.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.V363177.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.V363177.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 11th October 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. Fees charged as of October 2007 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.V363177.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took 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 six of the seven people living at the service at the time of the inspection. I also spoke to two members 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. Particular attention was paid to the homes management of Safeguarding Adults (Protecting Adults from Abuse). 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. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 6 People living at the home go on holiday at least annually with support from staff living at the home. The home has a track record of supporting people to gain the confidence and skills to move on to more independent settings. What has improved since the last inspection? What they could do better: People living at the home would benefit from more organised activities being offered to them in the evenings and at weekends, to ensure that they are encouraged to live stimulating and fulfilling lives. It remains required that all people living at the home must be prompted and supported to attend regular healthcare appointments including dentists and opticians, and that these must be recorded, to safeguard their health and welfare. Evidence must be available that all staff have had detailed induction training and have current fire safety and food hygiene training to ensure that they work with residents safely and in line with best practice. Likewise evidence is needed that staff have regular supervision sessions and appraisals. It remains required that more rigorous Quality Assurance procedures must 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. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 7 The Annual Quality Assurance Assessment must also be completed for the home and returned to the CSCI without delay. The CSCI must be notified of any major incidents at the home that affect residents including flooding, failure of central heating systems etc. and no records should be removed from the home without keeping a copy of the original record to ensure that the home is run efficiently in the best interests of residents. The home’s fire risk assessment must be updated to include greater detail to ensure the safety of people living and working at the home. All foods stored in the home’s refrigerators should be labelled with the date of opening and the date by which they should be discarded to ensure that residents’ health is protected by safe food handling procedures. It is recommended that the training undertaken by staff in person centred support, be used to develop more detailed and accessible care plans, including more varied goals for residents. It is also recommended that a record be kept of comments and suggestions made by residents on the running of the home, that consideration be given to buying a computer and printer for the home and that records of fire drills include the names of all residents and staff involved, for more efficient administration of 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.V363177.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.V363177.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): 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’s needs and wishes are fully assessed so that the home can be sure that it can meet their needs and preferences. EVIDENCE: I had the opportunity to speak with six of the 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 ‘I like living here – it’s a good place to live. We all help each other.’ Detailed assessments were available in each person’s care file indicating that a comprehensive assessment including social, cultural and emotional needs is undertaken prior to any person being admitted to the home. The high satisfaction level described by people living at the home also indicates that the home has a track record of being 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. Chesterfield Gardens 44 & 60 DS0000010722.V363177.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 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. Staff are effective at assessing and responding to the needs of people living at the home 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 four care plans, which identified the main needs of people living at the home and how these were being met. I also spoke to two staff members, who told me how they assisted residents to achieve the aims set out in their care plans including assisting or prompting people with personal hygiene, cooking, budgeting and social and cultural needs. 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. As required at the previous inspection staff had undertaken training in person centred planning, however this has yet Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 11 to be incorporated into people’s care plans. Some residents had a limited number of goals recorded for them, and would benefit from more detail being recorded about how their care needs and goals are actually met. It is recommended that this area be addressed to ensure to ensure that people’s needs and goals are addressed to a high measurable standard. The member of care staff interviewed was aware of the need to provide guidance and support to residents where necessary, whilst letting them make their own decisions as far as possible. People living at the home told me that 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. One resident is now taking more responsibility over taking their medication, whilst another is receiving increased help in this area following compliance issues. Feedback from residents indicated that they enjoyed opportunities to do more for themselves. Chesterfield Gardens 44 & 60 DS0000010722.V363177.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, 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. They 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 choices of leisure activities, educational and work opportunities. They are supported to have as much control over their lives as possible, but would benefit from more choices of leisure activities. 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: ‘We do all out own cooking’ one person told me. Others told me that they took part in a variety of daytime activities, including attending day centres, and Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 13 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, and occasional trips 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. One resident told me that staff were supporting them to keep in contact with family members abroad. Inspection of records, alongside discussion with staff and residents indicated that little in the way of recreational activities took place in the evenings and at weekends. This was clearly a choice on the part of some people living at the home but less so for others. A requirement is made accordingly to ensure that they are encouraged to live stimulating and fulfilling lives. Residents usually go on an annual holiday, and were looking forward to planning the next trip. 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. One resident has managed to stay off cigarettes after giving up with support from staff, having been smoking for many years. 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. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 14 The manager advised that staff were now worked with two people living at the home, to support them to move out into more independent accommodation in time. Chesterfield Gardens 44 & 60 DS0000010722.V363177.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 protected by the medication arrangements in place in the home. 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. 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. For example there was no record that one person had Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 16 been to the dentist for three years. Appointments must be clearly recorded in an format that makes them easy to monitor, in order to safeguard residents’ 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. As required the storage temperature for medicines was being monitored to ensure that it does not exceed 25°C. Chesterfield Gardens 44 & 60 DS0000010722.V363177.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. The area of adult protection, was addressed in particular detail during this inspection visit, in line with the Commission’s policy of highlighting the importance of staff awareness in this area. There had been no incidents in relation to adult protection in the home in the last year. Recruitment procedures are sufficiently rigorous to ensure the protection of people living at the home from abuse. Staff have had training in Safeguarding Adults and the home has appropriate adult protection and whistle blowing policies, which staff Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 18 told me they had read. The manager and both staff members on duty were aware of how to respond to incidents or allegations. One staff member told me about how they had dealt with an allegation of suspected abuse by another service user at an external day service, and records confirmed that this had been addressed appropriately. The manager advised that residents are provided with information about their rights within the home’s handbook. She also advised that she would raise this issue at future resident meetings. 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.V363177.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 and 30. 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 live in homely, clean and comfortable environments and a number of improvements had been made since the previous inspection, improving facilities for residents. 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 bath. As required action had been taken to address this issue. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 20 Radiators in both 44 & 60 Chesterfield Gardens were fitted with thermostatic valves so that residents can adjust the temperature to their bedrooms. By the time of the previous inspection, 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. As required at the previous inspection, part of the banister at number 60 Chesterfield Gardens had been repaired, and a new freezer had been ordered for the kitchen, as the broken shelving could not be repaired. The bathroom ceiling and identified windowsills at number 44 Chesterfield Gardens had also been redecorated, to ensure the comfort and safety of people living at the home. As recommended, paper towels were being provided in the bathrooms/toilets to improve hygiene for people living at the homes. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a committed and experienced team of staff at the home who have the skills and training needed to meet their needs. They 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 sufficient staff with up to date training in food hygiene and fire safety for their protection. 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 with two staff members 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.V363177.R01.S.doc Version 5.2 Page 22 I inspected three staff files and these contained sufficient information to demonstrate that all staff in the home have had the appropriate checks made to ensure that residents are protected from having unsuitable staff working at 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. In the previous 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. 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. This was confirmed by staff that I spoke to. The staff members spoken to advised that they had completed training in essential areas, such as food hygiene, health and safety, administering medication and first aid. Staff have a good understanding of the individual needs of each resident, and as required at the previous inspection they confirmed that they had now undertaken training in person-centred planning which focuses on the individual needs and wishes of residents. As noted under Standard 6, this training has yet to be carried forward into raising the quality of care plans for each person living at the home. One person living at the home told me that they would still prefer to have staff available in their home 24 hours daily, and I discussed this with the manager. She agreed that this would be raised again with the person’s placing authority, to ensure that their views regarding their support package are taken into account. Although staff told me that they had had thorough inductions prior to commencing work at the home, and this was confirmed by the manager, there were no records to evidence this. A requirement made accordingly at the last inspection is therefore restated. The manager advised that records were held at the head office for the organisation, however this needs to be kept at the home on staff members files. Identified staff members still required updated food hygiene training and, all needed an update in fire safety training. Inspection of records and discussion with staff indicated that some supervision sessions and appraisals are undertaken to ensure that staff provide a high standard of care and support to people living at the home. However insufficient records were available to evidence this. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 23 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 to ensure that high standards of care and support are maintained at all times. Rigorous health and safety procedures are in place to ensure that people living at the home are protected from harm. However insufficient notifications to the CSCI regarding events affecting residents and inadequate records available at the home, may place residents at risk of having some needs unmet. EVIDENCE: Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 24 The registered manager for the home has sufficient experience and qualifications to undertake this role, and advised that she receives support from the provider organisation as appropriate. 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. However although residents confirmed that they attend residents meetings, there were insufficient records of these meetings to indicate that these are held regularly. The manager advised that this was due to the most recent records having been taken to the provider’s head office for monitoring and typing. No records should be removed from the home, or sent to head office without keeping a copy of the original record within the home, as this causes disruption to the service that residents receive. Following the inspection visit, the manager provided evidence that a resident meeting was held in April 2008, and that staff team meetings were held in April and March 2008. As required at the previous inspection, reports of regular visits by the provider organisation are sent to the CSCI monthly and the manager confirmed that these had been happening. At the previous inspection it was required that 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. The manager advised that no quality assurance audit had been undertaken since the previous inspection, and this requirement is therefore restated. 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. The CSCI was notified, as appropriate, that the responsible individual for the provider organisation of the home, is currently unavailable due to ill health. It is acknowledged that his absence may partially explain some of the issues found relating to documents not available at the home which had apparently been taken to head office for monitoring and typing purposes. The current Annual Quality Assurance Assessment must still be completed for the home and returned to the CSCI without delay. Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 25 I was concerned to learn of two incidents that had occurred at the home one involving flooding at one of the houses and the other lack of central heating for a significant period of time. Although staff and residents assured me that appropriate actions had been taken to address these, these incidents should have been notified to the CSCI as they clearly would have affected residents’ welfare. A rigorous procedure was in place for checking residents’ monies, stored for safekeeping by the home. As required, a log of property stored e.g. bank books is now maintained. 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 gas and electrical installation certificates, portable appliances testing, water quality and fire safety and accident reports. These records were maintained up-to-date and accurate. As required action had been taken to ensure that the temperature of hot water is at a safe level at 44 Chesterfield Gardens, and daily freezer temperatures were also be recorded. As required fire drill records also included the time that drills are held. Following the inspection, the manager provided a copy of the general risk assessment for the home dated May 2008 which includes fire safety. However the information provided was not as detailed as information provided in the previous year’s fire risk assessment e.g. it included information about the safety of people smoking in the home, and should be updated accordingly. During the inspection I noted some perishable items stored in the home’s refrigerators that were opened but not labelled with the date of opening and the date by which they should be discarded. A requirement is made accordingly to ensure that residents’ health is protected by safe food handling procedures. In view of some of the problems with records not available at the home, it is recommended that a computer and printer be provided in the staff office, so that records do not need to be sent to head office for printing, and can be produced more speedily for the efficient running of the home. It is also recommended that records of fire drills include the names of all residents and staff involved, to ensure that all relevant people are included in drills at some point each year. Chesterfield Gardens 44 & 60 DS0000010722.V363177.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 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 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 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X 2 3 3 Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 27 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 YA14 Regulation 16(2mn) Requirement Timescale for action 04/07/08 2. YA19 12 3. YA35 16(2j) 18(1ci2) 23(4d) The registered persons must ensure that more organised activities are offered to residents in the evenings and at weekends, to ensure that they are encouraged to live stimulating and fulfilling lives. 27/06/08 The registered persons must 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. (Previous timescale of 07/12/07 not met). The registered persons 18/07/08 must ensure that induction records for all staff are maintained at the home. All staff must be provided with current fire safety and food hygiene training Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 28 and, Evidence must be available at the home that staff receive supervision sessions at least six times annually and annual appraisals to evidence this, to ensure that staff provide a high standard of care and support to people living at the home. The registered persons 27/06/08 must ensure that more rigorous Quality Assurance 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. The Annual Quality Assurance Assessment must be completed for the home and returned to the CSCI without delay. The registered persons 06/06/08 must ensure that the CSCI is notified of any major incidents at the homes, that affect residents including flooding, failure of central heating systems etc. No records should be removed from the home, or sent to head office without keeping a copy of the original record within the home. The registered persons must ensure that the fire DS0000010722.V363177.R01.S.doc 4. YA39 24 5. YA41 17, 37 6. YA42 23(4) 27/06/08 Chesterfield Gardens 44 & 60 Version 5.2 Page 29 7. YA42 16(2ij) risk assessment for the home is updated to include greater detail about all possible fire hazards and how these are addressed at the home. (Previous timescale of 07/12/07 not met). The registered persons must ensure that perishable items stored in the home’s refrigerators are labelled with the date of opening and the date by which they should be discarded to ensure that residents’ health is protected by safe food handling procedures. 20/06/08 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 YA6 Good Practice Recommendations It is recommended that the training undertaken by staff in person centred support, is used to develop more detailed and accessible care plans, including more varied goals for residents. 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. It is recommended that a computer and printer be provided in the staff office, so that records do not need to be sent to head office for printing, and can be produced more speedily for the efficient running of the home. It is recommended that records of fire drills include the names of all residents and staff involved, to ensure that all relevant people are included in drills at some point each year. 2. YA22 3. YA24 4. YA42 Chesterfield Gardens 44 & 60 DS0000010722.V363177.R01.S.doc Version 5.2 Page 30 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. 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