Inspection on 25/04/05 for Chesterfield Gardens 44 & 60

This inspection was carried out on 25th April 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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 01/11/05

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 44 & 60 CHESTERFIELD GARDENS London N4 1LP Lead Inspector Brian Bowie Announced 25th April 2005 @ 8:30 am 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 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 Stationary 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. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 3 SERVICE INFORMATION Name of service 44 & 60 Chesterfield Gardens Address London N4 1LP Telephone number Fax number Email 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 Mrs Mavis Ramsey of PRA Services (Psychiatric Rehabilitation Association) Mrs Norma Willis PC Care Home 7 Category(ies) of MD registration, with number of places Conditions of registration Date of last inspection 20/8/04 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. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over one day and lasted 9 hours. The manager was present throughout 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. On the day of the inspection no relatives or friends were present at the home but written comments were received in which they had given their views and comments on the home. All three staff on duty were also spoken to. A variety of records, including careplans, staff files and health & safety documents, were looked at. What the service does well: What has improved since the last inspection? At the previous inspection there had been 12 areas which the home had to improve. The home had taken action on 9 of these areas and as a result the majority of these areas are now better than before. This represents a more satisfactory response than previously by the home to ensuring that areas identified at previous inspections as needing improvement have been attended to. Three areas which relate to the maintenance of the two properties still need to be sorted out and are mentioned again in this report in order that they get done in the near future. Five new areas for improvement were identified at this inspection. Staff are putting more effort into finding 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 whilst 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 5 some are now cooking meals within the home. The manager together with PRA has also updated a number of the policies and procedures concerning the running of the home. 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. 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. What they could do better: A number of areas where the home could be doing better were discussed and agreed with the manager: • • • Careplans and risk assessments need to be regularly reviewed and updated. The medication administration sheets need to be a completely accurate record. In relation to the maintenance of the two properties repairs and replacements need to be completed more quickly than at present in order to ensure the home provides suitable and attractive living environments at all times. Care staff need to have regular 1-to-1 meetings with the manager so that their practice can be further improved. The ways in which the home reviews and improves the service it offers need to be more thorough and make more use of the views and comments of residents themselves. • • Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 6 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 Standards Statutory Requirements Identified During the Inspection 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 7 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 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: ‘So far it’s fine here.’ This resident had visited the home several times before moving in so that he could be sure it was the right place for him. His case file contained an assessment by his social worker and the psychiatrist of his needs and wishes. The manager had put together a plan of care setting out how this person’s needs and wishes would be met by the home. She had also completed a risk assessment to ensure that any risks identified could be managed by the home. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 8 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 standard(s) 6,7,9 The home is good at helping residents to make decisions for themselves about what they want to do and when they want to do it and taking calculated risks so that residents are helped to be as independent as possible. The plans for the care of the residents, including weighing up risks, need to be improved so that residents can be confident that these plans reflect properly their changing needs. EVIDENCE: Both 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 regular 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. 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. One resident had been supported by staff to attend a local day centre with a minicab provided to ensure he arrived safely. Feedback 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 9 from the residents themselves showed that they were enjoying these opportunities to do more for themselves. Plans of care were looked at and indicated the main needs of residents and how these were to be met. However these plans, including the assessments of risk levels, were not being reviewed and updated regularly enough. The manager agreed that systems for plans of care were still being developed and were in need of improvement. The home must make sure that these plans of care, including assessments of risk, are reviewed regularly and updated. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 10 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 standard(s) 13,15,17 Residents are getting a better quality of life because of the good links with the local community and the close contact with friends and family. Mealtimes are enjoyed by the residents who benefit from the opportunity to help prepare the meals and make sure there is a choice about what to eat. EVIDENCE: Public transport is used by residents who get out and about and make use of local facilities such as shops, cafes and pubs. One resident whose use of English is limited has made social links and contacts with people from his country of origin who live locally, including neighbours and shopkeepers. The residents take it in turn to go out to the local shops to buy food for the home. Residents said they could have visitors when they wanted and the written feedback from families indicated they felt welcomed at the home. One resident was very pleased that he was getting help from staff so that he could make the long journey to visit his elderly mother. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 11 Residents were spoken to over a snack lunch they had sorted out themselves. They were very relaxed and enjoying what they were eating. One resident said: ‘The food is good here. I like curries and get to have them.’ 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 12 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 standard(s) 19,20 Staff are good at supporting residents in a way which makes sure their physical and health needs are met. Record-keeping in relation to the administration of residents is not completely accurate so that residents are not fully protected at all times. EVIDENCE: The GP for the home had written that he was satisfied with the overall care provided to residents at Chesterfield Gardens. Feedback from families was also positive and included the comment: ‘I am delighted with the care and attention my brother has been receiving from the staff and I would like to thank you.’ Residents themselves commented that they thought their needs were being met and that staff were good at responding to their individual needs. The home is encouraging and enabling residents to take more responsibility for taking their medication. However the records relating to the administration of medication to residents indicated that an omission had been made in recording the medication given out on one specific occasion. The home must ensure that these records are always accurate. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 13 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 standard(s) 22,23 The home has a satisfactory complaints system so that residents and relatives feel confident their complaints and concerns will be listened to and acted on. The residents benefit from adult protection procedures which make sure that residents are safe and secure whilst at Chesterfield Gardens. 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. Some said: ‘We’ve got no complaints.’ Written comments from relatives confirmed that they had not had to make complaints about the home. The home had copies of the relevant local authority guidelines on dealing with abuse. There had been no incidents in relation to adult protection in the home in the last year. On one occasion the home had acted promptly when the whereabouts of a resident were unknown for a short period of time and as a result had quickly discovered where they were. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 14 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 standard(s) 24,30 Residents benefit from a clean and hygienic environment but do not have the benefit of a home that is well maintained at all times. EVIDENCE: Chesterfield Gardens provides 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. However some minor items of repair noted at the previous inspection had not yet been acted on. These included replacing the carpet in the office, the flooring in the toilets at 44 & 60, and a section of the kitchen flooring in 60. PRA must ensure that items needing repair and/or replacement are sorted out sooner rather than later and that the items listed above are dealt with swiftly. Throughout the inspection the home was found to be clean and hygienic. Written comments from residents and relatives indicated that they considered a satisfactory standard was being achieved in this area. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,35,36 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 however do not fully benefit from staff who are regularly guided on how to improve their practice. EVIDENCE: All 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 and their relatives. One family wrote about their relative: ‘He seems to be getting on quite well. The staff are very friendly when we speak to them on the phone.’ One resident commented: ‘I like it here. Staff are good and polite. I feel my needs are being met.’ 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 were looked at and showed that staff had done training in essential areas, such as food hygiene, health and safety, administering medication and first aid. Each member of staff has a training profile which lists the training they have done, and any training needs identified. Some staff are undertaking NVQ Level 2 training to improve their caring skills further. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 16 The staff files showed that staff are only having one-to-one supervision meetings with the manager now and again, and not on the regular twomonthly basis needed to ensure staff are fully supported and guided on how to improve their practice. The manager must ensure that she supervises all care staff at least two-monthly. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,42 The home runs well so that the residents really benefit by living at Chesterfield Gardens. However residents do not at present have sufficient say in how the home works out the quality of the care provided before residents can be completely confident it is run in their best interests. The home is good at making sure the residents are kept safe and secure whilst living at Chesterfield Gardens. 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 is also doing 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: ’This is a well run home.’ Feedback, written and verbal, from both residents and relatives, was positive about the way in which the home is run. The home has a policy on how it reviews the quality of care provided, but had not yet produced reports which highlight clearly what the home is doing well 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 18 and where things need to be better. These surveys need to draw on the views and comments of residents, relatives and professionals involved with the home in order that a system of ongoing evaluation and improvement takes place. The manager agreed that this area needed developing further. The home must make sure the views and wishes of residents are actively sought out so that they shape the way the home is run. A wide range of records were looked at, including fire safety and accident reports. These records were detailed, up-to-date and accurate and confirmed that the home is being run responsibly with statutory checks being made and acted on. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 44 & 60 CHESTERFIELD GARDENS Score Standard No 24 25 26 27 Version 1.00 Score 2 x x x Page 19 6 7 8 9 10 LIFESTYLES 2 3 x 3 x Score 28 29 30 STAFFING x x 3 Standard No 11 12 13 14 15 16 17 x x 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 x x 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 3 x 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15 Requirement The plans of care for residents, including assessments of risk, must be reviewed regularly and updated. The medication records must be accurate at all times. Items needing repair and/or replacement must be sorted out sooner rather than later. Action must be taken in relation to the items specified as needing repair or replacement. (Previous timescale of 30/9/04 not met) The manager must ensure that she supervises all care staff at least two-monthly. The views and wishes of residents regarding the home must be actively sought out and must shape the way the home is run. Timescale for action 30 June 2005 31 May 2005 30 June 2005 30 June 2005 30 June 2005 31 July 2005 2. 3. 4. 20 24 24 17 23 23 5. 6. 36 39 18 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 21 1. 44 & 60 CHESTERFIELD GARDENS Version 1.00 Page 22 Commission for Social Care Inspection North London Area Office Solar House, 1st Floor 282 Chase Road 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. 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