CARE HOME ADULTS 18-65
Cranbrook Road (477-481) 477-481 Cranbrook Road Ilford Essex IG2 6ER Lead Inspector
Helen Fontaine Unannounced Inspection 19 October 2005 15:00 Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Cranbrook Road (477-481) Address 477-481 Cranbrook Road Ilford Essex IG2 6ER 020 8586 7781 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) Sahara Homes Ltd Ms Lorraine White Care Home 18 Category(ies) of Learning disability (18) registration, with number of places Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th April 2005 Brief Description of the Service: 477 Cranbrook Road is a care home providing accommodation and support for service users with a learning disability/ physical disability and associated challenging behaviours. The registered providers are Sahara Homes Limited. The home is registered to accommodate 19 service users in two separate units of 10 and 9. House One is wheelchair accessible and has a passenger lift. House Two is more suitable for service users who are independently mobile. The home is situated in a busy residential area of Gants Hill in the London Borough of Redbridge. The area is well served by public transport and there are many easily accessible facilities and amenities within the local area. The home has its own transport. There is a large rear garden, which is wheelchair accessible. The home aims to integrate the service users into community life and supports them to access and participate in mainstream as well as specialist resources in the community in which they live, within their individual capabilities. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Unannounced inspection took place over two and half hours and was carried out as part of the yearly inspection programme. The Manager was present during the inspection and assisted with some of the documentation. A Tour of both of the houses took place and a number of records were looked at. Two of the Service Users were spoken to and a member of staff was talked to during the tour of the home. The previous unannounced inspection took place in April 2005, following an unannounced in January 2005 that raised a number of concerns. However there is now a new Manager who is registered. What the service does well: What has improved since the last inspection? What they could do better:
There are a number of areas that the home needs to improve and two areas remaining from the previous inspection in April. The medication administration records (MAR sheets) were not being completed, it is essential that the home makes sure that all its medication practices are sound, since there is a risk to service users. The visits under Regulation 26 of the Care Homes Regulations 2001 must be undertaken and a copy of the report provided to the Commission.
Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 6 Unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission considering enforcement action to secure compliance. This inspection identified that a number of fire doors were blocked open, one door upstairs by a fire extinguisher and the door between the lounge and kitchen was held open by two wedges. In the ground floor toilet and shower room, the toilet seat was broken, there was no toilet paper available and there was an odour. It is understood the broken toilet seat has been reported for repair as urgent but the home must make sure that the toilet is fully functional. The two fridges in the kitchen both had their door handles broken off, one was completely missing the other had left some of the handle behind. It is very difficult to access the fridge without the handles and these do need replacing. 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. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home does undertake an assessment of prospective Service Users and this covers areas of needs, likes and dislikes. EVIDENCE: During the inspection, initial assessments of prospective Service Users were looked at. The assessments were done by the Manager and covered areas like personal support, social contacts, and cultural, physical and mental health care. One of the sections covered by the assessment was the medical history of a Service User who was insulin dependent with the District Nurses visiting twice a day. This Resident had also had a stoke some years before, leaving a left sided weakness. The section about Personal History had documented that the Service User had lived at home with their family, until one member of the family had fallen. The assessment also covered the areas of what the Service User liked to do and it was documented that they liked to attend the Day Centre, where they had been going for many years. In addition to the homes own assessment present on the file was the assessment, Care Plan and Risk assessments, from the Service Users’ Social Worker. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 8 The home does inform Service Users of their assessed and changing needs and their plan also reflects their aspirations. The staff assist Residents in making decision about their lives if it is needed and all Service Users participate in all events in the home. EVIDENCE: Service Users files looked at during the inspection reflected the Residents ongoing and changing needs. Although there was no direct evidence that the Service Users were involved, documentation showed that preferences and desires were part of the Care Plan. On one Service User’s file it documented that when the Resident returned from the Day Centre, they liked to go straight up to their room and put their slippers on. Although this particular Service User has not been a resident in the home for long, there had already been a review. This was done by the Key worker and was able to identify current and continuing needs of the Service User. During the tour of the home, one of the Service Users was moving themselves independently in the wheelchair, however they were experiencing difficulties getting the wheelchair into the lift. The member of staff asked if this Service User could manage and when asked then assisted them into the lift. Staff
Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 10 were then observed asking the Service User, once downstairs if they wanted to go out and when they indicated they did the staff took them out. The Residents meeting minutes were looked at and these were well documented and each Service User present had been assisted to participate. There was an agenda and areas covered from the previous meeting, although these meetings are not happening every month they are happening frequently enough to allow the Service Users to participate in the events happening in the home. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 17 The staff encourages and support Service Users to undertake social and leisure pursuits mixing with their peer and age groups. Service Users were accessing the local community and having appropriate contact with family and personal friends. EVIDENCE: During the inspection there were quite a number of Service Users and family coming and going from the home. One Service User was going out with a member of staff into the community to go shopping, this resident when asked indicated that they liked going out. Present during the inspection were family members visiting one Service User and other Service Users were out at Day Centres. One of the Service Users file looked at and showed that they had attended the Day Centre for many years; this was documented as being important to the Resident, as they were able to meet up with long standing friends. Another Service User attends another Day Centre twice a week, which allowed them meet with their peer group. The home had for the use of the Service Users an activity room for artwork and also a sensory room. Also available was a separate television room, that would allow either Service Users to have visitors in private or watch particular
Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 12 programmes. However a member of staff said that this room was not used very much as the Residents liked to mix in the large lounge. One Service User spoken to said that they very much liked the food and it was observed during the tour of the home, that there was a meal being prepared. Both houses have their meals prepared in the one kitchen and then each house has it’s own dining area. The Service User spoken to is able to access the kitchen and is able to get snacks and anything they need. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Service Users wishes about how they receive support for personal care is acknowledged. The home ensures that all Service Users emotional and health needs are met. The medication policies and procedures are clear, but there are some isolated inconsistent recording resulting in unsafe practices. EVIDENCE: There is a section in the Care Plan for personal and healthcare support and this was looked at during the inspection. One of the Service Users was a diabetic and had a section in their Care Plan for this health need. The District Nurses visit twice a day and they monitor and give insulin to the Service User. This Resident needed full support with personal care and moving and handling and the care plan stated, “Resident needs to sit down on the shower chair as they are unable to stand for any length of time”. It then went on to say that when providing personal care it is necessary to explain to the Resident what they need to do and when transferring from wheelchair to shower chair to allow plenty of time and ensure the handrail is in place. In part of the Care Plan for another Service User, the area around depression is identified as a need. Here the Care Plan says that if it is observed that the Resident is becoming depressed, staff are to spend time with Service User talking to them and encouraging them to take part in activities.
Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 14 During the inspection the Medication Administration Records (MAR sheets) were looked at and showed that one Service User has not had their medication that morning. On discussion with the Manager and a member of staff, the member of staff said that it had been given but they had forgotten to sign the MAR sheet. The home does need to make sure that all policies and practices are followed for the safety of the Service Users. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has good practises for Service Users to air their views and complaints. Staff are now receiving training and protecting Service Users from abuse, neglect and self-harm. EVIDENCE: The home has a written policy and procedure for the protection of vulnerable adults. The Manager was able to show the recent training dates and the staff attending, but the certificates had not yet come through. The home has Residents meetings and the minutes of the last meetings were seen. The meeting was well attended and it was noted that each Service User was communicated with and their views were documented. Staff were seen responding to requests and questions from the Service Users, which were responded to. The home’s policies and procedures on the handling of Service Users’ money does now reinforce the need for two signatures to be recorded for all financial transactions, to safeguard both staff and Service Users. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30 The home is comfortable and appropriately suited to the needs of the Service Users living there. Bedrooms are designed for the needs of the Service Users and their lifestyle. There are sufficient toilets that provide privacy, but were not all in working order. The home was clean throughout, but one area in the toilet there was an odour. This makes for an unpleasant environment for service users. EVIDENCE: During the inspection a tour of the home was undertaken and one Service User showed the inspector their bedroom. This bedroom was individually decorated and furnished to the requirements of the Service User. However, in the toilet/shower room that this Service Used, the toilet seat was broken and there was no toilet paper available. A member of staff, when this was pointed out, did say that the maintenance man had been informed of the broken seat. It was also noted that there was an odour of urine and a member of staff said Service Users using this toilet had incontinence problems. The home does need to make sure that the home is odour free and needs to find a way of addressing this issue. The home needs to make sure that they maintain the toilets and make sure that all toilets have an adequate supply of toilet paper available.
Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 17 The home has a lift and wide corridors and there is a large lounge/dinning area that is suitable for wheelchairs. The home was light and airy and furnished and equipped to a high standard. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 and 34 Service Users are benefiting from the homes’ recruitment policies and practices and from a competent and qualified staff team. EVIDENCE: During the inspection staff files were looked at, one file looked at was that of the newest member of staff and the other was of a member of staff who had been working at the home for sometime. Both files had two references and CRB’s, identification and personal details with a photo of the member of staff. On both of the files there were a number of training certificates with the newest recruit having, physical intervention, first aid, health and social care pre NVQ 2. The other member of staff had certificates for Medication, sign language, access to social work and community development. The staff rota looked at did clearly show the name of the member of staff on duty and their designation. It was noted that the home had adequate staff to meet the needs of the Service User and to assist the Residents to access activities and the community. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The home is well run but is allowing fire doors to be blocked open, which poses a risk to Service Users. The home does have other areas that are a hazard to the Service User, with broken fridge doors. EVIDENCE: The current Manager is now registered and has a good understanding of the areas in which the home needs to improve. The Manager has already developed some good practices and is very keen to continue to develop and improve the home. It was noted during the tour that one fire door on the top floor was blocked open with a fire extinguisher and the fire door between the kitchen and the lounge/dinning room was blocked open with two wedges. The home must make sure that all fire regulations are adhered to and that home does not place the Service Users at risk. The two fridges in the kitchen, both had their handles broken. A member of staff said that a Service Users accessing the fridge had broken these. One of broken handles is a hazard, as the remaining broken handle has a sharp edge. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 20 The missing handle on the other fridges makes opening the fridge difficult. The home needs to either mend or replace both the broken handles. The registered providers undertake regulation 26 visits but a copy of the report is not always sent to the Commission. Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 3 X 1 X X 1 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Cranbrook Road (477-481) Score 3 3 1 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 1 X DS0000052799.V259270.R01.S.doc Version 5.0 Page 22 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 YA20 Regulation 13 Timescale for action Staff must ensure that if a 19/11/05 prescribed item of medication is not administered, the reason why must be clearly recorded on the Medication Administration Record (MAR) chart. This is repeated from the previous inspection. The Registered person must 19/12/05 ensure that all toilets are maintained and toilet paper is provided. The Registered person must 19/12/05 ensure that the home is free from offensive odours Visits under Regulation 26 of the 19/12/05 Care Homes Regulations 2001 must be undertaken and a copy of the report provided to the Commission. This is repeated from the previous inspection. The Registered person must 02/01/06 ensure that all equipment in the home is maintained and this in regard to the two fridges. Requirement 2. YA27 23 3. 4. YA30 YA39 16 26 5. YA42 23 Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 23 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 Cranbrook Road (477-481) DS0000052799.V259270.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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