Inspection on 03/04/06 for Cranbrook Road (477-481)

This inspection was carried out on 3rd April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cranbrook Road (477-481) 14/09/07

Cranbrook Road (477-481) 08/01/07

Cranbrook Road (477-481) 19/10/05

Cranbrook Road (477-481) 07/04/05

Cranbrook Road (477-481) 19/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Cranbrook Road (477-481) 477-481 Cranbrook Road Ilford Essex IG2 6ER Lead Inspector Ms Gwen Lording Unannounced Inspection 3rd April at 0:800 am and 7 April 20 th Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 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.V287631.R01.S.doc Version 5.1 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.V287631.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cranbrook Road (477-481) Address 477-481 Cranbrook Road Ilford Essex IG2 6ER 020 8554 2057 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 19 Category(ies) of Learning disability (19) registration, with number of places Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 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.V287631.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two separate visits. The first visit during the early morning and afternoon, and the second visit during the late morning and afternoon. This was a key inspection visit in the inspection programme for 2006/2007. All parts of the home were visited on the first day and the ground floor on the second day. Staff records were examined on the first day and care records examined on both days. Where possible residents were asked to give their views of the service and their experience of living in the home. For some of the residents their level of disability meant that this was not possible. However, the Inspector was able to communicate with two residents with the assistance of staff. An invitation had been sent to the authorities responsible for placing residents in the home but only one response was received. The Inspector took the opportunity to speak to a District Nurse who was visiting the home during the inspection. Discussion took place with the registered manager, who was present during both visits. Care staff were asked about the care that residents receive, and were also observed carrying out their duties during both visits. Two Statutory Requirement Notices were issued on 10/03/06 for breach of Regulations in relation to failure to notify the Commission of events under Regulation 37 and failure to undertake regular visits in compliance with Regulation 26. At this inspection the registered providers were able to evidence that the Statutory Requirement Notices have been complied with. The Commission is aware of a number of adult protection matters that are subject to ongoing investigation. The registered providers are working cooperatively with the Commission and local authority to address these matters. The Inspector would like to thank the staff and residents for their input and assistance during the inspection. What the service does well: During both days of the inspection staff were observed providing residents with assistance and support and were respectful of their right to make decisions. Staff support residents to maintain family links inside and outside the home and their involvement is encouraged, with individual resident’s agreement. Residents’ physical health care needs are monitored and this ensures that residents’ needs are recognised and met. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: 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.V287631.R01.S.doc Version 5.1 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.V287631.R01.S.doc Version 5.1 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): Standard 2 and 3 Appropriate assessments are carried out prior to admission to the home, and the information is being used by the home to set out written care plans, but this does not mean that all residents, and their representatives can be sure that all their needs will be met by the home. EVIDENCE: The files of all nine residents were examined. Where assessments had been carried out by the placing authority, there was a copy on file. There were also pre-admission assessments by the home, and the information had been used to continue assessment once the resident moved into the home, and to develop written care plans. Several of the care plans have been developed during the past six weeks, some in response to reviews carried out by the placing social services departments. The homes Statement of Purpose states that the home can meet the needs of residents with a learning disability and associated conditions such as sensory impairment; physical disability and challenging behaviours. However, whilst examining the file of one resident it was noted that he had a mild learning disability with an associated diagnosed mental health problem. It is the responsibility of the registered providers in accordance with their Statement of Purpose to demonstrate that the assessed needs of all residents are being understood and met, whether these needs are the primary reason for admission or not. In this instance because of the extremely high dependency levels of other residents the home may be unable to meet the lower dependency needs of this resident. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 9 The day-to-day practice in relation to care plans is commented on in the next section of the report, Individual Needs and Choices. The evidence to support Judgement 2 is also set out in the section on Individual Needs and Choices. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Residents’ health, personal and social care needs are set out in an individual plan of care, but not all care plans are detailed enough to provide staff with sufficient information about how to meet residents’ individual needs on a day to day basis. Staff provide residents with assistance and support to enable them to make decisions about their own lives. EVIDENCE: The care plans of all nine residents were examined, staff and where possible residents, were asked about the care being provided. There was evidence to show that the development of care plans has been given a high priority over the past 6 weeks, since the issues raised in the ongoing adult protection investigation. However, the standard and development of care planning is still not consistent for all residents. Entries in daily recordings did not always relate to specific care plans and some entries made gave very little indication of the actual care given. Comments made included: “Personal care given; went for a ride in the minibus; watched TV/ Video; ate dinner well. The manager stated that staff are receiving training on report writing and the completion and implementation of care plans. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 11 The authorities commissioning services for individuals, and the registered manager must ensure that they both clearly understand that the service which is being commissioned, is the same as the service being provided to a resident. Both parties need to ensure that their understanding of the terminology used in the contracts and care plans are compatible. For example,1:1 supervision; close supervision; close contact supervision. Such clarity is required in the best interests of a resident’s protection, health, welfare and safety. There was evidence that some referrals had been made to visiting specialist health professionals but in some cases the Medical Appointments pro forma was not being maintained. Up to date information pertaining to an accident sustained by a resident had to be sought from a number of different sources. The Commission is concerned about the ability of the home to meet the diverse and wide range of needs that residents have. The home currently has 9 residents between 21 and 56 years of age who have a learning disability ranging from mild to severe. In addition to a learning disability, individuals have a wide range of physical, psychological, rehabilitative and social care needs. In all, these needs span functional mental health problems, unstable insulin dependant diabetes, wheelchair dependency, continence problems, assistance with feeding and challenging behaviours. The registered providers must be able to demonstrate that the assessed needs of all residents are being understood and met. This must include staff having appropriate experience, knowledge and training in the care of the full range of illnesses and disabilities that the current residents have, whether they are the primary reason for admission or not. This training must also be included in the induction programme so that all new members of staff are equipped with the knowledge and skills to deliver the complex and diverse levels of care required. Risk assessments were in place for the use of equipment such as cot sides and lap belts. Permission had been sought for its use through discussion with relatives or representatives of the resident and was detailed in the individual care plan. As a result of the ongoing adult protection investigation risk assessments covering other areas have been reviewed. Currently neither the manager nor the organisation acts as an appointed agent for any resident. Written records of all transactions are maintained and receipts kept where necessary. Secure facilities are provided for the safekeeping of money and valuables on behalf of residents. One resident manages all his own financial affairs and retains responsibility for all his bank and building society matters. Residents require varying degrees of support with their finances. Where support is needed, the reasons for, and the manner of support must be clearly documented in the individual’s care plan and regularly reviewed. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 12 During both days of the inspection staff were observed providing residents with assistance and support and were respectful of their right to make decisions. Information is displayed on the residents’ notice board in the main corridor about how to access local independent advocacy services and several residents have named advocates. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13,14, 15, 16 and 17. Residents are provided with varied and nutritional meals, staff promote healthy eating where possible and individual preferences are catered for. The lifestyle within the home matches the expectations of some residents, but not others. In particular social and recreational needs are not being met for those residents who are more independent and require social and emotional support. Family and friends are welcomed and involved in activities in the home so that residents are able to maintain these links. EVIDENCE: Residents, where possible, were asked their views, and the lifestyle of the residents was observed over the two visits, as well as care plans being examined. Most of the residents attend specialist day centres and others participate in leisure activities in the community including swimming, shopping and eating out. Staff were observed to be supporting some individuals to pursue their individual interests and hobbies for example, football. One of the Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 14 younger residents was admitted to the home at the beginning of the year for a period of respite until a more suitable semi-independent placement could be identified for him. He has a very mild learning disability with associated mental health problems, is very independent and attends college where he is studying for a National Vocational Qualification. His care plan gave very little indication of his needs and included only limited information regarding his emotional needs and the support he needed to develop and maintain social, emotional and communication skills and personal relationships. Through discussion with him it was apparent that these are the key areas he would like support with. In discussion with the manager it appears that staff sometimes accompany him to the cinema or other events at the weekend but this is dependant on staff availability and is not planned for as part of his care. Staff time with, and support for, an individual resident outside the home, should be flexibly provided, include evenings and weekends and be a recognised part of staff duties. The home must be able to meet an individual’s needs with particular attention to gender, age, sexuality, cultural background and personal interests. It is important that individuals are able to develop and maintain personal relationships whilst they are resident in a care home. The management of personal relationships has been an issue of concern. The manager must ensure that the home has the policies and that the staff have the required knowledge and skills, appropriate to the needs of people living in the home, around supporting relationships whilst still ensuring protection against abuse. The Inspector left some Department of Health publications with the manager around Effective Sexual Health Promotion and Self-Esteem Building for people with learning disabilities, physical and sensory impairment. The manager stated that this guidance was in line with the training she has begun with care staff. Staff support residents to maintain family links and friendships inside and outside the home and their involvement is encouraged, with individual resident’s agreement. Two residents regularly spend weekends at home and contact with the families of other residents is encouraged and supported by staff. For example one resident recently celebrated his fortieth birthday and his extended family were able to hold a party in the home. At the recent Mother’s Day, staff were able to support residents to make contact with their mothers through writing and sending cards or making contact by phone on the day. Those residents spoken to indicated that they enjoyed the food and there is sufficient choice. Staff are aware of individual likes/ dislikes and those residents who had special dietary needs, such as diabetic diet, and cultural and religious requirements and preferences, for example the purchasing of particular Halal foods. Residents are supported where possible to be involved in the preparation of meals. There is a wide range of drinks and snacks available at all times to meet individual needs. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 15 As many of the residents are attending day services during the day, the main meal is served in the evening. Residents from both Houses eat in House 1, though it was not clear from the care plans that this had been discussed with residents and was in accordance with their individual choice. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 16 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): Standards 18, 19 and 20 The medication policies and procedures are clear and staff have received training to ensure the safe administration of medication to residents. For those residents who are self-medicating, risk assessments must be updated regularly to ensure that any changes are recorded and acted upon. Residents’ physical health care needs are monitored and this ensures that residents’ needs are recognised and met. EVIDENCE: There are policies and procedures for the handling and recording of medicines in the home and the majority of staff have received an appropriate level of training. One resident retains and administers his own medication and there is a self-medicating policy/ procedure to support this activity. The resident has a lockable facility in his room and there was a completed risk assessment in his care plan. The manager must ensure that this risk assessment is regularly reviewed and any changes recorded. All of the care plans examined recorded referrals to specialist health care professionals and that appointments were being kept. However, the care plans must include all up to date information about the outcomes or follow up issues relating to any outside appointments. Two residents are insulin dependant diabetics and receive visits by the District Nursing service twice a day. One of Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 17 the visiting District Nurses was spoken to and he was very positive about the home’s management of the residents specific care needs and the effective level of communication between himself and the home. The Inspector noted that the District Nurse administered an insulin injection to a resident in the main lounge. The manager must ensure that any visits to residents from medical/ health care practitioners take place in private. The majority of staff have undertaken training in the management of people with epilepsy and there was evidence to show that staff were maintaining up to date and detailed epilepsy monitoring charts. Staff were observed to be providing residents with sensitive and flexible personal support and all such support is provided in private. Intimate personal care by staff of the same gender as the resident is provided, where possible, and if the resident wishes. In other such situations two staff are always available. One female resident is continent during the day as the staff follow an agreed continence programme. However, during the night the resident has to use incontinent pads, as she cannot summon staff for assistance, as she is unable to activate the alarm call bell due to reduced mobility in her hands. The manager must seek specialist support and advice, as needed, for example, wrist alarm or possible modification of current equipment in order to maximise this resident’s dignity, independence and control over this aspect of her life. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 18 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): Standards 22 and 23. The manager and staff make every effort to sort out any problems and concerns. However, all complaints/ issues of concern must be recorded and followed up so that residents and their relatives feel confident that their complaints are listened to and will be acted upon. All staff working in the home have now received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: There is a written policy and procedure for the protection of vulnerable adults and whistle blowing. All staff working in the home have now received training in Adult Protection/ Abuse Awareness and this topic is also included in the induction training for all newly appointed staff. Those staff spoken to were conversant with the action to take for responding to any suspected or witnessed abuse or neglect to ensure the safety and protection of residents. The manager must ensure that the home’s written policy is understood by all staff and reinforced at regular intervals There are a number of adult protection matters that are subject to ongoing investigation, led by the police. The registered providers are working cooperatively with the Commission and the local authority to address these matters. The home has a complaint policy/ procedure, which is also produced in a part pictorial format for the benefit of residents. The records indicate the number of complaints received and brief details of any action taken. The manager must Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 19 ensure that all complaints/ issues of concern are recorded with details of the investigation, any action taken and the outcome for the complainant. There was no evidence of the action taken to address concerns raised by residents, at previous meetings. The manager and staff must listen to and act upon the views and concerns of residents and others, as expressed for example at house meetings. This will help to highlight to the management team any concerns being expressed by residents to staff, that may be recorded in the house meeting minutes, but that are not necessarily being relayed to the manager by staff. Staff should encourage discussion and action on issues raised by residents before they develop into problems or formal complaints. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 20 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): Standards 24 and 30 The décor furnishings and fittings in the home are of a good standard but some of the facilities and arrangements in the communal areas appear sparse and do not provide a home-like atmosphere for all residents living in the home. EVIDENCE: The home is divided into two separate units of 10 and 9 residents. House 1 is fully wheelchair accessible and has a passenger lift. House 2 is more suitable for residents who are independently mobile. Several of the residents present varying degrees of challenging behaviour and others are wheelchair users, which to some degree has restricted the use of some homely fittings and furnishings such as rugs, wall hangings, ornaments etc. However because of the diverse needs, levels of independence and mobility of all the residents the current living environment is not appropriate or conducive to the preferred lifestyle of some residents in the home. On resident described the lounge as “bare and plain”. The manager must review the physical environment in the communal areas of the home particularly the lounge/ dining areas. This is to ensure that the furnishings/ fittings are as domestic and ordinary as can be achieved to meet individual and collective needs of all residents and provide surroundings that are homely, comfortable and safe for all residents to live in and in line with the home’s Statement of Purpose. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 21 All the bedrooms are single, have en suite facilities and are furnished and decorated to suit individual’s preferences and particular needs. The home was very clean during both visits with no offensive odours throughout. There is a well-equipped laundry in each house, which some residents are able to use with the support of staff. The London Borough of Redbridge, Public Protection Unit, undertook a Food Hygiene inspection of the premises on the 9/03/06. The report states that the premises were “Satisfactory”. The home has CCTV cameras which are restricted to the entrance areas only for security purposes and do not impinge on the daily life of the residents. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 22 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): Standards 32, 34 and 35 The home employs staff in sufficient numbers, to meet the needs of the residents, but the wide range of needs that the home is attempting to meet may mean that there is a skills shortfall. The home’s recruitment policies are not being consistently followed and may result in residents receiving care from staff members who have not been properly vetted. EVIDENCE: Health and personal care needs were discussed with the manager and some staff, and staff were observed carrying out their duties during both visits. The duty rota was examined during the first visit and when compared with the needs identified in the care plans there were sufficient numbers of staff on each shift to meet the need. As stated earlier in this report the Commission is concerned that the home is attempting to meet a very wide range of needs. Staff would need to be extremely knowledgeable and experienced to meet all needs comprehensively. This was discussed with the manager, who reported that she believed that collectively the staff group did have the knowledge and skills to meet all the needs of current residents. A requirement has been made in this report so that the manager must demonstrate to the Commission that this is the case. The required skills audit and training needs analysis will need to take account of all current needs i.e. care of people with challenging behaviour; people with physical disabilities; functional mental health and psychological problems; younger people during transition to more independent Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 23 living; people with a mild to severe learning disability; and associated health problems such as unstable insulin dependant diabetes and epilepsy. It will also need to take into account current standards of good practice and guidelines in social care policy, such as Valuing People, for services for people with learning disabilities. These skills must be reflected across all shifts. As previously commented on in this report the Commission is aware of a number of adult protection matters that are subject to ongoing investigation. A number off staff have been suspended from duty, without prejudice, whilst the investigation continues. The home has made satisfactory arrangements to staff the home in their continued absence and has transferred staff from other homes within the organisation to make up the shortfall in numbers however; there remains a skills shortfall. An examination of three staff personnel files identified that one member of had been recruited to work in the home without a POVA first check having been undertaken, though a Criminal Records Bureau (CRB) disclosure had been applied for. Whilst this member of staff was working under the direct supervision of another experienced member of care staff, the manager must ensure that all the required checks are undertaken prior to any member of staff commencing employment in the home. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 24 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): Standards 37, 39, 41 and 42. The manager is an experienced and qualified person. However, she must ensure that the residents’ best interests are safeguarded by the home’s record keeping. It is also essential that the lines of accountability and monitoring systems within the home are robust enough to ensure that the manager is, at all times, fully appraised of any issues relating to the day to day running of the home and the specialist needs of residents. EVIDENCE: Two Statutory Requirement Notices were issued on 10/03/06 for breach of Regulations in relation to failure of the home to notify the Commission of events under Regulation 37; and failure of the registered providers to undertake monitoring visits to the home in compliance with Regulation 26 of the Care Homes Regulations 2001. Since the issuing of these Notices the registered providers have complied with both these regulations. Monitoring visits are now being undertaken by a designated representative of the organisation to monitor and report on the quality of the service provided in Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 25 the home. These reports are now more comprehensive and a copy of the report is sent to the Commission. The registered manager must put in place more effective monitoring systems to enable her to maintain informed day-to-day control of the delivery of care. Whilst some day-to-day responsibilities may be delegated to a deputy manager or senior carer, the registered manager retains overall responsibility and must ensure that any such arrangements are monitored effectively. A wide range of records were looked at, including fire safety, emergency lighting, recording of water temperatures, accidents/ incidents and portable appliance testing (PAT). These records were detailed, up to date and accurate. Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 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 2 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 2 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 2 3 X 2 3 X Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2YA3YA6 Regulation Requirement Timescale for action 31/07/06 2. YA12YA15YA23 3. YA12YA15 12, 13, 15 The registered persons & 18 must be able to demonstrate that the assessed personal, health and social care needs of all residents are being met. This must include staff having appropriate experience and knowledge in the care of the full range of illnesses and disabilities that the current residents have, whether they are the primary reason for admission to the home or not. 12, 13, 15 The registered persons & 18 must ensure that the home has the policies and the staff have the required knowledge and skills, appropriate to the needs of people living in the home, around supporting relationships whilst still ensuring protection against abuse. 15 Care plans need to be more specific with regard DS0000052799.V287631.R01.S.doc 30/06/06 31/05/06 Cranbrook Road (477-481) Version 5.1 Page 28 4. YA14YA16 16(2) (m) (n) 5. YA18 12 & 13 6. YA18 12 & 16 7. YA20 13 8. YA22 22 to the recording of personal, social care needs and leisure activities. Clarity is required with regard to the service, which is being commissioned, and the service, which is being provided. Residents must be given opportunities for stimulation through leisure and recreational activities, in and outside the home, which suit their needs, preferences, and individual capacities. Particular consideration should be given to residents who are more independent but still require support. The registered manager must ensure that any visits to residents from medical/ health care practitioners take place in private. The registered manager must seek specialist support and advice as needed for the resident who is unable to activate the alarm call bell during the night. For those residents who are self-medicating the registered manager must ensure that the risk assessment is regularly reviewed and any changes recorded. The registered manager must ensure that all complaints/ issues of concern are recorded with details of the investigation, any action 30/05/06 07/04/06 30/05/06 30/05/06 07/04/06 Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 29 9. 10. 11. 12. 13. taken and the outcome for the complainant. YA24 23 The registered manager must review the physical environment in the communal areas of the home, particularly the lounge/ dining areas. This is to ensure that the individual and collective needs of all residents are being met through the provision of surroundings that are homely, comfortable and safe. YA31YA32YA33YA35 18 The registered manager must carry out a skills audit, and training needs analysis on all staff. From this a training and development programme must be developed so as to ensure that the wide range of needs of the residents can be comprehensively met. YA33 18 The registered manager must ensure that the staff skill mix and experience on each shift is appropriate to meet the needs of all residents. YA34 19 The registered manager schedule must ensure that all the 2 required checks are undertaken prior to any member of staff commencing employment in the home. YA37YA38YA41 9, 17 & 24 The registered manager must put in place effective monitoring systems to enable her to maintain informed dayto-day control of the delivery of care in the home. 30/05/06 31/07/06 31/07/06 07/04/06 31/07/06 Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 30 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.V287631.R01.S.doc Version 5.1 Page 31 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 © 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 Cranbrook Road (477-481) DS0000052799.V287631.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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