Inspection on 08/01/07 for Cranbrook Road (477-481)

This inspection was carried out on 8th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 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) 03/04/06

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 Key Unannounced Inspection 8th January 2007 10:00 Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 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) info@saharahomes.co.uk Sahara Homes Ltd None registered at present Care Home 19 Category(ies) of Learning disability (19) registration, with number of places Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2006 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. On the day of the inspection the range of fees for the home was between £500.00 and £2,299.00 per week. A copy of the Statement of Purpose and service user guide is made available to both the residents and their family or representative. A copy of both these documents and the most recent inspection report are available in both House’s 1 and 2. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by the lead inspector, Gwen Lording. It started at 10am and took place over seven hours. A new manager has recently taken up post, and she was available throughout the visit to aid the inspection process. This was a second key inspection visit in the inspection programme for 2006/2007. Discussion took place with the manager and care staff were asked about the care that residents receive, and were also observed carrying out their duties. Where possible residents were asked to give their views of the service and their experience of living in the home. For some residents this was not possible due to their level of disability. However, the inspector was able to communicate with these residents with the assistance of staff. The inspector also took the opportunity to speak to one resident’s advocate, who was visiting the home at the time. She spoke very positively about the care the resident was receiving in the home. A tour of both houses was undertaken and all areas were clean and tidy with no offensive odours throughout. A random sample of residents’ files were case tracked, together with examination of staff and other home records, including medication administration, staff rotas, accident/ incident reports, maintenance records and staff recruitment procedures and files. Information was also taken from a pre-inspection questionnaire, which was completed by the manager. Between March 2006 and June 2006 there were a number of adult protection matters that were subject to ongoing investigation, led by the police. The registered providers undertook a voluntary agreement to restrict the number of admissions to the home during the course of the investigation. This restriction was lifted following the conclusion to the investigation and it was agreed with the registered providers that the resumption of admissions to the home be phased in on a gradual basis. During this time the registered providers worked co-operatively with the Commission, local authorities and the police to address these matters. The registered provider and the home’s previous registered manager were able to attend the feedback by the inspector at the end of the visit and this was helpful in clarifying a number of issues. The inspector would like to thank the staff and residents for their input during the inspection. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Whilst staff have a good understanding of the individual residents needs and were seen to be providing good personal care, it is essential that health records are adequately maintained in care plans and planned interventions are appropriately recorded and actioned. The registered provider must operate a robust recruitment procedure and ensure all necessary information; checks, references and documents are obtained prior to the commencement of employment of all staff. If the majority of activities continue to take place in House one, then alternative access arrangements between the two houses must be made. This is to ensure that residents and staff moving between the two houses are protected from inclement weather conditions. The recently appointed manager must submit an application with the Commission to be registered as the manager. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessments completed by the home and the information and reports received from health and social care professionals means that staff have detailed information to enable them to determine whether or not the home can meet a prospective residents needs. EVIDENCE: Since the last inspection only one resident has been admitted to the home and this is for short periods of respite admission. In ongoing discussions with the registered providers since that last inspection, it is evident that they have been asked to assess prospective residents. However, they do not accept residents for admission if they determine that they cannot fully meet any prospective residents needs. The file of the resident admitted for periods of respite care was examined and this was found to contain a detailed assessment that had been undertaken prior to their admission to the home. Where assessments had been carried out by the placing authority, there was a copy of this assessment and care plan on file. Contracts are included in each residents file. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 10 The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006, for new residents, and for existing residents with effect from the 1st October 2006, so that more comprehensive information is to be included in the service users’ guide. Details of information to be included are contained within the amended regulations. Therefore, the service users’ guide must be reviewed and amended by the stated timescales. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal and social care needs are set out in individual plans of care, but care plans are still not being used as working tools and do not always provide staff with sufficient written information about how to meet residents’ individual needs on a day to day basis. EVIDENCE: Individual care plans are available for each resident. Five residents were case tracked and their care plans and related documentation examined. There was a noted improvement in the development and general standard of care plans however, this was not to a consistent standard for all residents. Whilst it was evident that care plans were being reviewed/ evaluated on a monthly basis, some of the care plans examined did not reflect changes identified. Care plans must reflect any changes identified at reviews; appointments with GP’s and other health professionals, so as to accurately record changing and current needs. In discussion with some staff it was evident that they were knowledgeable about residents individual care and were able to provide good Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 12 verbal information. However, it is important that written care plans be used as working tools and are sufficiently detailed as to be understood and used by others who may not be as familiar with the individual resident. Recordings are made by staff in individual daily communication diaries, but many of these entries gave little indication of the actual care given. (The evidence to support this judgement is set out in the section on Personal and Healthcare Support) Residents require varying degrees of support with their finances. Where support is needed, the reasons for and manner of support must be clearly documented in the individual’s care plan and regularly reviewed. Risk assessments are in place, but can be improved, as the specialist needs of residents must be balanced with choice, independence and normal living. For example, one resident has 15 minute recorded observations throughout the night, as he is prone to falls. Personal aids and equipment have been obtained to minimise the risk and it is strongly recommended that the risk assessment be reviewed by the appropriate agencies involved in his care. Information is displayed on the residents’ notice board in the main corridor about how to access local advocacy services and several residents have named advocates. On the day of the visit the inspector was able to speak to a visiting advocate for one resident. She was very positive about the quality of care being provided to the individual resident she works with, and to other residents in the home. There is a focus on maintaining and promoting independence whenever possible, and individual staff were observed providing residents with information, assistance and support and were respectful of their right to make decisions. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with varied and nutritional meals and individual preferences are catered for. Residents are involved to varying degrees in menu planning, cooking and shopping. Opportunities for social and leisure pursuits and personal development are actively promoted and supported by staff, for all residents to enable them to participate in the wider community in which they live. Family and friends are welcomed and involved in activities in the home, so that residents are able to maintain these links. EVIDENCE: Each resident has an individual planned activity programme, which takes account of the resident’s preferences, interests, experiences, age and capabilities related to their disability. Residents, where possible were asked Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 14 their views, and the activity programmes of those residents case tracked were discussed with key workers. Some residents attend specialist day centres and others have programmes of activities in the home being managed/ supervised by the staff. For example, planned daily activity programme monitored by the psychology department for one resident, which has proved very successful; and another resident is being supported by staff in his transition to supported housing. All residents are supported to participate in leisure activities in the community, both specialist and mainstream. On the day of the visit staff were observed to be supporting individuals to pursue their individual interests and hobbies. House 1 has a sensory room and an activities room on the top floor, but it appears that these facilities are rarely used and the majority of activities take place in the main lounges in House one. Where appropriate residents are involved in taking some domestic responsibility for their room. Staff support residents to maintain family links, and their involvement is encouraged, with individual residents agreement. One resident was due to return from weekend leave at home with parents, on the day of the visit. Those residents spoken to indicated that they liked the food and there is sufficient choice. The staff prepare and cook meals with some involvement from the residents and staff know what each person likes to eat and those residents who have special dietary needs, such as diabetic diet. The lunchtime meal was observed to be very relaxed, staff were patient and helpful, and residents were not rushed. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The concerns around the management of health records impacts upon the assessed judgement on this group of standards. Health records were not being adequately maintained in individual care plans and planned interventions were not always being appropriately actioned to ensure effective healthcare support. There are clear medication policies and procedures for staff to follow. However, there are some inconsistencies in the recording of medication, which may result in unsafe practices. EVIDENCE: All of the care plans examined recorded referrals to specialist health care professionals and that appointments were being kept. However, not all the care plans included up to date information about the outcomes or followed up issues relating to outside appointments. For example, one resident had attended a GP’s appointment and it was advised that an appointment be made with the Epilepsy nurse specialist, but no follow up action had been recorded. On the file of another resident it was noted that she had attended an Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 16 outpatient appointment and a letter had been sent to the GP advising a change in medication. Again it was not recorded if this had been actioned accordingly. Where there were gaps in recording information, staff were able to give a good verbal account. However, it is essential that this is clearly recorded in individual care plans to provide up to date information and ensure effective healthcare support. A number of monitoring charts were examined however, not all charts were being maintained as directed. The following was noted and discussed with the manager: • In the care plan of one resident it was noted that his appetite is sometimes diminished and he should be offered nutritional supplements, and this was observed to be happening. Staff stated that his weight was monitored monthly. However, on examination of his weight monitoring chart the last recorded entry was April 06. The care plan of the same resident had a completed risk assessment that indicated half hourly observations during the night. This was due to the frequency of his epileptic fits. On examination of the monitoring charts it indicated that fifteen-minute observations be made. However, the recorded observations were very sporadic and there were significant gaps in the recording intervals. • If specific recordings are indicated for a resident then these are important health records and must be monitored by the manager accordingly. It is essential that all monitoring records are maintained accurately and up to date. 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. There are policies and procedures for the handling and recording of medication. An audit was undertaken of the management of medicines in the home, and Medication Administration Record (MAR) charts were examined. The following issues were discussed with the manager: • Hand written entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information i.e. GP, District Nurse. When directions for administering medicines are variable i.e. one or two tablets, then the dose given is to be entered on the MAR chart. • Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 17 • When signing and witnessing the administration of a Controlled Drug (CD) both members of staff must sign the CD register with their full signature; initials, first name or printed names are not acceptable practice. The manager was provided with a copy of Medical Device Alert Ref: MDA/2006/066, issued on the 6/12/06 regarding the use of lancing devices for blood glucose monitoring in nursing homes. The manager is required to take the appropriate action as detailed in this alert as issued by the Medicines and Healthcare products Regulatory Agency (MHRA). At the last inspection a requirement was made for the registered providers to seek specialist support and advice as needed for a resident who was unable to activate the alarm call bell whilst in bed at night. There was an effective continence programme being followed by staff during the day, but incontinent pads were being used during the night, as the resident was unable to activate the alarm due to reduced mobility in her hands. Whilst contact has been made with a specialist service, little progress has been made. The manager must continue to actively progress this issue in order to maximise the resident’s dignity, independence and control over this aspect of her life. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered persons make every effort to sort out problems and concerns and make sure that residents and their relatives feel confident that their complaints and concerns are listened to and will be acted upon. All staff working in the home have received training in Adult Protection/ Abuse Awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: There are policies and procedures for dealing with complaints, which is also produced in a part pictorial format that is well presented and more easily accessible by this resident group. At the last inspection a requirement was made for all complaints/ issues of concern to be recorded with details of the investigation, any action taken and the outcome for the complainant. The inspector was able to evidence that this requirement has been met. One resident spoken to about what they would do if they were unhappy with anything said: “Ask the staff to help me”. Another resident said: I can speak to anyone” There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. All staff working in the home have received training in Adult Protection/ Abuse Awareness, and this included in the induction training for all new staff. Those staff spoken to during the inspection were aware of the Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 19 actions to be taken if there were concerns about the welfare and safety of residents. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The overall atmosphere in House 1 is very welcoming and the décor and furnishings in both houses are of a good standard. The manager must ensure that the physical environment in the communal areas in House 2 are appropriate to the specific needs of all the residents living there. The safety and protection of staff and residents must be assured whilst they are moving between the two houses. EVIDENCE: Both houses were toured, accompanied by the manager at the start of the inspection. All the bedrooms are single, have en suite facilities and are furnished and decorated to suit individual’s preferences and particular needs; and are reflective of their interests, hobbies and lifestyle. All areas of both houses were clean, tidy and free from odour throughout. There is a wellCranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 21 equipped utility room in each house, which some residents are able to use with the support of staff. As stated in the last inspection report a requirement was made for the registered providers to review the physical environment in the communal areas in House 2 to ensure that they are appropriate to the specific needs of all the residents living there. There was no evidence to demonstrate that this requirement had been met and this requirement is therefore repeated with a new timescale for action. Although House 2 has the facilities, such as lounge / dining room and kitchen these are not conducive to a homely environment. This is possibly due to the fact that the majority of activities of daily living, including main meals, take place in House one; and that neither houses are accommodated to their full capacity. At the time of registration of the service it was the intention of the registered providers to operate House 1 and House 2 as two separate units under the management of one registered manager. This obviously does not appear to have happened. Residents and staff from House 2 access House I via the rear garden or via the front doors. If the majority of activities continue to take place in House 1, the registered providers must make alternative access arrangements between the two houses, such as an interconnecting doorway. This is to ensure that residents/ staff moving between the two houses are protected from inclement weather conditions. This situation is also not conducive to enabling individual residents whose bedrooms are in House 2, to access their rooms as and when they wish during the day, as the House is often unoccupied during the day. The home has CCTV cameras, which are restricted to the entrance and perimeter areas only for security purposes. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The concerns around the home’s recruitment procedures impacts upon the assessed judgement on this group of standards. Staffing levels are satisfactory and there are sufficient staff on duty to meet the individual needs of the residents. The home’s recruitment procedures are not being consistently followed and may result in residents receiving care from staff members who have not been properly vetted. EVIDENCE: Staff rotas were inspected and the staffing levels, gender and skill mix of staff was sufficient to meet the assessed needs of residents. The service now has a relatively stable staff team and effective team working was observed and evidenced throughout the inspection. In discussion with staff it was evident that they understand and fully support the main aims and values of the home. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 23 The two houses are registered as one service under the management of one registered manager. (Concerns around how this currently operates in practice during the day have been reported on earlier in this report). During the night there is one member of staff on waking night duty in both house one and two; and one member of staff sleeping in House one. Through observation of staff interaction with residents’, it is evident that they have confidence in the staff that care for them, and that staff have a good understanding and knowledge of the particular needs of the residents. Staff were seen to have the skills to communicate effectively with all residents. An examination of four staff personnel files identified that staff had been recruited to work in the home without a POVA first check having been undertaken, though Criminal Records Bureau (CRB) disclosures had been applied for and obtained for all these individuals. In discussion with the proprietor it was evident that the organisational systems in place to ensure that all necessary checks are completed prior to the commencement of employment, were not sufficiently robust. The registered providers must ensure that all necessary information and documents are obtained as specified in Regulation 19, Schedule 2 of the Care Homes Regulations 2001; and operated in line with the organisations recruitment policies/ procedures. This is an unmet requirement from the last inspection and must be complied with by the new timescale. The pre-inspection questionnaire completed by the manager stated that 60 of care staff are qualified to NVQ level 2 or above, and a further five staff have enrolled to undertake this qualification. All new appointed staff receive induction training in line with “Skills for Care” training. Staff training records showed that staff had received training in essential areas such as health and safety, fire safety, protection of vulnerable adults and first aid. Other training undertaken by care staff includes management of epilepsy, diabetes and care planning. The service has recently changed the pharmacy services to the home and there is a planned programme of medication training with the new service. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39, 41 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The registered providers must ensure that the home is efficiently managed in the absence of a registered manager. They must ensure that there is an effective system in place for monitoring practice and compliance with record keeping, and in line with the home’s Statement of Purpose and policies and procedures. This will ensure that residents benefit from a home that is run in their best interests. EVIDENCE: The current manager has been in post since November 2006, following the transfer of the previous registered manager to another service within the organisation. The current manager has not yet submitted an application to be registered as the manager of the service and this will be requirement in this report. Ms Warren is qualified to NVQ level 3 and has significant supervisory Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 25 experience in similar care settings. With the support of the registered providers she is seeking to secure a place to undertake the Registered Manager’s Award. It is not possible to comment on her fitness to manage the service and this will be determined by the Commission’s Central Registration Team, through the registration process, which includes a ‘Fit Person’ interview. Concerns and corresponding requirements around effective record keeping; adherence to policy and procedure; the management of medicines; environmental issues and effective communication have already been detailed in this report. The registered providers must ensure that there are effective monitoring systems in place in order to ensure that the care home fulfils its stated purpose and objectives, and meets the needs of the people who live there. From discussions with staff and records inspected it was evident that staff receive regular formal supervision and staff meetings take place on a regular basis. A representative of the organisation undertakes monthly Regulation 26 monitoring visits and a copy of the report is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Resident’s financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of a small number of residents and secure facilities are provided for their safekeeping, with records being maintained. A wide range of records were looked at including, fire safety, emergency lighting, accident/ incident records and Portable Appliance Testing (PAT). These were found to be detailed, up to date and accurate. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 3 X 2 2 X Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 27 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 YA18 YA29 Regulation 12 & 16 Requirement Timescale for action 28/02/07 2. YA24 23 3. YA34 19 schedule 2 4. YA6 15 The registered provider must seek specialist support and advice as needed for the resident who is unable to activate the alarm call bell during the night. (Timescale of 30/05/06 not met) 28/02/07 The registered provider 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. (Timescale of 30/05/06 not met) The registered provider must 08/01/07 ensure that all the required checks are undertaken prior to any member of staff commencing employment in the home. (Timescale of 07/04/06 not met) The registered provider must 28/02/07 ensure that care plans are working tools and provide staff DS0000052799.V322340.R01.S.doc Version 5.2 Cranbrook Road (477-481) Page 28 with sufficient information about how to meet residents’ individual needs on a day-to-day basis. Care plans must reflect any changes identified at reviews; appointments with GP’s; and other health professionals, so as to accurately record changing and current needs. The registered provider must 28/02/07 ensure that where a resident requires support with their finances, the reasons for and the manner of support must be clearly documented in the individual’s care plan and regularly reviewed. The registered provider must 08/01/07 ensure that all health records are adequately maintained and planned interventions/ instructions from health care professionals are actioned accordingly. The registered provider must 08/01/07 ensure the following: • Handwritten entries on MAR charts must be signed and dated by the person making the entry. The entry must also include the source of the information. i.e. GP, District Nurse. • When directions for administering medicines are variable i.e. one or two tablets, then the dose given is to be entered on the MAR chart. When signing and witnessing the administration of a Controlled Drug (CD), both members of staff must sign the CD register with Version 5.2 Page 29 5. YA7 15 6. YA19 12 & 13 7. YA20 13 • Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc their full signature. 8. YA24 23 The registered provider must make suitable alternative access arrangements between the two houses. This is to ensure that residents and staff moving between the two houses are protected from inclement weather conditions. The registered provider must ensure that the current manager submit an application to the Commission to be registered as the manager of the home. The registered provider must ensure that residents’ best interests are safeguarded by the home’s record keeping. 31/03/07 9. YA37 8&9 31/01/07 10. YA41 YA42 17 08/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA9 Good Practice Recommendations It is strongly recommended that the risk assessment be reviewed by the appropriate agencies, for the resident who has fifteen minute recorded observations throughout the night. The specialist needs of residents must be balanced with choice, independence and normal living. Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cranbrook Road (477-481) DS0000052799.V322340.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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