Inspection on 08/07/07 for Downs Park Road (93)

This inspection was carried out on 8th July 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Downs Park Road (93) 19/12/06

Downs Park Road (93) 30/11/05

Downs Park Road (93) 19/04/05

Downs Park Road (93) 28/10/04

Downs Park Road (93) 13/05/04

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 Downs Park Road (93) 93 Downs Park Road Hackney London E5 8JE Lead Inspector Rob Cole Unannounced Inspection 8th July 2007 10:00 Downs Park Road (93) DS0000010267.V344671.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 Downs Park Road (93) DS0000010267.V344671.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. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Downs Park Road (93) Address 93 Downs Park Road Hackney London E5 8JE 020 8533 5340 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) Hackney Independent Living Team Ms Ellen Georgiou Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. House not to be left unattended when any tenant is in the house. A worker will always be available by radio pager when house is empty 19th December 2006 Date of last inspection Brief Description of the Service: 93 Downs Park Road is a care home offering support, personal care and accommodation to a maximum of four service users who have learning difficulties. The home offers support 24 hours a day. The home is a large three-storey terraced house situated in a residential area of Clapton, in the London Borough of Hackney. The home has good bus links and is within walking distance of local shops, and amenities. Hackney Independent Living Team, (HILT) manages the home, which is a voluntary sector provider of care services. The current rate of fees charged by the home is £1254.88 per person per week. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days, on the 8th and 13th of July 2007. During the first day of the inspection two service users were present, and one service user was present on the second day of inspection. Service users who were present have complex communication needs, with no speech. The inspector was therefore unable to speak with service users. However, evidence gathered for this report included an observation of the staff interaction with service users, and of service users ability to make decisions and choices over their daily lives. The inspection also included discussions with care staff and the acting senior support worker, an examination of records and other documents, and a tour of the premisis. The CSCI requested that the home complete and return an Annual Quality Assurance Assessment, but this was not returned to the CSCI by the time of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Despite these improvements there are still some issues that must be addressed. The inspector had concerns in relation to a lack of staff training, in particular around medication, adult protection and autism, whilst the inspector was informed that none of the staff have as yet achieved a relevant care Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 6 qualification. Appropriate and adequate training is important to help ensure that service users are safe, and that they receive appropriate levels of care and support. Other areas in need of improvement include staff receiving regular formal one to one supervision, and care plans must include details around service users needs with regard to equalities and diversity issues. 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. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 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 Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that service users are provided with sufficient information about the home to enable them to make an informed choice as to move into the home or not. This information is provided through written documentation, and the opportunity of visiting the home. EVIDENCE: The home has a Statement of Purpose in place. This has been amended since the previous inspection and now includes contact details of the CSCI. Describing the philosophy of care provided, the Statement says that “People will make informed choices about how their service is provided … and make their own decisions.” The Statement also includes details of the aims and objectives of the home, the organisational structure, and details of the staff team and their qualifications. The Statement is written in plain English, and is subject to review. The home has a Service User Guide in place. This was produced in plain English and pictorial form. The Guide contained information about the homes physical environment and the complaints procedure. Brochures were also Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 9 available providing information about Hackney Independent Living Trust (HILT), the organisation that runs the home. There have been no new admissions to the home since the previous inspection, but records evidenced that appropriate pre admission assessments have been carried out in the past. The home has an admissions procedure, this sated that pre admission assessments would be carried out on any referrals, and that prospective service users should be given the opportunity of visiting the home prior to making a decision as to move in or not. All service users have been provided with a tenancy agreement. These include details of the fees charged, the accommodation provided and of the rights and obligations of both parties. Tenancy agreements were in line with National Minimum Standards (NMS). Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the inspector’s judgement that service users have a large measure of control over their daily lives, although the home must ensure that care plans are comprehensive, covering all areas of need, including those around equalities and diversity issues. EVIDENCE: Care plans are in place for all service users. These are drawn up with the involvement of service users, their relatives and staff from the home. Although some plans have been subject to regular review, this is not the case for all of them. For example, the care plan for one service user has a section on dental care. One of the actions to take is to invite the community dental services to the home by May 2005 to provide advice on oral hygiene. There was no evidence as to whether this had taken place, or to suggest that this particular Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 11 care plan had been reviewed since then. It is required that all care plans are subject to regular review, at least once every six months. Plans are however clear and easy to follow. They provide detailed information around health and personal care issues, and indicated that service users are supported to manage their own personal care as much as possible, to maintain and develop independence and dignity. Care plans addressed some issues around equalities and diversity, for instance around disability and religion. However, in other equalities and diversity issues care plans were not sufficiently detailed. The homes currently provides support to a culturally and ethnically diverse client group, yet care plans provided very little information on the needs of service users in this area, or how the home was able to meet those needs. It is required that all service users have comprehensive care plans in place, which are subject to regular review, and that they cover all areas of need, including needs around equalities and diversity issues. Risk assessments are in place for all service users, and these have been subject to regular review. They contain clear information and instructions on how identified risks can be managed and reduced. The homes Statement of Purpose states that service users are supported to take reasonable risks, subject to the completion of a satisfactory risk assessment, and there was evidence that this is indeed the case. For example, one service user is frightened of animals, and it has been identified that there is a risk that they will run out into the road if they encounter a dog whilst out in the community. However, their care plan makes clear that they enjoy visiting a variety of places in the community, and like to access it on a regular basis. Consequently a risk assessment is in place around this issue, which includes clear instructions around calmly informing the service user if a dog is nearby, and ensuring that staff walk in-between the service user and the road, and giving them reassurance. The home currently has four service users, at the time of inspection only two of which were at home. Both service users have complex communication needs, without speech, and the inspector was unable to discuss issues with them. The inspector was however able to observe service users during the course of the inspection, including an observation of their interactions with staff. Through these observations, there was evidence that service users have a large measure of control over their daily lives, and that staff support is provided in a way that promotes choice and independence. For example, during breakfast, one service user indicated that they wanted more sugar for their tea, and staff were observed to facilitate this. Another service user was able to indicate that they preferred toast and jam to beans on toast, which again was facilitated. Discussions with staff and a review of care plans provided further evidence that service users have control over their daily lives. Staff informed the inspector that service users are able to get up and go to bed Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 12 at a time of their choosing, and choose their own clothes to wear. The care plan for one service user stated that they liked to change into their nightclothes at about 4pm, when they returned from day services. Care staff were clear this was the service users choice, and it is respected. There was evidence that the home has taken steps to address equalities and diversity issues with regard to communicating with service users. Some service users have some signs they use to communicate, and staff were observed to have developed a good understanding of this. For one service user, their first language is Arabic (although they understand English when spoken clearly), and the home has various key phrases on display in Arabic to aid communication with this service user, for example “Would you like a drink.” The home holds weekly service user meetings, and again there was evidence that communication tools are used to help meet equalities and diversity issues. The homes menu is planned for the week during these meetings, and an extensive picture card system is used to enable service users to choose and plan their own menu. Again, pictures are used to help plan leisure activities and holidays. The home has recently purchases a new television for the lounge, staff informed the inspector that service users were involved in choosing this. The home has a confidentiality policy in place. This makes clear under what circumstances a confidence may be broken in the health, safety and welfare interests of service users and others. Staff spoken to demonstrated a good understanding of their roles and responsibility with regard to confidentiality issues. Confidential records are stored securely, and staff and service users can access their records as appropriate. Downs Park Road (93) DS0000010267.V344671.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): 11,12,13,14,15,16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the judgement of the inspector that service users are supported to live valued and fulfilling lives, and that they have regular access to the local community. EVIDENCE: Service users have regular access to the community. This in part helps to meet service users needs with regards to equalities and diversity issues. For example, one service user is of Caribbean ethnic origin, and regularly eats at a local Caribbean restaurant, while two service users are supported to attend church on a weekly basis in line with their religious beliefs. On the day of inspection it was observed that the two service users did indeed attend church, and both gave the impression that this was something that they wanted to do. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 14 Other regular activities include visits to pubs, cafes, bowling, the cinema, and parties organised by the home and by other HILT projects. Service users are supported in activities to help promote a healthy lifestyle, including swimming and cycling. The home has a weekly activities plan that was on display within the home. All service users are offered a weeks holiday away from the home, service users are involved in choosing these holidays through their weekly meetings. In house service users have access to a variety of activities, including television, music and dancing and cards. One service user likes to play the keyboard, and they have their own electronic keyboard in their bedroom. Service users have access to day services. Three service users were attending day services on the second day of the inspection. These day services provide service users with the opportunity to develop and maintain relationships, and also the opportunity to participate in a variety of activities, such as gardening. One service user attends art classes run by HILT. Service users access local community facilities, such as shops and banks, and use public transport networks. Service users are involved in the day to day routines of the home, this is detailed in their care plans. During the course of the inspection service users were observed to set the table for lunch, help with the washing up, and to assist with tidying their bedrooms. Service users are able to receive visitors at any time, the inspector was informed by staff that service users can see visitors in private if they so wish. Service users are able to visit their family in their own homes, and regularly go for overnight stays. Two service users were visiting their family on the first day of the inspection. Service users are given their own mail to open, and have access to a telephone, which they can use in private. As mentioned, service users are able to plan their weekly menus. Records are kept of menus, and these indicated that service users are offered a varied, balanced and nutritious diet. There was evidence that the home prepares culturally appropriate food, for example Caribbean cuisine, and that fresh produce is routinely used in cooking. Fresh fruit was available on both days of the inspection. Service users are involved in food preparation, including buying the food. The kitchen was clean and tidy, and food was stored appropriately. Records are maintained of fridge and freezer temperatures. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is the judgement of the inspector that the home is generally able to meet the personal and health care needs of service users. However, the home must ensure that only appropriately trained staff administer medications. EVIDENCE: Service users are supported to manage their own personal care as much as possible, to help promote and develop independence. This is in line with their care plans. Service users are able to choose their own clothes to wear, and all were appropriately dressed on the day of inspection. Any personal care provided to female service users is always given by female staff. To help ensure continuity of care, the home has a keyworker system in place, and all service users have an allocated keyworker. All service users are registered with a GP. Detailed records are maintained of medical appointments, including details of any follow up action necessary. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 16 These indicate that service users have access to a variety of health professionals, including GP’s, chiropodists and opticians. Records indicated that one service user had a dental appointment on the 20/7/05, at which the dentist said they would be referring the service user for an operation. However, there were no further dental records for this person, thus it was not possible to determine whether this operation had taken place, or indeed if they have had any further dental treatment since July 2005. It is required that service users have access to all relevant health care professionals as appropriate, including dental care. One service user uses continence products, and used continence products are disposed of appropriately. The home has an appropriate medication policy, and medications were stored securely in a locked cabinet inside the office. No service users currently self medicate or are on any controlled drugs. Records are maintained of medications entering the home, and of those that are returned to the pharmacist. Medication Administration Record charts are maintained, those examined by the inspector were up to date and accurate. However, on the second day of the inspection the staff member for administering medications on that day informed the inspector that they have not had any training around medication, other then been talked through what was needed by the senior support worker. The senior support worker confirmed that this was indeed the case. The inspector was informed that most staff who administer medications have had appropriate training in this area. It is required that all staff undertake appropriate training in the administration of medication, including an assessment of their competence, before they are able to administer medications within the home. The acting senior support worker informed the inspector that service users would be able to remain in the home with a terminal illness, so long as the home was able to meet their medical needs. For one service user, their care plan indicated that the home had sought and recorded their views on the arrangements to be made in the event of their death. However, it is required that this information is in place for all service users. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that the home has generally appropriate systems in place to help ensure service users are safeguarded from the risk of abuse, although the home must ensure that all staff undertake appropriate training in adult protection issues. EVIDENCE: The home has a complaints procedure in place. This included timescales for responding to any complaints received, and made appropriate reference to the CSCI. The procedure has been produced in pictorial form to help make it more accessible to service users, thus helping to meet their needs with regards to equalities and diversity issues, around disabilities. The home also had a complaints log, although staff informed the inspector that no complaints have been received since the previous inspection. The home has a copy of the Local Authorities adult protection procedures, and also its own policy on adult protection. However, this needs amending, as it is not in line with current legislation. It states that whichever local authority placed a service user at the home has the lead responsibility with regard to any allegations of abuse, yet in fact this responsibility rests with the host local authority, in this case the London Borough of Hackney. Staff on duty spoken to by the inspector demonstrated a good understanding of the issues involved Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 18 with adult protection, and informed the inspector that they have had training in adult protection issues. However, training records seen by the inspector evidenced that as yet not all staff employed at the home have had this training, and this must be addressed. Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28 and 30. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The inspector was satisfied that the home is able to meet its stated purpose with regard to its physical environment. Service users are provided with adequate communal and private space. The home was generally well maintained, although there are some maintenance issues that must be addressed, as detailed below. EVIDENCE: The home is situated in a quiet residential street in the London Borough of Hackney, close to shops, transport networks and other local amenities. The home is in keeping with other homes in the area. The home was well maintained externally, although internally there are a number of maintenance issues that must be addressed, both to help ensure the health, safety and welfare of service users and others, and to ensure that Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 20 they live in a homely environment. Maintenance issues that must be addressed are: • • • • • Windows in upstairs bedrooms must have restricted openings to prevent the possibility of service users falling/jumping from windows. Radiators around the home must have appropriate protective coverings in place to reduce the risk of scalding. The missing cupboard door in the kitchen must be replaced. A working lock with an emergency override device must be fitted to the upstairs bathroom door. It was noted that taps in service user bedrooms were “push” taps, i.e. to get them to work, it is required to press down on the top of the tap, rather then turn the tap. This means that water only comes out of the tap for a very limited period of time before they have to be pressed again, thus causing an inconvenience during personal care such as shaving or brushing teeth. The inspector asked if service users had been consulted over these taps, or if there was any reason why the home had this kind of taps in the bedrooms. Staff were unable to provide satisfactory reasons for these taps, and confirmed that they were not the choice of individual service users. It is therefore required that these taps are replaced with “turn” handle taps, which allow water to flow continually until they are turned of. The home is built over three floors. Communal areas consist of a sitting room, a kitchen/dining area and a garden. The garden was well maintained, with appropriate garden furniture. The home was well decorated, and communal fixtures and fittings were well maintained and domestic in character. Service users were observed to move freely around communal areas. All service users have their own bedrooms, these meet National Minimum Standards on size requirements. Bedrooms contained adequate furniture, including table, chairs, chest of draws and a wardrobe. Carpets, curtains and bedding were well maintained and domestic in character. Service users have been able to personalise their bedrooms, for example with televisions and family photographs. Bedrooms had adequate natural light and ventilation. All bedrooms contained central heating, although as stated radiators must have protective coverings installed. Bedrooms were clean and tidy, and service users have responsibility for keeping their rooms tidy. The home has two bathroom/toilets, and one toilet on its own. Both baths also have showers fitted, thus service users have a choice of bath or shower. The inspector was satisfied that the home has sufficient bathrooms/toilets to meet the needs of service users. Bathrooms were clean, tidy and free from offensive odour. Two of the bathrooms have working locks fitted, however, the bathroom on the second floor has not got a working lock fitted. Instead it has a sign on the door that states that the lock is not working, and to knock before entering. However, the inspector was informed that several of the service users are not Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 21 able to read English, thus this sign is meaningless to them. As stated, a working lock with an override device must be fitted. The home has a separate laundry room, with an impermeable floor covering. Laundry facilities are appropriate in scale for the home. Hand washing facilities are situated around the home, and protective clothing such as gloves and aprons are available to staff to help prevent the spread of infection. None of the current service users require any specialist adaptations around mobility. Downs Park Road (93) DS0000010267.V344671.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): 31,32,33,34,35 and 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although the inspector was satisfied that the home is staffed in sufficient numbers to meet the needs of service users, they have concerns that staff do not have access to all appropriate training and supervision. It was further noted that the home does not carry out all required employment checks for all staff. EVIDENCE: The home provides 24-hour support, including an emergency on-call procedure. There was a staffing rota on display within the home, this accurately reflected the staffing situation on the day of inspection. The rota indicated that staff work flexible shift patterns, based around the needs of service users. The inspector was satisfied that the home is staffed in sufficient numbers to meet the needs of service users. Through observation and discussion there was evidence that staff have built up good relations with service users, and that they have a good understanding of Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 23 the individual needs of service users. Staff were observed to interact with service users in a friendly and respectful manner. Service users were supported and encouraged to do things for themselves as much as possible, for example making their own cup of tea and washing up afterwards. Staff were able to explain to the inspector that promoting independence was central to their work with the service users. On commencing work at the home, new staff undertake an induction programme. This includes a week working in the home in a supernumery capacity, shadowing more experienced members of the staff team. The inspector checked staff training records. These evidenced recent staff training in fire safety, first aid, moving and handling and supervision skills. However, the inspector had concerns that staff have not undertaken all training relevant to the job. As previously stated, not all staff have undertaken training in medication, or adult protection, and it was further found that staff that have not yet had training in food hygiene are expected to be involved with food preparation within the home. It was further noted that many of the care staff have not had any training around working with adults with autism, although several of the service users are autistic. All of this must be addressed. It was further found that none of the care staff have achieved a relevant care qualification (although the acting senior informed the inspector that several staff were currently working towards such a qualification). It is required that at least 50 of the care staff employed at the home have an NVQ Level 2 in Care or equivalent qualification. The home has various employment related polices in place, including recruitment and selection and equal opportunities. The inspector checked staff employment files. These were found to contain CRB checks and employment references, but they did not all contain any proof of ID, such as a copy of a passport or birth certificate. It is required that the home has all necessary documentation in place for all staff, as detailed in Schedule 2 of the Care Homes Regulations 2001. There was evidence of some staff supervisions taking place, but this has only been very sporadic. Several staff have not received regular formal one to one supervision over the past year. It is required that all staff have regular formal supervision, at least six times a year. Where supervision has taken place, records are maintained, and staff get a copy of these records. These evidenced discussions around training needs, performance and service user issues. Downs Park Road (93) DS0000010267.V344671.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): 37,38,39,40,41,42 and 43. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst it is accepted that the home is run in a way that promotes generally beneficial outcomes for service users, it is the inspectors view that service users would further benefit from the appointment of a permanent registered manager. EVIDENCE: The inspector was informed by the acting senior support worker that the home does not currently have a registered manager in place. The home is been run by the manager of another HILT project, who divides his time between the two services, and is supported in the running of Downs Park Road by an acting Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 25 senior support worker. Whilst the inspector acknowledges that the home presents as having a warm and friendly atmosphere, they nevertheless had some concerns that the current management arrangements are not sufficiently meeting the needs off the home. As detailed in this report, there are a number of issues that must be improved upon, including staff training and recruitment practices, health and safety management and care planning. It is consequently required that the home appoints a permanent manager, and applies for their registration with the CSCI. The home has copies of previous inspection reports available to view, and since the last inspection there was evidence that the home now has monthly unannounced Regulation 26 visits. Reports of these visits were available in the home. The home has all necessary policies and procedures in place. These were of a generally satisfactory standard (with the exception of the adult protection procedure as stated elsewhere in this report). Other policies checked by the inspector included equal opportunities, medication and recruitment and selection. All of these appeared to be in line with National Minimum Standards. Records within the home were stored securely, staff and service users can access their records as appropriate. Fire extinguishers were situated around the home. These were last serviced in August 2006. The home tests its fire alarms on a weekly basis, and these were last serviced on the 11/5/07. Regular fire drills are held. The home had in date safety certificates for PAT testing and electrical installation, but there was no evidence of a landlords gas safety check been carried out since May 2005, and it is required that these are carried out at least once every twelve months. COSHH products were stored securely, and the home tests fridge and freezer temperatures daily. However, hot water temperatures have been tested very infrequently over the past twelve months. It is required that all hot water outlets used for personal care are tested at least once a week to ensure the water temperature is 43 degrees centigrade. The home had in date employer’s liability insurance cover in place. Downs Park Road (93) DS0000010267.V344671.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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 1 33 3 34 2 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 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 2 2 3 3 3 3 2 3 Downs Park Road (93) DS0000010267.V344671.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 YA36 Regulation 18(2) Requirement The registered person must ensure that individual staff supervision sessions are consistently conducted (at least six times a year) and documented on file. (Timescale 01/06/07 not met) The registered person must ensure that care plans are subject to regular review, and that they include information on how the home can meet all service users needs, including needs around equalities and diversity issues. The registered person must ensure that service users have access to all relevant health care professionals as appropriate, including dental care. The registered person must ensure that all staff with responsibility for administering medications first undertake appropriate training in medication, including an assessment of their competence. The registered person must ensure that the home seeks and records the wishes of service DS0000010267.V344671.R01.S.doc Timescale for action 30/09/07 2. YA6 15 30/09/07 3. YA19 13 31/07/07 4. YA20 13 31/07/07 5. YA21 15 30/09/07 Downs Park Road (93) Version 5.2 Page 28 6. YA23 13 7. YA23 13 and 18 8. YA24 23 9. YA32 18 10. YA34 19 users on the arrangements to be made in the event of their death. The registered person must ensure that the home has an adult protection procedure which is in line with current legislation. The registered person must ensure that all staff employed to work at the home undertake training in adult protection issues. The registered person must ensure that the following maintenance issues are addressed: • Windows in upstairs bedrooms must have restricted openings to prevent the possibility of service users falling/jumping from windows. • Radiators around the home must have appropriate protective coverings in place to reduce the risk of scalding. • The missing cupboard door in the kitchen must be replaced. • A working lock with an emergency override device must be fitted to the upstairs bathroom door. • Sinks in service users bedrooms must be fitted with taps that let water flow out of them until they are turned of. The registered person must ensure that at least 50 of care staff employed at the home have an NVQ Level 2 in Care or equivalent qualification. The registered person must ensure that the home carries out all employment checks for staff working in the home in line with DS0000010267.V344671.R01.S.doc 30/09/07 30/09/07 31/10/07 31/12/07 31/08/07 Downs Park Road (93) Version 5.2 Page 29 11. YA35 13 and 18 12. YA35 18 13. YA37 8 14. YA42 13 and 23 15. YA42 13 and 23 Schedule 2 of the Care Homes Regulation 2001, including obtaining proof of ID in the form of a passport and birth certificate. The registered person must ensure that all staff with responsibility for food preparation in the home undertake appropriate food hygiene training. The registered person must ensure that care staff working within the home undertake training in working with adults with autism. The registered person must ensure that the home appoints a permanent manager to the home, and applies for their registration with the CSCI. The registered person must ensure that all hot water outlets used for personal care are tested at least once a week to ensure that the water temperature is 43 degrees centigrade. The registered person must ensure that the home has a landlord’s gas safety check carried out at least once every twelve months. 30/09/07 31/10/07 31/10/07 31/07/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Downs Park Road (93) DS0000010267.V344671.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 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. 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