CARE HOME ADULTS 18-65
Edgeworth Crescent 55 Hendon London NW4 4HA Lead Inspector
Tola Akinde-Hummel Unannounced Inspection 5th January 2006 09:00 Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Edgeworth Crescent 55 Address Hendon London NW4 4HA 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) 020 8203 4707 020 8203 4707 edgeworth@norwood.org.uk Norwood Ravenswood T/A Norwood Ms Tracey Ann Evans Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1), Physical disability (1) of places Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Limited to 6 adults of either gender with a learning disability (LD). Specific Service user with a Physical Disability One specific service user who is currently resident in the home and also has a physical disability can reside in this home. This condition will need to be reviewed when s/he vacates the home. Specific service user over 65 years One specific service user who is currently resident in the home and is over 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. 25th July 2005 3. Date of last inspection Brief Description of the Service: 55 Edgeworth Crescent is a residential care home accommodating six young adults with mild to moderate learning disabilities. The home is owned and run by Norwood/Ravenswood, a Jewish Charity that provides a service to Jewish and non-Jewish children, adults and their families. The homes stated objective is to provide safe and secure twenty-four hour care in a homely environment to adult males and females with learning disabilities. The house was built in the 1920s as a private dwelling and was eventually converted into residential care home and opened in 1995. The entrance leads into a large lounge there are two service users bedrooms both with en-suite facilities. In addition there is a laundry room, small reception room, bright lounge and a large bright kitchen/diner. On the first floor there are four bedrooms a large bathroom and a shower toilet room. The small open planned office has been designed and converted within the upstairs hallway and is accessed from two stairways, one of which leads directly into the office. The home has a secluded back garden, which is set on two levels, with steps leading to the lower level. The top level is paved has garden furniture and a handrail leading to the lower level. The lower level has a well-kept lawn. There is off street parking to the front of the house for several cars. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took approximately three hours to complete. The newly appointed manager, Ms Irit Garty was available for most of the inspection. On arrival four service users were in the home. Two left to attend work. At the time of inspection there were three staff in the home including the manager. The inspection consisted of a tour of the building with the manager, an examination of care plans, medication recording, health and safety records, handover records, and daily logs. The inspector was able to speak briefly to two service users, one relative one staff member and the manager. During the inspection a review of care was being held. The staff team were also having due to have a team session that afternoon at Norwoods’ headquarters. The home does not have any vacancies at present. What the service does well: What has improved since the last inspection?
The last inspection brought three requirements. These related to the lack of care plans signed by service users, the inconsistent weekly fire tests and the need to replace a towel holder and sealant around the bath. The home has improved the signing of care plans by 90 , the manager assures the inspector that the outstanding care plans will be done. The weekly fire tests have improved in the last three months and the towel holder has been removed. The sealant around the bathroom was completed but needs to be looked at again. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 6 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.
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 3 were examined at the previous inspection and assessed as met. EVIDENCE: Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Plans of care are regularly updated to ensure that service users needs are identified and met. EVIDENCE: Three care plans were examined during the inspection. The plans are detailed and informative. The plans examined have all been updated in the second half of 2005. The plans include detail relating to service users capabilities, interests and medical appointments. It is evident that service users needs are well recorded by staff and following the previous inspection there has been some improvement in the number of care plans and reviews signed by service users. This requirement is therefore partially met. The service user files require some organisation as information is duplicated and misfiled. This makes tracking of information slow and frustrating. The manager explained that part of the team day is to look at the organisation of files in the home and make them easier to follow. Service users have weekly residents meetings where all issues in the home are raised and discussed fully. During the inspection the wishes and feelings of service users about everyday activities were expressed. They were able to
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 10 make decisions supported by staff who provided the relevant information required. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14,15 The home ensures that appropriate work and social activities are made available to service users to increase their social skills and improve their confidence. EVIDENCE: At the time of inspection, two service users were leaving the home to go to work, one service user works in a Norwood establishment and the other works in a retail outlet. One of the service users stated, “ I have been to the Galleria in Hatfield with my parents, I have also been to Camden Lock and Convent Garden”. Another service user advised the inspector “ I went to the Arsenal game yesterday and I am upset at the result, but I will be going to the next home game”. Service users continue to be involved in all aspects of the running of the home. The meal rota is still in place as is the cleaning rota. The fire equipment testing records show that service users take part in this on a weekly basis. One service user in the home took part in the review of her care. The service user read the previous review minutes, welcomed those attending the review
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 12 and made warm drinks for them. The service users relative told the inspector “ The home is fine, I am very happy with the home” Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 The general personal and healthcare support provided by Edgeworth Crescent is good. The home must ensure that service users are able to access particular specialist health checks. The recording of prescribed creams and powders administered to service users is inconsistent and must be improved. EVIDENCE: Service users in the home are very independent and able to make many decisions for themselves in relation to their personal care. Where service users require assistance, this is well documented in care plans. The plans have information relating to medical appointments and service users know when they have appointments. The home has begun to explore specialist health care for some service users but this needs to be expanded to male service users to ensure optimum health. Where service users refuse specialist checks these should be well documented in their records. The medication records were checked. The home records oral medication administered. Two service users records of creams and powders are not properly recorded. One service users Mar sheet states that cream should be applied twice daily. The MAR sheet is signed that this was applied only once on a number of occasions. When tracked with the daily record sheets the record stated the cream was applied am and pm. Clearly there are some
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 14 inconsistencies. Whilst it is clear that staff assist service users with creams and powders in the privacy of their bedrooms, staff must ensure they complete the MAR sheets afterwards. Two service users medication front sheets record their bank details. This is not appropriate and should be removed. The new manager was not clear why this was recorded and stated that this will be removed. The home does not have a list of all staff names and signatures trained to administer medication at the front of medication records. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 Complaints made by service users are taken seriously in the home and fully investigated. EVIDENCE: The home has an excellent complaints policy and procedure, which service users in the home are familiar with and well able to access. This is produced in pictorial form and outlines the stages of any complaint made. The home currently has one complaint outstanding. A service user made this complaint against a bank member of staff. The staff member is no longer employed in the home whilst the complaint is being investigated. The outcome of the complaint is yet to be established. Norwood’s vulnerable adults policy is due for review in January 06. The policy remains robust and includes definitions of abuse and procedures for responding to any suspicions or allegations. The home has a copy of Barnet’s Adult protection procedure. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 Edgeworth Crescent must improve the internal decoration of the home to allow service users to feel comfortable in their environment. EVIDENCE: A tour of the building with the manager revealed that Edgeworth Crescent is in need of redecoration in most communal areas of the home. On the ground floor the curtains in the lounge do not stay attached to the curtain rail due to the system used and the way in which some service users open and close the curtains. The new kitchen has still not been fitted and the present kitchen is old and worn. One part of the ceiling in the kitchen requires re plastering, as it appears that there has been water penetration from an upstairs bedroom. The beading on the floor in front of the kitchen patio exit has lifted and requires repair or replacement to reduce the risk of tripping. On the first floor, the stair carpet requires replacement. A relative of a service user has agreed to replace the carpet once the work in the kitchen has been completed. The bathroom lino appears to have been penetrated by water and requires removal. The bath mat in the bath and the sealant around the bath also require replacing. The shower room on the first floor requires complete re
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 17 decoration, there is evidence of damp, loose tiling beneath shower unit and a large hole in the shower room door that should be repaired. The previous requirement to replace the towel holder has been met. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 Service users benefit from staff that receive training and have delegated responsibility. This allows the home to run more smoothly thereby making it possible for service users to enjoy stability and consistency. EVIDENCE: The home continues to delegate certain essential functions in the home to staff members. All service users have a key worker. Their role includes identifying areas of development for service users, managing service users activity programmes and their various health appointments. This is then shared with other staff that will also support service users. One service user confirmed that she continues to have a good relationship with staff members and the rapport observed between staff and service users was positive. Staff members also take responsibility for other areas including purchasing cleaning materials and completing weekly fire tests. This allows for clear lines of responsibility and audit trails. The home currently has 3 staff vacancies. One post has been filled however the home is awaiting criminal records checks. The manager is hoping to recruit to the remaining posts shortly. The home therefore has a number of regular bank staff to cover shifts. The home has 7 permanent staff members. 3 staff have obtained NVQ 2 or 3 and the remaining 4 staff are completing the course. The manager and another
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 19 member of staff are NVQ assessors so are able to support and assist staff to complete the qualification. The manager advised that since her appointment, she has been supervising all staff. However the manager has now sent two “B” grade staff on supervision training and they will take some of the supervisory responsibility from January 2006. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 20 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): 41,42 Staff at Edgeworth Crescent must tighten up their health and safety practices in the home to prevent any accidents, which may affect service users and staff members. EVIDENCE: The home has appointed a new manager since the previous inspection. The manager was previously an “A” grade member of staff who is familiar with the service users and their relatives. The manager reports that the transition to manager has been smooth and she is learning new things as she goes along. The manager stated that she is able to call on the previous manager for advice as and when needed. The new manager has identified areas of practice within the home that need to be developed. This includes service users plans of care plans, which require re arranging. The manager has also instigated a handover procedure for staff. This allows staff to record any issues that have taken place on the previous shift. The manager has also arranged for staff in the home to have a team afternoon to look at areas of development for the home.
Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 21 The records of fire alarm testing in the home have only improved in the last 3 months despite a requirement being made at the previous inspection. The manager advised that she is aware of this and will be addressing this issue shortly. The home has recently updated all risk assessments in the home to ensure service users safety. A new risk assessment has been put into place as the front door of the home is being left open. On the day of inspection, the inspector was able to walk straight into the lounge area of the home, as the door was ajar. Fortunately a member of staff was in the lounge and asked for identification. The home has put a risk assessment in place with control measures. This is not sufficient due to the nature of the home, the role of staff and the independence of service users. The home must explore the possibility of a door safety alarm to alert staff when the door is open so immediate remedial action can be taken. Records of the homes water temperature in the bathroom indicate that the temperature is consistently too high which means that service users are at risk of scalding. This is also the case in one service users bedroom. Staff must report issues as mentioned above to the manager in order to enable the manager to deal with situations as they arise. Staff must be clear that they are all responsible for health and safety in the home. The home must ensure that a qualified plumber is called to regulate the water temperature in the home. On the day of inspection the COSSH cupboard was unlocked and unattended. This cupboard should be kept locked at all times. Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 4 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 1 X X X X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 4 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Edgeworth Crescent 55 Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score X X X X 2 1 X DS0000010426.V269779.R01.S.doc Version 5.0 Page 23 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 YA6 Regulation Requirement Timescale for action 10/02/06 2. YA19 3. YA20 4. YA20 5. YA24 6. YA24 15(2)(a)(b) The registered manager must ensure that service users sign their care plans and reviews. Staff must also ensure that they have read and understood service users care plans. (The previous timescale 30/08/05 partially met). 13(1)(b) The registered person must ensure that specialist medical appointments are made for service users and any decisions taken are recorded. 13(2) The registered person must ensure that all prescribed creams and powders are correctly signed as given on the MAR sheet. 13 (2) The registered person must ensure that staff administering medication has their full name and signatures available at the front of medication records. 23(2) (c) The registered person must 16 (2) (h) ensure that the kitchen units are replaced as planned as a matter of priority. 23 (2) (d) The registered person must ensure that the kitchen ceiling is re plastered and the beading on
DS0000010426.V269779.R01.S.doc 28/02/06 10/02/06 10/02/06 13/03/06 27/02/06 Edgeworth Crescent 55 Version 5.0 Page 24 7. YA24 23 (2)(d) 8. YA24 16 (2) (c) 9. YA24 23(2) (c) 10. YA41 17 (3) (a) 11. YA42 13(4)(c) 12. YA42 13 (4)(c) 13. YA42 13 (4) (c) the kitchen floor at the patio door is made safe. The registered person must ensure that the bathroom lino, the bath sealant, and the bath mat are replaced. The registered person must ensure that the curtains in the lounge area are properly fitted to prevent them from falling. The registered person must ensure that the first floor shower is completely redecorated. The damp must be treated, the tiles replaced, and the hole in the door repaired. The registered person must ensure that service user files are reorganised. Service user files must be easy to read and follow. The registered person must ensure that a system is in place to minimise the risk of strangers entering the home due to the door being left open. The registered person must seek the assistance of a plumber to regulate the water temperatures in a service users bedroom and the bathroom. The registered person must remind staff that the COSHH cupboard is to be kept locked at all times. 27/02/06 27/02/06 13/03/06 13/03/06 13/03/06 27/02/06 10/02/06 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 Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Edgeworth Crescent 55 DS0000010426.V269779.R01.S.doc Version 5.0 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
