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Inspection on 14/11/07 for Endymion Road, 2

Also see our care home review for Endymion Road, 2 for more information

This inspection was carried out on 14th November 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has provided a family style environment and has actively encouraged the independence of the people who live there and supported them to have fulfilling lifestyles. People have learning disabilities, varying degrees of Autism and they don`t communicate in conventional ways. It is evident that the staff have good relationships with the residents and make real efforts to ensure a good standard of service for them. Lots of effort is being put into supporting and improving the ways that people can communicate. Choice Support places emphasis on providing staff with the training that they need to support the people living in the home.

What has improved since the last inspection?

A new manager has been appointed and it was evident that she is proactive in that she has identified several areas for improvement and was able to demonstrate that she is making progress in addressing them in real and practical ways. As she has not been in the home for very long, not all of the tasks that she has started are yet completed. However, there was evidence that with the support of a new assistant manager, real progress was being made. There were four main areas of improvement identified at the last inspection and these were mainly in relation to the building and health and safety issues. The smell of damp in the basement has now been addressed. The temperature of the water in the first floor bathroom has been adjusted and people have been provided with the means to wash their hands after dealing with dirty laundry. The residents` risk assessments are very much improved and each person now has a health care assessments. The manager has been reviewing peoples` activities and making sure that people are getting opportunities to be involved in home and community based activities.

What the care home could do better:

Despite there being evidence that money is being spent and efforts being made to repair and redecorate the house, it is not as homely and as comfortable as it should be and still needs a large investment of time and money to make it a pleasant, homely place for people to live in. This is the main challenge that the registered person must focus upon over the next year, as there are many areas that need to be redecorated and improved. The registered person has been asked to create an action plan of how these are going to be done, including reasonable timescales for action. The domestic assistant is ill and as this is a large house and the people who live in this home have a high level of support needs, it is for proper domestic support to be provided until the staff member concerned returns to work. Some staff still need training in infection control. Some progress has been made in completing residents` plans in the new PCP (person centred planning format. However, the plans seen by the inspector had been only partially completed, and further work needs to be done to ensure that they are completed to a high standard. As previously mentioned the manager and assistant manager are making progress in a number of areas. However, the management team are hampered in their progress because the computer equipment that is available in the home is not suitable. This leads to the manager spending time away from the home in order to complete administrative tasks. Where tasks are progressing, but are not completed recommendations are made to reflect the progress made. These include ensuring that staff are provided with training in managing challenging behaviour, Autism and PCP, ensuring Makaton and picture boards are used to help residents to communicate, and make choices and helping residents gain access to transport. Although the organisation of records showed improvement generally, there is still some work to do to make sure that the staff files are organised, with the necessary information in them, and that staff training records are up to date.

CARE HOME ADULTS 18-65 Endymion Road, 2 2 Endymion Road London N4 1EE Lead Inspector Caroline Mitchell Key Unannounced Inspection 14 & 15thNovember 2007 09:30 th Endymion Road, 2 DS0000060622.V333366.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 Endymion Road, 2 DS0000060622.V333366.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. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Endymion Road, 2 Address 2 Endymion Road London N4 1EE 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) 0208 341 3888 bowoffice@care4free.net www.choicesupport.org.uk Choice Support ** Post Vacant *** Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st August 2006 Brief Description of the Service: 2 Endymion Road is a large converted terraced house situated in the Finsbury Park area of North London. The home is registered to provide personal care for up to 6 residents of either sex and over the age of 18 who have a learning disability. The stated aim of the home is to provide a supportive environment where residents can live their lives according to their individual wishes and needs with the assistance of staff. There are 3 floors and all residents have single rooms. There are 6 single bedrooms and 1 sleep-in room for staff; none of the rooms are en -suite. There are 3 bathrooms, and 4 toilets, a kitchen and a lounge. The accommodation is not suitable for residents with physical mobility problems. Choice Support, a large organisation that provides residential services for people with learning disabilities nationally, operates the home. Some housing management is provided by London and Quadrant. Placements at the home costs around £1,300 for each person per week. Residents are expected to pay separately for some toiletries. Following Inspecting for Better Lives the provider must make information available about the service, including inspection reports, to residents and other stakeholders. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was done on an unannounced basis. However, because the inspector had invited an expert by experience to be involved, the inspector contacted the manager of the home the day before the inspection, to talk about the expert being able to spend time with the residents. The inspector took 2 days to complete the inspection and the expert by experience spent an afternoon in the home, was shown around the home, and spent time with the residents. The things that the expert by experience noticed and commented on are included in this report. Regarding the visit generally, the he expert by experience said, “All staff and the management were friendly and willing to answer questions throughout the visit”. The inspector was shown around the home and aided in the inspection by the manager and the assistant manager. The inspector saw a number of the written records that are kept in the home, such as the residents’ and staff members’ files, met some staff members and was able to spend some time with residents. What the service does well: What has improved since the last inspection? A new manager has been appointed and it was evident that she is proactive in that she has identified several areas for improvement and was able to demonstrate that she is making progress in addressing them in real and practical ways. As she has not been in the home for very long, not all of the tasks that she has started are yet completed. However, there was evidence that with the support of a new assistant manager, real progress was being made. There were four main areas of improvement identified at the last inspection and these were mainly in relation to the building and health and safety issues. The smell of damp in the basement has now been addressed. The temperature of the water in the first floor bathroom has been adjusted and people have been provided with the means to wash their hands after dealing with dirty laundry. The residents’ risk assessments are very much improved and each person now has a health care assessments. The manager has been Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 6 reviewing peoples’ activities and making sure that people are getting opportunities to be involved in home and community based activities. 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. The summary of this inspection report can be made available in other formats on request. Endymion Road, 2 DS0000060622.V333366.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 Endymion Road, 2 DS0000060622.V333366.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. As there have been no admissions to the home in some time, the standards about admissions were not inspected on this occasion. The home understands the importance of having sufficient information when choosing a care home. It has developed clear information to help people understand what specialist services the home can provide. The service user guide says what people can expect, in a format that is accessible to people with learning disabilities. EVIDENCE: There have been no admissions to the home for several years, and the standards regarding the admission process have been assessed previously and found to have been satisfactory for the people currently living in the home. These standards were not inspected on this occasion. The inspector saw the service user guide. This was in large print and has pictures to help people living in the home to understand it. It is personalised for each resident, and people have their own copy. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are encouraged to make decisions about their lives. Each person has a plan and these are reviewed regularly. A new Person Centered Planning format has been introduced and is being completed. However, this is taking a long time to complete. The service recognises the right of individuals to take control of their lives and to make their own decisions and choices. Risk assessments are completed. Where limitations are in place, there is evidence that decisions are agreed as part of a multi-disciplinary approach. Documents are usually provided in a format that is easier for people with learning disabilities to understand. EVIDENCE: Due to the nature of their learning disabilities, residents don’t communicate in conventional ways, and it is difficult to gain their opinions of life in the home. However, the inspector was able to meet people when they returned from their day services, and observed the interaction between the residents and the staff. The inspector looked at the written records of 2 people and each had a written Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 10 care plan. These emphasise staff helping people to be as independent as possible. The expert by experience noticed that residents can choose what they want to eat, are allowed to take snacks from the cupboard, can have baths when they wish, are able to go to bed when they are tired and awake when they wish and are allowed to choose what they want to buy with their money. There were good monitoring records that show how people are, and what activities they have been doing each day. The home has a key worker system and each person’s key worker reviews how they are progressing, and writes a brief summary each month. At the last inspection the registered person was required to ensure that all residents plans are completed in the new PCP (person centred planning) format that Choice Support have introduced. At this inspection the inspector found that some progress had been made with the plans. However, none of the plans were actually completed. This is largely due to changes in the staff and management team in the home. Several staff members and the previous manager have left and a new manager has taken over. There are new staff, who have not yet done the PCP training. The requirement is restated with an extended timescale to give the new manager more time to ensure the task is completed. At the last inspection the registered person was required to ensure that the residents risk assessments are reviewed and updated. At this inspection the inspector saw the risk assessments for 4 people and found that they have improved considerably. They are now clear and up to date, and give guidance to staff about how to minimise the risks. The inspector looked at 1 resident’s records, as their behaviour has become more challenging recently. This was reflected in their risk assessments, and there is evidence that the resident and the staff were getting support and advice from the resident’s psychiatrist and psychologist. A request had also been made by the home, for help from the speech and language therapist, and the manager told the inspector that staff will be going on communication awareness training in December. The manager also explained that the team are looking for meaningful activities for this resident. Most staff have had training in working with challenging behaviour, and the manager told the inspector that training has been provided in breakaway and diffusion techniques recently. The manager showed the inspector evidence that she is arranging this training for those staff who haven’t yet attended. A recommendation is made for the manager to continue with the work that she has already started to ensure that all staff are equipped with training around managing challenging behaviour in a positive way. The expert by experience noticed that this resident had time out used, for using inappropriate behaviour. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally staff are aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Residents are consulted regarding the choice of daily activity, but this process could be improved with more creative communication such as picture boards and Makaton. People are given the opportunity to take part in a variety of activities both within the home and in the community. Guidance promotes individual independence and choice. The home tries to be flexible and attempts to provide a service that is as individual as possible using its staff and resources effectively. Having transport would help to support this. The food in the home is of satisfactory quality, well presented and meets the dietary needs of residents. Opportunities are available for residents to be involved in food shopping, the preparation of meals and menu planning. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 12 EVIDENCE: As part of the AQAA (annual quality assurance assessment) recently provided to the Commission by the home, the manager stated that the team aims to support residents to have more opportunities to get out in the community, to support 1 resident to get a day care package and to support some of the residents to puchase a car through a Mobility Scheme. The manager says that some of the people living in the home have behaviour that can be challenging in the community, and public transport is not suitable for 1 resident in particular. It was evident in discussion with staff that people not having their own transport does sometimes impact on the opportunities they have to get out and about. A recommendation is made in respect of this. The expert by experience said, “The home could do with having their own mini bus”. At the last inspection it was recommended that the registered persons review the activities undertaken by residents, in order to ensure a good balance of activities, both inside of the home and in the community. Each person has a good, varied schedule of activities that reflects their abilities and interests. When talking to the staff the expert by experience was told that residents help sort the washing, that they go to the local pubs, go swimming, attend the day centre and can access the arts club and the carpentry club should they wish to. The expert by experience said, “Residents should be given more opportunities to access other activities in the home, as although they all enjoy their visits out, they have to pay using their own money for activities/clubs they attend”. There is evidence in the day-to-day records that the residents are assisted and supported to develop on a personal level and each resident’s written records include a cultural needs assessment. These are of a good standard, and provide guidance for staff about the residents’ ethnic, cultural and religious needs and preferences. The expert by experience noticed that staff are from a culturally diverse backgrounds. When talking to staff the expert by experience was told that was no discrimination taking place at the home, and the expert said that they didn’t see any discrimination during the visit. Staff told the expert that 4 residents attend the local church to follow their religion. Specific plans and strategies are in place and staff work with residents to ensure they develop to their full potential. The inspector saw records of the activities that people actually take part in on daily basis. These records help the management team to monitor if people are getting opportunities to actually take part in the activities that are part of their planned schedules. It was evident that people are encouraged to use their skills, to help look after their home, that they are getting out more, and that they are doing various leisure activities in the home. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 13 Because of people’s needs, finding ways of helping people to communicate is important, and as part of the AQAA (annual quality assurance assessment) recently provided to the Commission by the home, the manager stated that the team aims to support residents to communicate by using more signs, pictures and objects. The assistant manager has been working on building upa collection of photographs of residents doing day-to-day activities and showed these to the inspector. He explained that they will be used to make picture boards, to help residents to communicate, and to help them to make more choices. They will also be used as part of people’s PCPs, to make them more understandable and person centred. A recommendation is made for progress made to be continued, in order that the picture boards are made and used. The expert by experience said, “If the staff designed a chart (eating/cleaning schedule) including pictures to support the text, possibly residents could take some further control over this area and be given the chance to be included more”, and that, “More picture prompts are needed, maybe a picture text with birthdays up for staff to see as well as residents”. The expert by experience said that the residents interacted well with each other and all staff. The expert noticed that people communicated through sign language. The manager told the inspector that she had recently been provided with a pack of Makaton signs and is concentrating on supporting staff to learn them and use them with residents. A recommendation is made for progress made to be continued, in order that Makaton be used more effectively in the home. The inspector saw the menu and this reflected people’s, preferences, cultural backgrounds and there is a pictorial menu that helps people to make choices. The inspector also noticed that there was plenty of fresh fruit available for people to help themselves to. During the inspection the inspector saw 1 person having lunch, and the staff member explained that they were having their favourite. The expert by experience said, “Residents can chose what they want to eat” and that, “Residents are allowed to take snacks from the cupboard, staff were seen to be friendly, they were very nice to talk with”. The house routines support people’s individuality and independence. Some controls have been established because of some of the rituals residents engage in, and these are documented as part of individual plans and risk assessments. Evidence was seen in the residents’ files that staff support them to maintain family involvement and to make friends and develop relationships. The manager explained that some residents have a lot of support from their families, whilst other people’s families are not able to play such an active part in their lives. A recommendation is made for the home to help the people who live in the home, who don’t have regular support from and contact with their families to look for advocates or volunteers. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. People are supported and helped to be as independent as they can. People have access to healthcare and remedial services. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity. The home has an efficient medication policy supported by procedures and practice guidance. Medication records are fully completed, contain required entries, and are signed by appropriate staff. Staff have completed an appropriate medication course and an assessment has been carried out to ensure that they are competent to handle, record and administer medication properly. When staff have not followed good practice or safe practice guidelines, the registered person has responded with appropriate action. EVIDENCE: There was detailed information on file of how the staff should support residents around their personal care needs. This guidance emphasised how to promote each person’s independence. The expert by experience said, Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 15 “Residents are able to go to bed when they are tired and awake when they wish”. The inspector looked at 3 people’s files regarding their health care, and noted that there was detailed health information in place for each person. Evidence was seen on people’s records that they are assisted and supported to access appropriate health care services and each person is registered with a General Practitioner. The residents are supported to attend the GP surgery and outpatient hospital appointments when necessary. The expert by experience said, “Residents have a local Doctor around the corner and they can attend with their key worker to see him when they need to”. At the previous inspection it was noted that some residents’ records included health care assessments, the format of which was devised by the learning disabilities partnership. This assessment is quite thorough and helps to ensure that people’s health care needs are properly considered. At the time of the previous inspection, not all residents had these, and a recommendation was made in respect of this. At this inspection the health care assessment had been completed for each resident. The inspector looked at the way in which medication is stored, administered and recorded in the home. There was a list of people who administer medication with a sample of their signatures. There was also evidence that where staff had not followed good practice guidance, the manager had taken action to address this, providing clear guidance to staff about what is expected of them. The medication is provided by Boots in the bubble pack system and was stored securely, appropriately and at the required temperature. The records of administration and all medication coming in and going out of the home. These were satisfactory. The inspector noted that there was a good quality pack of written information and guidance about medication, and the inspector was told that the manager had put this together for staff. There was also evidence that staff had received training in handling medication, and their competence had been assessed when taking on the responsibility of administering medication. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 16 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, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can feel that their views are listened to, and will be acted on, and that residents are protected from abuse, neglect and self-harm. The home keeps a full record of complaints and this includes details of the investigation and any actions taken. Unless there are exceptional circumstances the service always responds within the agreed timescale. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Training of staff in the area of protection is regularly arranged by the home. Other training around dealing with physical and verbal aggression is also made available to staff as needed. EVIDENCE: The inspector saw a copy of the guidance for residents about how to make a complaint. It is written in plain language, large print, and includes “widget” pictures to help residents to understand the process. 2 complaints had been recorded in the home since the last inspection. 1 was from a neighbour, about the fence panels needing repair, and 1 was from a resident’s relative, raising some concerns about the resident’s care. There was clear evidence that each of these complaints had been dealt with in an open and fair way by the home and that the complainants had been involved and informed about what action was being taken to respond to their complaints. Choice Support has developed an adult protection policy to comply with the Department of Health guidance “No Secrets” and this is available in the home along with a whistle blowing policy for staff. Staff have received training in safeguarding people and, stated in this report other training has been provided Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 17 to staff regarding dealing with challenging behaviour and breakaway and diffusion techniques so that they are equipped to support and protect the people living in the home. There have been no adult protection issues since the previous inspection. However, there was a recent Whistle blower complaint made by a staff member, and senior managers of Choice Support had investigated this. The inspector also noted that the manager comes across as very committed to safeguarding residents and places a lot of emphasis on promoting good practice, and challenging poor practice. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not have an on-going maintenance programme in place. Essential maintenance is only done when a problem has already arisen. A number of the fixtures and fittings need replacing and most of the décor requires upgrading. The quality of life for people using the service is being made worse by the environment they are living in. Bathrooms are bare and institutional in design. Domestic cleaning arrangements are not adequate due to staff sickness and cleaning is being done by care staff. Most staff need training in infection control. EVIDENCE: Since the last inspection the outside steps and all tarmac leading to the front door has been renewed. When going into the house, the expert by experience thought that a second handrail was needed, for people who are not steady on their feet. Once inside the home, the expert noticed that there were no pictures on doors, to show what is behind each door. The inspector found that generally the home was not in a good state of decorative repair. The manager explained that the television has free view Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 19 channels, as some of the residents really enjoy being able to watch the music channels. Despite having new leather sofas, the décor in the lounge looked worn and stark, the room didn’t have a homely feel, and there were few pictures or items that reflected people’s tastes or interests. It needs to be redecorated, the damaged edges of the floor covering need attention, the fireplace surround needs to be refurbished or replaced. Because of some of the resident’s behaviour, creative ways need to be found to make it feel more homely. The manager explained that there were a new dishwasher, toaster and microwave cooker in the kitchen diner. However, the kitchen units, work surface, tiles, chairs and table, and floor covering were all looking worn. The finishes on the grouting and sealant were not of a good standard. The expert by experience said, “While we were visiting the home we observed broken equipment in the kitchen, this needs to be removing straight away in case an accident occurs”. New showerheads and shower curtains have been provided, but all of the bathrooms and toilets are urgently in need of redecoration and refurbishment. They were poorly decorated and stark. There are areas where the tiles are damaged and the sealant in very poor condition. The expert by experience said, “Showers are needed and could be built into bathrooms”. The expert told the inspector that they thought that this might give people more opportunity to be more independent. It was evident that staff have tried to make people’s bedrooms comfortable, and this is more challenging for some residents so some people’s rooms are more pleasant than others. The floor covering needs repair in 1 person’s room in particular, as it has been laid leaving large gaps. There are areas of damage to the walls and ceilings from a leak from a water tank at the top of the house and this needs to be repaired and repainted. The hall landing and stairs have been painted in quite a dark colour, and the finish is poor. The hall stairs and landings were provided with new carpet relatively recently, but this was already showing signs of damage. About the decoration in the home generally, the expert by experience said, “The carpet need replacing, rooms are very dull and need redecorating in brighter colours”. Because the decor and finishes are not of a good standard generally, particularly in the shared areas, this adds to the impression that the house is not very clean. The staff member employed to clean the home had been on sick leave since August, and staff were trying to keep the house clean in addition to their usual duties. As this is a large house and the people who live there have complex needs and behaviours, it is the view of the inspector that proper domestic support needs to be provided to ensure that the home is kept adequately clean. A requirement is made in relation to this. The expert by experience said, Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 20 “The home did not look very clean, was dirty looking.” Although the laundry room is reasonably well equipped, the floor covering is in a very poor state and the room needs redecorating. As part of the AQAA (annual quality assurance assessment) recently provided to the Commission by the home, the manager stated that the team aims to improve on the back garden, and to improve on the large basement room for relaxation and sensory sessions. The expert by experience said, “The sensory room needs more equipment”. The manager explained that there was not enough money in the budget to improve the sensory room this year, but that this remains 1 of her aims for next year. She explained that progress had been made in the garden, and showed the inspector where several fence panels had been replaced, as they had blown down in the wind. She explained that the larger trees had been cut back to give more light and space and said that she intendes to request that the metal stairs, that go down into the garden be re-painted in preparation for next year. At the last inspection the registered person was required to ensure that the covers on the light fittings in the kitchen were cleaned, and to ensure that that soap and disposable hand towels are available in the laundry room. At this inspection the inspector was able to confirm that these issues had been addressed. It was also recommended that the staff be provided with updated training regarding infection control. At this inspection the inspector found that, some staff had attended this training, but there were several who had not, and a requirement is made in respect of this. At the last inspection the registered person was required to ensure that the smell of damp at the bottom of the stairs in the basement be dealt with. At this inspection the inspector found that this issue had been dealt with and there was no longer any evidence of damp in that area, the walls had been repainted and new carpet provided. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 21 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): 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have the skills, competencies and experience, and are employed in sufficient numbers, to meet the assessed needs of residents. The service recognises the importance of training, and tries to delivers a programme that meets any statutory requirements and the National Minimum Standards. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service has a recruitment procedure that meets the regulations and the National Minimum Standards. There is acceptable use of temporary staff that doesn’t adversely affect the quality of the individual care and support that people receive. The frequency of staff supervision has improved and this improvement needs to be sustained. EVIDENCE: The inspector saw the planned rota for the week of the inspection and noted that the numbers of support staff employed in the home were sufficient to meet the needs of the residents. 1 resident needs high levels of support whilst out in the community and is supported by 2 staff when out. However, as stated under standard 30 of this report, the domestic assistant is sick and a requirement is made for adequate cover to be put in place until the issue is resolved. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 22 Interactions between staff and residents were observed to be appropriate, professional and relaxed. It was apparent that the staff team are committed to working with individual residents to enable them to live as they wish and to fulfil their individual goals and aspirations. The inspector had the opportunity to talk to a senior staff member staff, and the feedback was that Choice Support provide good quality training, and that providing training to staff is high on the organisation’s agenda. The inspector looked at the personnel records for 6 staff and saw the records of the training received by all staff. The inspector noted that there are staff, who have worked for the organisation for some time, who have CRB checks that are more than 3 years old. A recommendation is made for up to date CRB checks to be obtained for these staff. The records themselves were not very well organised and it was difficult to access a full record of the training that staff had received. A recommendation is made for the personnel records to be re-organised and training records updated. A requirement is made for each staff member’s file to include a recent photograph. Records indicate that the frequency of 1-1 supervision for staff is improving. This work needs to continue and remain consistent in order to provide the necessary support to staff. A recommendation is made in respect of this. As part of the AQAA (annual quality assurance assessment) recently provided to the Commission by the home, the manager stated that the team aims to recruit additional staff in order ensure more effective service delivery, to provide comprehensive training for the staff team to help ensure that each staff achieves their potential, and to ensure PCP training is on-going, for staff, to work effectively with residents working towards any changes in their lives. The inspector noted that some progress has been made in recruiting staff, with an assistant manager and 2 new support workers starting work in the home since the summer. The home uses temporary workers to cover the vacant posts and it was evident that all efforts are made to ensure that this is done in a way that maintains as much consistancy as possible, the same people being used regularly so that they get to know the residents. The inspector was told that 2 more support workers had been recruited and were waiting to start, once all of their pre-employment checks had been completed. Records show that only a small number of the staff have attended training in working with people with Autism and PCP training. Recomendations are made in respect of this. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 23 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, 39, 41, 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a need for the manager to apply to be registered by the Commission. The manager is aware of the need to keep up to date with practice and continuously develop management skills, and continues to attend regular formal training courses. The manager is developing a staff team who are generally competent and knowledgeable to care for the people living in the home. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with people’s families and professionals. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. More work is needed in this area and the provision of good quality IT equipment and support would help support the manager in this task. There is a health and safety policy that generally meets health and safety requirements and legislation, although the fire risk assessment can be improved. The way in which information is organised in the home has been improved generally. Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 24 EVIDENCE: At the last inspection the registered person was required to ensure that the manager applies to be registered by the Commission. Since this requirement was made, the previous manager has been dismissed and a new manager has been placed in the home. She has worked for Choice Support for several years and comes across as enthusiastic and committed to maintaining stability in the staff and management team for the future and to improvement of the service. She demonstrated awareness of the need for improvement in a number of areas and it was evident that she is proactive in her approach, and is making progress in addressing them, as reported throughout this report. The registered person must ensure that she now applies to be registered by the Commission and the previous requirement is restated as part of this report. In discussion with the manager it became evident that she is spending quite a lot of time away from the home, at a Choice Support office in Bow, in order to use the computer, as the IT equipment in the home is not suitable for the task. A recommendation is made in respect of this. It was also evident that the fax machine in the home was not working, which is contrary to Regulation 16. A requirement is made in respect of this. The organisation of records in the home had improved considerably since the previous inspection. The office space was much better equipped and organised. It was better to work in and it was easier to find records and other written material. A more appropriate place had been found for the residents’ day-to-day records, and they were no longer kept in the main kitchen. The inspector saw the satisfaction survey given to the residents, to give them a chance to say what they think of the service. This was in large print and has pictures to help people living in the home to understand it. The manager told the inspector that staff helped the residents to fill them in on the most recent occasion, but that residents are often provided with help from independent organisations to fill in their surveys. At the last inspection the thermostatic control to the bathwater in the first floor bathroom needed adjusting. At this inspection the inspector found that the water temperature in this bathroom was within reasonable limits. At the last inspection it was recommended that the residents bedroom doors be fitted with magnetic closures. At this inspection the inspector noted that the bedroom doors were not being propped open, in the way they were at the previous inspection. The inspector saw records of the most recent fire drill, health and safety walk round checks, and water and fridge temperature monitoring. The other safety checks such as fire alarm and fire equipment checks, gas, electrics and PAT Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 25 (portable electrical appliance testing) were up to date. A fire risk assessment is in place, but would benefit from being reviewed and updated in the light of recent guidance from the Fire authority. A requirement is made in respect of this. Endymion Road, 2 DS0000060622.V333366.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 X 3 X 4 X 5 X 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 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 3 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X 3 2 X Endymion Road, 2 DS0000060622.V333366.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 YA6 Regulation 15 Requirement The registered persons must ensure that all residents’ plans are completed in the new PCP format. The previous timescale of 30/10/07 was not met. The registered person must produce an improvement plan regarding the redecoration and refurbishment of the home, addressing all of the areas for improvement identified in the main body of this report, and providing reasonable timescales for action. A copy must be provided to the Commission. The registered persons must ensure that staff are provided with updated training regarding infection control. The registered persons must ensure that adequate domestic support is provided in order to ensure that the home is kept adequately clean. Timescale for action 28/02/08 2. YA24 23 30/01/08 3. YA30 18 (1) (c) 13 (3) 20/02/08 4. YA30 18 23 (2) (d) 30/12/07 Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 28 5. YA34 17 19 Schedule 2 8 The registered persons must ensure that all staff personnel files include a recent photograph. The registered persons must ensure that the manager applies to be registered by the Commission. The registered person must ensure that the fax machine is in proper working order. The registered person must ensure that the fire risk assessment is updated in the light of recent guidance from the Fire Authority. 20/02/08 6. YA37 30/01/08 7. YA37 16(2)(a) 30/12/07 8. YA42 23(4) 30/01/08 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 recommended that the manager continue to work to her planned schedule to ensure that all staff receive training in managing challenging behaviour in a positive way. It is recommended that the manager continue to work to her planned schedule to ensure that Makaton is used more effectively in the home. It is recommended that the manager continue to work to her planned schedule to ensure that picture boards are made and used. It is recommended that the manager continue to support residents to consider leasing or buying their own transport. 2. YA11 3. YA11 4. YA13 Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 29 5. YA15 It is recommended that the home to help the people who don’t have regular support from and contact with their families to look for advocates or volunteers. It is recommended that the up to date CRB checks be obtained for those staff whose CRB checks are more than 3 years old. It is recommended that the staff personnel files be better organised, and records of training updated. It is recommended that all support staff be provided with PCP (person centred planning) training. It is recommended that all support staff be provided with training in working with people with Autism. It is recommended that the manager continue to work to her planned schedule to ensure that all staff receive regular 1-1 supervision. It is recommended that proper computer equipment be provided in the home for the use of the manager in order to reduce the number of management hours spent outside of the home. 6. 7. 8. 9. 10. YA34 YA34 YA35 YA35 YA36 11. YA37 Endymion Road, 2 DS0000060622.V333366.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Endymion Road, 2 DS0000060622.V333366.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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