Inspection on 02/11/05 for Essex Park 49

This inspection was carried out on 2nd November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Essex Park 49 30/09/09

Essex Park 49 21/10/08

Essex Park 49 26/10/07

Essex Park 49 04/07/06

Essex Park 49 17/05/05

Essex Park 49 02/11/04

Essex Park 49 03/06/04

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Essex Park 49 Finchley London N3 1ND Lead Inspector Tola Akinde-Hummel Unannounced Inspection 09:00 02 November 2005 nd Essex Park 49 DS0000010437.V259224.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 Essex Park 49 DS0000010437.V259224.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. Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Essex Park 49 Address Finchley London N3 1ND 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 8346 3860 020 8346 3860 Walsingham Community Homes Shirley Deane Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2005 Brief Description of the Service: Essex Park is a home for six adults with learning disabilities. The home is owned and managed by Walsingham Community Homes; an organisation, which provides special, needs housing in other parts of the U.K. The home is a detached, two storey building, located in a pleasant residential area of Finchley in North London. It is close to shops and many other amenities. Service users bedrooms are located on the ground and first floor. The communal lounge, dining rooms and kitchen are located on the ground floor. There is a large attractive garden at the rear of the property which is accessible to service users. A car is provided for the purpose of taking service users out on various shopping trips and excursions. The stated aim of the home is to enable service users to experience community life, by providing up to date information about the local community projects and facilities, and supporting service users to use them. Essex Park 49 DS0000010437.V259224.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 five hours to complete. Five service users live in the home and there is one vacancy. At the time of inspection all five service users were at home. Four service users were preparing to attend their activities in the community and one service user was staying at home for the day. There were three staff on duty and the manager was available throughout the inspection. The inspector was able to speak briefly to two service users, speak to a new member of staff in confidence and speak generally to two members of staff. The manager Ms Sally Smith throughout the inspection assisted the inspector. The inspector had a tour of the building, looked at person centred care plans, service users files, checked medication, looked at complaints, accidents and incidents, checked one staff file and looked at the requirements from the previous inspection. The inspector would like to thank all staff and service users who participated in the inspection. What the service does well: What has improved since the last inspection? Essex Park have introduced the Person Centred Planning Model to ensure the support given to service users is relevant and progressive. The plans seen are impressive and actions carried out are relevant. Essex Park have met seven of the thirteen requirements made at the previous inspection and one has been partially met. The immediate requirements relating to reviews of service users plans and the two immediate requirements about the repair of a service users wardrobe and the whistle blowing policy have been met. The home now records the wishes of service users in the event of their death. This will ensure that should this occur all matters to be undertaken are organised and carried out sensitively. The home has a cleaner Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 6 that ensures the skirting boards are cleaned regularly. The testing of portable appliances has been completed and the broken panel on the front door has been replaced. 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. Essex Park 49 DS0000010437.V259224.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 Essex Park 49 DS0000010437.V259224.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): 4 Service users are assured that should they wish to consider the home as a place of residence, the home will ensure the above standards are met. EVIDENCE: The home has not admitted any new service users for the last nine years therefore the above standards are difficult to assess. The manager has advised that the home is seeking to fill the current vacancy. There has been some interest in the current vacancy and a prospective service user has visited the home. The statement of purpose reflects that interested parties will be introduced to the home, and invited for visits and overnight stays with support prior to a decision regarding admission being made by service users and the home. Essex Park 49 DS0000010437.V259224.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): 6,7,9, There is evidence of improvement in the assessment, planning and review of service users needs. This enables service users to have confidence that staff understand their needs. The process must be completed for all service users to ensure all staff are aware of ways in which to best support all service users in the home. EVIDENCE: The previous inspection revealed that service users care plans are not orderly and their needs were not being reviewed on a regular basis. Since then, the home has adopted person centred care plans and has updated most of the plans in the home. These plans are very detailed and cover issues such as communication, mobility, health and behavioural problems. The plans highlight what service users have difficulties with and what actions can be taken to overcome these difficulties. These areas range from health to social and personal development. The home has completed risk assessments for service users whose person centred plans have been completed. The requirement relating to the specific risk assessment of a service user has not been met. The manager acknowledged that this has not been completed. The managers has assured Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 10 that this will be incorporated in the person centred care plan and will be completed as a priority. The risk assessments seen have been reviewed and are clear and informative. Issues relating to obtaining bank accounts for service users have not yet been resolved. The commission agreed to extend the timescale for action on this issue and work is ongoing. Essex Park 49 DS0000010437.V259224.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): 11,13, 16, Service users have an active lifestyle that is tailored to match their interests and maintain contact with the wider community. This gives service users a sense of choice and freedom. EVIDENCE: Service users living in Essex Park continue to participate in a wide range of activities within the community. Programmes of activities are recorded in service users plans. Service users have been assisted by staff to go on holiday to Tenby and Norfolk since the last inspection. Feedback received indicates that the holidays were a success. Interaction observed between staff and service users is positive. Staff are patient and have developed methods of communication with service users who have limited verbal ability. The manager stated that there are days when service users are reluctant to attend clubs or centres. They are therefore supported within the home. Service users are encouraged to take on some household chores including setting the dinner table, loading the dishwasher and making drinks. Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 12 One newly recruited staff member stated that “ service users do have choices here, they have a good, full life and are well cared for”. Essex Park 49 DS0000010437.V259224.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): 18,19,21 Essex Park supports service users well in relation to their personal care and health. This is done in a sensitive and professional manner allowing service users to maintain some independence and ensuring that all health needs are adequately met. EVIDENCE: The medical section in service users individual plans of care provides information about service users medical conditions. Information is researched and placed on the file. One service user who also suffers from diabetes has information that details how diabetes can affect him, what symptoms to look out for and what action should be taken. Service users plans also highlight how to help maintain optimum health in relation to all medical conditions. Those plans that have not been re written in the new format also have this information, which will be transferred. All records have information regarding medical appointments attended by service users. These include specialist medical appointments for women. The male service user also requires a specialist medical appointment to ensure good health. This was discussed with the manager at the time of inspection. Service users continue to have regular appointments with the Community Health Services and good relationships have developed with health and social Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 14 care professionals. On the day of inspection the community psychiatric nurse was visiting the home. The home has recently employed two male members of staff to assist the only male service user in the home. This appears to have had a positive impact on the service users who now has male company supporting him The previous requirement to ensure service users wishes in the event of their death are recorded has been met. Essex Park 49 DS0000010437.V259224.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): 23 Essex Park staff cannot adequately protect service users at risk of abuse until training has been undertaken and The London Borough of Barnet’s Adult Protection procedures are read and understood. EVIDENCE: The immediate requirement issued at the previous inspection relates to the lack of whistle blowing procedures for staff. This was met and is satisfactory. Staff in the home have not received adult protection training. Staff spoken to are aware of the basic principles of protection but lack a clear enough understanding of the Barnet Adult Protection procedures and how this works in conjunction with their own procedures. The manager is keen to undertake the training and pass this on to staff. This is a priority. There have not been any complaints since the previous inspection. Thirteen incidents have been adequately recorded some with guidance for staff around preventing similar incidents. Most service users in the home have relatives and one service users has an advocate. These interested parties are able to make a complaint on behalf of service users that live there. Essex Park 49 DS0000010437.V259224.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): 24,25,27, Essex Park generally maintains the interior and exterior of the home well. However, the entrance to the home is not welcoming and requires redecoration. This will give service users an added sense of care and comfort in their home. EVIDENCE: On entering the home the hallway wallpaper is peeling and there is evidence of black mould on the wall. The manager stated that this has been treated. This is unsightly and unwelcoming when entering the home and must be redecorated. The lounge in the home has recently been redecorated and new flooring has been purchased. The environment is comfortable and homely. The home is clean and staff and a part time cleaner maintain this. The skirting boards have been cleaned as previously required and are being maintained. An inspection of the downstairs shower room showed that the extractor fan requires cleaning. The sealant around the bath on the first floor needs to be replaced to prevent water penetration. An inspection of service users bedrooms found that the wardrobe in one room had been repaired as required in the previous report. Two service users Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 17 bedrooms seen are comfortably furnished and personalised according to their tastes Essex Park 49 DS0000010437.V259224.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, 33,34 Whilst there is still some way to go, staff are developing their competency in their caring role. The recruitment procedure is robust thereby minimising potential risks to service users. EVIDENCE: Evidence shows that staff have developed good ways of communicating with service users who have limited verbal ability. Staff also demonstrate that they are aware of service users moods and are able to adapt their working practices to ensure the necessary support is provided. On the day of inspection, one service user was being supported at home due to a change in mood that prevented socialisation at regular daily activities. Records demonstrate a positive working relationship between Essex Park staff and outside professionals. At present two care staff are completing their NVQ. The manager and the deputy are also undertaking NVQ training. The manager is aware that 50 of all staff should have completed their NVQ by April 2005, therefore the home has not reached this target. The manager states that the staff team have improved their practice in the last six months but there still remains an issue around taking responsibility for some aspects of running the home. The manager states that due to the issues in the home on her arrival it was necessary to implement a lot of changes very Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 19 quickly. This was initially difficult for staff but they have adapted to the changes, which have improved working relationships and service delivery. This is absolutely necessary as the home must be able to function in the absence of the manager or the deputy without putting service users at any risk. Presently the staff team is stable and sickness levels have reduced. The staff team have started to look at different cultures within the team and the culture of service users. This is to improve understanding and communication between all in the home. Records of a recently recruited staff member show that the recruitment was conducted according to procedure. These included references and criminal records checks and proof of identification. The staff member confirmed that these checks had been carried out and that he is still completing the induction. The staff member stated that the short courses he has attended have proved very informative. These courses include the mandatory training and epilepsy awareness. Essex Park 49 DS0000010437.V259224.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): 37, 42 Whilst a competent manager runs the home, attention must be paid to the health safety and welfare within the home. Staff must take responsibility for implementing good practice that has been put into place to ensure the health and safety of service users. EVIDENCE: The daily communications book in the home captures some issues relating to care staff carrying out some duties adequately. Entries in the book state clearly that if staff do not understand the instruction, they should discuss this with the manager. One example is the need for staff to label food in the home. An inspection of the contents of the fridge found out of date food and opened products have not been labelled. It is important that staff take responsibility for ensuring the health of service users. This requirement made at the previous inspection is not met. The manager has records of water temperatures but has not yet undertaken water testing for the presence of Legionella in the system. The homes portable appliances have been tested following a requirement at the previous inspection and the fire safety Essex Park 49 DS0000010437.V259224.R01.S.doc Version 5.0 Page 21 equipment test is up to date. The glass panel on the front door has also been repaired following a requirement from the previous inspection. The manager has produced a delegated responsibility list for all staff. There is also a need to know folder and what to do in a crisis. The manager was advised to include contact details of water, gas and electricity suppliers including where to find stopcocks and other important installations in the home. Essex Park 49 DS0000010437.V259224.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 3 X Standard No 22 23 Score X 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 2 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 2 X X X LIFESTYLES Standard No Score 11 3 12 X 13 3 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score 3 2 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Essex Park 49 Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000010437.V259224.R01.S.doc Version 5.0 Page 23 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 YA9 Regulation 13(4)(c) Requirement The registered person must ensure that a risk assessment is undertaken for a service user with visual impairment. In relation to her bedrooms proximity to the kitchen. This should be sent to the commission on completion. (Previous timescale 31/07/05 not met) The registered person must ensure that risk assessments are undertaken on all service users to ensure their safety in the home. (Previous timescale of 31/07/05 not fully met). The registered person must ensure that a GP appointment is made for the male service to ensure that specialist medical attention is received as discussed with the manager. The registered person must ensure that all staff receive adult protection training and are familiar with The London Borough Of Barnet Adult Protection manual. The registered person must ensure that the entrance hall in DS0000010437.V259224.R01.S.doc Timescale for action 31/12/05 2. YA9 13(4)(C) 05/01/06 3. YA19 13(1)(b) 16/12/05 4. YA23 18(1)(c) (i) 30/01/06 5. YA24 23(2)(b) (c) 31/12/05 Essex Park 49 Version 5.0 Page 24 the home is re decorated. 6. YA27 23(2)(p) The registered person must ensure that the extractor fan in the ground floor shower room is cleaned regularly to prevent a build up of dust. The registered person must ensure that the sealant around the bath on the first floor is replaced to prevent water penetration. The registered person must ensure that 50 of staff complete their NVQ. The registered manager must ensure that the water supply is tested and chlorinated to ensure that any risk of legionella is detected and treated. (Previous timescale 31/07/05 not met) The registered person must ensure that all food is labelled to ensure consumption within the specified time and minimise the risk of food poisoning. (Previous timescale 03/06/05 not met) 16/12/05 7. YA27 23(2)(c) 16/12/05 8. 9. YA32 YA42 18(1a)(c) (i)(ii) 13(3) (4)(c) 01/04/06 05/01/06 10. YA42 16(2)(g) 16/12/05 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 Essex Park 49 DS0000010437.V259224.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. 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