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Inspection on 18/07/05 for Evering Road (41)

Also see our care home review for Evering Road (41) for more information

This inspection was carried out on 18th July 2005.

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 9 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

HILT`s Evering Road project continues to offer good quality care for service users living at the home. The project also continues to make good efforts to find creative methods to increase the independence social and communication skills of residents. Staff have continued to develop work around person centred planning with current service users

What has improved since the last inspection?

The purpose of the inspection was to review the home`s progress in addressing outstanding requirements from the previous inspection. It was noted by the inspector that some of the requirements had indeed been addressed satisfactorily, in particular the development and implementation of key policies and procedures. On this occasion, in the absence of senior members of staff, the inspector had no access to staff personnel file that may have confirmed that other, staff related requirements had also been resolved satisfactorily.

What the care home could do better:

The previous inspection had highlighted the need for an urgent review of the placement of the service user living semi-independently at the project. At the previous inspection, the inspector had questioned the purpose and validity of the placement; this was further compounded by the service user`s clear breach of his tenancy agreement. The inspector reviewed again at this inspection this service user`s case file and remained of the opinion that the placement at Evering Road was inappropriate; it remains unclear, more so since the file evidenced no current care plan, of placement objectives.

CARE HOME ADULTS 18-65 Evering Road (41) 41 Evering Road Stoke Newington London N16 7PU Lead Inspector Sandra Jacobs-Walls Unannounced Inspection 18th July 2005 11:00am 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 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 Stationary 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. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Evering Road (41) Address 41 Evering Road, Stoke Newington, London, N16 7PU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0207 241 2145 0207 241 2145 info@hilt.org.uk Hackney Independent Living Team (HILT) Ms Sheilagh Hindmarsh Care Home - PC 6 Category(ies) of LD - Learning Disability (6) registration, with number of places Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 29th March 2005 Brief Description of the Service: Hackney Independent Living Team (HILT) Evering Road project is a residential home offering services to a maximum of 6 residents who have learning disabilities. HILT, a private sector organisation, manages the home. The home is situated in a residential area of Stoke Newington in the London Borough of Hackney. It is within easy access to local shopping and transport facilities. The ground floor is wheelchair accessible. At the time of the inspection four service users were accommodated. One service user lives on the first floor in a self contained flat, the remaining service users are accommodated on the ground and first floor. There is a garden to the rear, which is largely paved and has a swing. The building is homely in appearance and can cater for service users who have significant physical disabilities. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the morning of July 18th 2005 for 2.5 hours. At the time of the inspection, the registered manager was off sick, while the home’s deputy manager was off shift. Two support workers on shift assisted with the inspection process. Only one service user was in the home at the time of the inspection, however communication difficulties prevented the inspector from obtaining this service user’s wishes and feelings. The purpose of the inspection was to review the home’s progress in addressing requirements made at the last inspection that was conducted on March 29th 2005. The process included discussions with staff, review of key policies, procedures and other documentation and the review of one service user case file. As a result of this inspection nine requirements and one recommendation were made. The inspector would like to thanks all staff and service users who contributed and co-operated with the inspection. What the service does well: What has improved since the last inspection? The purpose of the inspection was to review the home’s progress in addressing outstanding requirements from the previous inspection. It was noted by the inspector that some of the requirements had indeed been addressed satisfactorily, in particular the development and implementation of key policies Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 6 and procedures. On this occasion, in the absence of senior members of staff, the inspector had no access to staff personnel file that may have confirmed that other, staff related requirements had also been resolved satisfactorily. 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. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 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 standard(s) No standards under this heading were assessed during the inspection. EVIDENCE: Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 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 standard(s) 6,7,9,10 Service users assessed and changing needs were not consistently reflected on individual files. Service users made decisions about their lives, but current risk assessments were not consistently evident on file. Staff were unable to produce the organisation’s confidentiality policies. EVIDENCE: The inspector reviewed the individual file for one service user. The file contained no current care plan, so it was difficult to ascertain how the placement was addressing assessed and changing needs. Individual files must evidence current care plans that are explicit in outlining services to be provided. The file reviewed also did not contain a written risk assessment, essential, the inspector felt since a number of recent issues highlighted the need for staff to be aware and vigilant of the service user’s continued vulnerability. The inspector asked to review the home’s Confidentiality policy as it relates to service users; this was in need of development at the previous inspection. No policy document could be evidenced; this requirement is therefore repeated. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 10 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 standard(s) No standards under this heading were assessed during the inspection. EVIDENCE: Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 19 &20 The home’s medication policies and procedures are sound and staff practices offers protection to service users. EVIDENCE: The inspector reviewed the medication information for one service user in detail. Information was appropriately recorded on MAR sheets and there was evidence of staff consistently checking information for accuracy. It was difficult to ascertain whether the physical and emotional health needs of the service user were being well met, since there was no care plan on file to assist clarify current placement objectives. There was evidence however, of minimal involvement of healthcare professionals. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 22 & 23 The home must ensure that literature kept on site regarding the home’s complaints procedure is consistent and the most current information. All documented complaints must be centrally kept and available to be reviewed as part of the inspection process if necessary. The home adult protection procedures must be complied with fully to ensure service user’s safety. EVIDENCE: The home’s complaints procedure at the last inspection was in need of revision. At this inspection the inspector asked to see the home’s written complaints procedure. Information seen was the previously reviewed policy document and not the updated information as evident on the home’s computer system. The inspector noted that the home’s Statement of Purpose document had similarly not been updated. Service users and other stakeholders must have access to the most current complaints policy information. The inspector also saw in the home’s complaints log a complaint regarding the care practices of one member of staff by another. In reviewing the documentation, it was unclear how this complaint had been resolved or whether appropriate adult protection procedures had been followed in this instance. The inspector was clear that the incident in question was of an adult protection nature, however it was unclear for example whether other relevant bodies e.g. the local authority, had been informed. The staff member present during the inspection commented that this complaint was a counter complaint to one made by the other worker involved in the documented incident. However, the original complaint was not evident in the home’s complaints file. Staff must ensure that all complaints/ instances of actual or suspected abuse/neglect of service users are appropriately documented and managed. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 13 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 standard(s) No standards under this heading were assessed during the inspection. EVIDENCE: Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34.35 & 36 There would appear to be increasing tension between the staff group on a number of different levels that has negatively impacted upon the team’s effectiveness. The lack of access to staff personnel files meant no evidence was produced at this inspection to confirm service users are protected by the home’s recruitment practices or that the frequency of staff supervision had improved; these were areas in need of improvement at the last inspection. Training opportunities for staff had improved since the last inspection. EVIDENCE: Staff personnel records were not available for review during the inspection. In the absence of confirmation that recruitment practices and staff supervision levels had been addressed, these requirements are repeated. Review of the home’s complaints file and discussion with staff present, highlighted ongoing relationship difficulties between some members of staff that had been alluded to at the previous inspection. It would appear that tensions within the staff group had not been resolved as recommended at the previous inspection and as a result the inspector got the impression that at times the staff group did not function as cohesively as it had several months prior. Written documentation seen in the home’s complaints log supported this view. There is a need for these issues to be addressed as a matter of urgency since it is Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 15 probable and perhaps inevitable that the home’s current atmosphere may well have a negative impact on the household and service users. The staff member who spoke with the inspector about training opportunities commented that she was currently completing NVQ training and that in the past year she had participated in a range of workshops/training. These included first aid (refresher) training, risk assessment and fire safety training. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) No standards under this heading were assessed during the inspection. EVIDENCE: Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x 2 2 x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Evering Road (41) Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 18 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, 19 Regulation 12(1) Requirement The registered manager must ensure that all service user care plans are maintained on file to assist establish placement goals and objectives (Timescale of 01/06/05 not met) The registered manager must ensure that risk assesments are evident on all service user files. The registered manager must develop and implement a confidentiality policy that relates to service user information. (Timescale of 01/06/05 not met) The registered manager must ensure that only the homes revised complaints policy is available for use on site The registered manager must ensure that all complaints are appropriately recorded in the homes complaints log The registered manager must ensure that the homes adult protection procedures are complied with fully in every instance. The responsible individual must ensure that current staff group tensions are effectively addressed and resolved. Timescale for action 01/09/05 2. 3. YA9 YA10 12 12(4)(a) 01/09/05 01/09/05 4. YA22 22 01/09/05 5. YA22 22 01/09/05 6. YA23 13(6) 01/09/05 7. YA33 12(5) 01/10/05 Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 19 8. YA34 19 9. YA36 18(2) The registered manager must ensure that staff files contain all information as specified in Schedule 2 of the Care Homes Regulations. (Timescale of 01/06/05 not met) The registered manager must ensure that all staff receive regular supervision that is documented (Timescale of 01/06/05 not met) 01/10/05 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA33 Good Practice Recommendations It is recommended that the entire staff group participate in team building exercises to assist enhance the cohesiveness of the team. Evering Road (41) G56 G06 S10268 41 Evering Road V239045 180705 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway Stratford, London E15 4BQ 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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