Inspection on 19/08/08 for Evering Road (41)

This inspection was carried out on 19th August 2008.

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 36 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Evering Road (41) 04/12/08

Evering Road (41) 03/09/07

Evering Road (41) 06/09/06

Evering Road (41) 19/01/06

Evering Road (41) 18/07/05

Evering Road (41) 29/03/05

Evering Road (41) 19/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Evering Road (41) 41 Evering Road Stoke Newington London N16 7PU Lead Inspector Anne Chamberlain Unannounced Inspection 19th August 2008 09:45 Evering Road (41) DS0000010268.V368463.R02.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 Evering Road (41) DS0000010268.V368463.R02.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. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Evering Road (41) Address 41 Evering Road Stoke Newington London N16 7PU 020 7241 2145 020 7241 2145 evering@hilt.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hackney Independent Living Team Syed Salique Ahmed Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd September 2007 Brief Description of the Service: 41 Evering Road is a residential home which is registered to accommodate six younger adults with a learning disability. Hackney Independent Living Team (HILT), a voluntary sector organisation, is the registered provider for the home. The home is a converted terraced house with a self-contained flat for one person and accommodation for five more people on the ground and first floors. The ground floor is wheelchair accessible. 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 stated aim of the home is to support people with a learning disability to live happy and fulfilling lives in the community. The London Borough of Hackney block purchases all the places in the home. The current weekly cost of a placement is between £1040 and £1680, depending on the person’s needs. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this home is 0 star. This means that people who use this service experience poor quality outcomes. This inspection was conducted on behalf of the Commission for Social Care Inspection (CSCI) and the terms we and us are used throughout. The home submitted an Annual Quality Assurance Assessment (AQAA) prior to the inspection. This contained useful information about the service. The site visit of the inspection took place over one day and lasted for some eight and a half hours. We spoke with service users and two staff members. The manager of the home was not present on the day of the inspection and neither was the deputy, but we were assisted by two members of staff. We looked at files for three service users, as well as other key documentation. We inspected the arrangements for the administration of medications and made a tour of the communal areas of the home and one service users bedroom. We would like to take this opportunity to thank the service users and staff at the home for their co-operation and assistance with the inspection. What the service does well: What has improved since the last inspection? The new manager of the home is registered with The Commission for Social Care Inspection (CSCI). A plinth has been replaced in the laundry room and a seal around the first floor bathroom. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 6 What they could do better: The inspection resulted in thirty six statutory requirements, seven of which are restated and two good practice recommendation. Where assessments are old, reassessment must be undertaken. Care plans must be accessible and reviewed every six months. They must be carried out. Service users must be supported to enjoy appropriate leisure and recreational activities as identified on their care plans. Risk assessments must be comprehensive and reviewed regularly. The manager must review the risks attached to a service user being at home unsupervised. Risk assessments and people moving people plans must be up to date. Key documents must be signed by service users. If a service user has been deemed by a physiotherapist to need regularly physiotherapy then this must be incorporated into his care plan, carried out and recorded. The manager should give consideration to having cleaning help in the home and arranging for staff to have time identified for their administration work. Service users must be protected against all forms of abuse. Recording must be of an adequately detailed standard. Medication practice needs some improvement. The environment needs urgent attention, particularly the ground floor bathroom. Staff training and supervision levels must be improved. Fire exit signs must be put up and smoke detectors tested regularly. Control of Substances Hazardous to Health (COSHH) items must be kept locked away and data sheets kept for all products. Other poisonous substances (like paint) must be kept locked away. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 7 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. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 8 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 Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 9 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): 2. Service users experience good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Service users needs are properly assessed before they are offered a place in the home, but old assessments must be updated. EVIDENCE: We looked at the files of two service users. The first file for service users A, had evidence of assessment in the form of a Statement of Need which was dated May 2000 and a Community care Plan dated May 2000, both of which had been undertaken by the London Borough of Hackney. The second service user, service user B has been admitted recently. The file had a fair amount of assessment information including a HILT referral assessment form and reports by professionals. We feel that assessment practice at the home is acceptable now. However the assessment information for the first service user is so old and so fragmented we believe that a reassessment of needs should be undertaken and placed on the file. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 10 The manager must undertake a reassessment of need for the service user and any other service user whose assessment information is over three years old. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 11 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 and 9. Service users experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Individual service user plans are fragmented and difficult for staff to access. Risk assessment is inadequate. Plans and assessments are not updated regularly. Service users are encouraged to make some decisions with regard to their lives. EVIDENCE: The care planning information was fragmented for service user A, and staff were not confident about where to find it. A staff stated that she thought the care plans were being redone electronically and the computer was not working. Service user plans are not standardised across the home. A staff member explained that the files for people he keyworks with are much clearer and Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 12 easier to access and he showed a file to us to demonstrate. We recommend that care plans are standardised. Support information can be found on shift support plans and on daily plans. Support plans for service user A were found on a separate folder to his file (induction folder) in the form list of things which the service user is assisted with throughout the day. A worker told us that these tasks are supposed to be ticked off by staff, as they are achieved, as a form of record. These records had not been completed since July 2008. Service user B had a support plan dated 12/5/08. It was noted that nothing had been entered in the section on education, employment and daily activities. However the service users plans states that an agreement will be set up regarding the service user accessing the community and a risk assessment for this is discussed below. The funding authority had given a statement of needs for service user B. It cannot be said that care plans are accessible to staff at all times and again the previously stated requirement for this is restated. We examined the record of review of care plans in the files of two service users. The plan for the first service user had not been reviewed since September 2007 and before that in March 2006. A requirement was issued at the last inspection that care plans are reviewed every six months. The requirement will be restated in this report. It was difficult to evidence service users making decisions for their lives because daily recordings were sparse and the files of service user A and B rendered little evidence of their undertaking activities. However the support plan for service user A stated staff should give him time to choose clothes and he should be able to change clothes when he wants and should be involved and informed in decisions regarding his life. We were also told by staff that service users decide what they would like to eat at their weekly residents meetings. Service user A had a manual handling risk assessment dated 24/5/07 undertaken by an outside professional RGN. The plan had been reviewed and superseded by a plan dated 30/5/07 which stated on the plan that it replaced the previous one. The first plan was handwritten, the second was typed. The first plan was the one staff were currently following. Both plans stated that they should be reviewed in one month or sooner. The risk assessment is over a year old and out of date. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 13 Service user B had a risk assessment dated 22/2/08 regarding anti-social behaviour in the community. Actions were identified in his service user plan to reduce this risk, by liaison with agencies in the community (psychology services, occupational therapy and the police) and the replacement of negative activity by more positive activities. The service user has an appointment to see a clinical psychologist in August 2008, but otherwise there was no evidence of these connections to other agencies being achieved. An action identified to reduce risk to and from service user B (in the community) was a curfew set on the service user that he return home by 8p.m. each evening. It was not clear how this would reduce the risk of antisocial activity in the community. Also a staff member stated that the service user now does not go out. The planning around risk management needs to be updated. Actions identified to address risk must be carried out. A risk of service user B starting a fire has been identified by the home, based on his history before coming to live there. However he often chooses to remain at home on pub night, when all the other service users (excluding the service user who lives in the self-contained flat) and the staff go to the pub. We feel that service user B is at risk from fire, as is the person who lives in the self-contained flat, when service user B is left unsupervised in the home. This situation must be risk assessed and if there is significant risk then the practice must stop. Requirements have been made regarding risk assessment and two of these are restated. Key documentation has not been routinely signed by service users and staff. Service user plans and risk assessments must be signed and dated by the service users and by a representative of the home. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 14 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): 12,13,14,15, 16 and 17. Service users experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Service users do not have adequate opportunities for leisure or recreation outside of the home. Family relationships are supported and a varied diet is offered. EVIDENCE: As stated we examined the files of two service users. In these files there was little information as to the cultural needs of service users or how they will be met. Service user A attends a day centre twice a week, however apart from this his daily record showed that between 1/8/08 and the date of the inspection 19/8/08 he had been out to Dalston once and out with his volunteer once. This is despite the fact that his Essential Lifestyle Plan states that he likes to Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 15 go about with the general public, to buy a paper or visit a café or shop for personal items, including sweets. We spoke to a staff member about why service user A does not go out with staff. He said that this is due to staffing levels and that there is a significant amount of lone working at the home which precludes one to one support in the community. During the course of the site visit service user A had a massage from a visiting masseuse. We noted on the service users planned activities sheet that this massage is a regular event every week. Service user B does not appear to go out unless taken by a relative. According to his daily records between 9 August and 17th August he went out twice and on both occasions it was with his relative. The service users file contains a number of ideas of activities the service user could undertake. He has been advised to walk for health reasons and he is a football fan, supporting a London team. The service user has been connected to a walking club and he has a volunteer to accompany him. There was evidence on the file of the volunteer calling on several occasions to take him to the club and finding him unwilling to go. On three consecutive occasions the volunteer wanted to support the service user to cancel by telephone but the telephone number was lost. The task of attending the walking club would seem to be too daunting for the service user, but no suggestion has been made regarding scaling it down to perhaps just walking to the local shop. The home failed for three weeks to locate the lost telephone number of the group and their support of this service user and volunteer falls below an acceptable standard. We were pleased to hear that three service users have been booked to go on holiday in September, 2008. We were told by staff that service users choose what they would like to eat and they do this at their meetings. We saw the pictoral material which is used to support this choice. We also saw the menu plans. We were told that the home orders a takeaway once a week and the takeaway menus are used for this. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 16 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 and 20. Service users experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Service users receive personal support in a sensitive way and their health and emotional needs partially are met. Some improvement in mediation practice is needed. EVIDENCE: There was some information on the file of service user A to the effect that he benefits from physiotherapy. A care worker said that staff do undertake physiotherapy with the service user. He said that staff do this depending on their own physical abilities and willingness to undertake the task. He stated where we can we do. The manager must obtain clarity around whether or not service user A or any service user needs regular physiotherapy in the home. If physiotherapy is an identified need it cannot be provided on the basis of staff discretion. If a Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 17 service user needs physiotherapy this then it must be documented on the care plan and provided with a proper programme. We inspected the arrangements for the administration of medication. We noted that the keys to the medication cupboard are kept on the top of the cupboard. This is unsafe practice. We noted that there are no balances of medication brought forward on Medication Administration Record (MAR) sheets. This makes it difficult to balance stocks of medications. We recommend that brought forward balances are recorded. There were two quantities of paracatomol tablets dispensed to a service user, dated 10/3/08 both of which were marked discontinued. These should be disposed of back to the pharmacist. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Service users receive poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The home is not protecting service users adequately from emotional abuse, the complaints policy needs to be updated. EVIDENCE: The home has a complaints policy. However it stated NCSC instead of CSCI and gives an old address. The policy needs to be updated with the correct details. A laminated copy of the complaints form was seen and a staff member said that the complaints form is stored electronically. The home has a whistleblowing policy which we saw. We also had a discussion with the staff member present about what to do in the case of an allegation or suspicion of abuse. He said that he would ensure that the service user was safe and would inform the manager and possibly the police and preserve evidence. He said that the home usess the local authority (Hackney policy) but that he could not find it at that moment. The home receives visits from two volunteers. We met one of the volunteers (volunteer A) working with a service user on the day of the inspection. She told us that she was undertaking the visits as part of an NVQ course and that Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 19 she had had a CRB disclosure undertaken. Staff said that volunteer B is also undertaking the visits in order to pass and NVQ qualifications. Volunteer B we noted, visits quite frequently, having been there ten times over the six weeks before the inspection. Unfortunately we could access no documentary information on the source of the volunteers, or their vetting. There was nothing in the files of the service users which we inspected, although both work with volunteer B. Volunteer B writes a file note of all his visits. We were sorry to read an entry dated 17/8/08 which stated… ……I and the other service users asked him to have a bath……..we had to force him to have a bath (the service user)……we were able to deal with it (his refusal) by making him understand he will have no cigarettes for half a day, and will not be allowed access near any of the service users This is emotional abuse. The volunteer must be made to understand this and to have or revisit training in the protection of vulnerable adults. The manager must submit to the CSCI information on all volunteers who currently visit the home, where they come from, what qualifications they have, whether they have satisfactory Criminal Records Bureau (CRB) checks and what training they have had prior to volunteering at the home. We understand that volunteers do not work alone with service users but with other staff. This means that another staff was involved in this incident and did not correct the actions of the volunteer. We do not understand if the reference to working with another service user is an error and the volunteer meant to write staff member, but volunteers must work with staff, and other service users should not be taking on staff support roles. This matter was brought to the attention of a staff member on the day of the inspection and was also reported to a senior manager in the organisation subsequent to the inspection. She agreed to deal with the matter in the absence of the manager. The matter has also been reported to the safeguarding officer at the local social services. We asked the a staff member for the information to be used should someone go missing. After a little deliberation the missing persons information for service user A was found on the staff induction folder. There was no missing persons information for service user B who has been at the home for six months. A requirement has been made. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 20 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, 27 and 30. Service users experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The environment of the home is not homely, comfortable and safe. Toilets and bathrooms are not of an acceptable standard and the home is not especially clean. EVIDENCE: We toured the environment of the home including (with his permission) the bedroom of one service user. The bedroom was very pleasant but the environment in the communal areas of the home was generally not satisfactory. The décor was poor with walls and doors generally scratched and scarred. No cleaning help is employed in the home and staff are expected to keep the house clean as part of their duties, although there is no plan of responsibilities Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 21 or expectations outlined for this. A requirement has been made and it is suggested that if a cleaner cannot be employed then at least a plan is made for staff to incorporate cleaning the home into their work with responsibilities which have been made clear. The home suffers from very high levels of limescale in the water supply. It appears that nothing is done to address this i.e. there is no water softening unit and limescale remover is not used. The utility room sink and the sink in the kitchen were very scaled up. Floors had been hoovered and appeared clean but the paintwork was generally very dirty and dusty, including the skirting boards. Doors and switch plates were finger marked. A recommendation was made at the last inspection that the kitchen be refurbished. It has not been done. The kitchen appears to be a cheap one which has not withstood the rigours of residential provision. It was in a poor state of repair, not clean, and really needs replacing. The heater cover in the sitting room is metal and quite buckled. The seats of the dining chairs are torn. The seat was off of the toilet on in upstairs bathroom. The carer said this was easy to fix and he would do it later in the day. We had the impression that the seat comes off fairly often. There were rusty paint tins on the roof terrace outside of the office on the first floor. The adapted bathroom on the ground floor is used by two service users who have compromised mobility. It is below any acceptable standard of public health or residential care. The ventilation is poor. The plughole in the in the floor is defective and the plug has been pulled out by staff. This means that staff or service users could get their feet caught in the hole. The walls of the bathroom are covered in a mixture of thick limescale and mould. The radiator in the bathroom is rusty and there are black marks above itl. No service user or member of staff should be asked to use this bathroom. A staff member stated that the ground floor bathroom is to be refurbished during the month of September when service users are on holiday. A requirement has been made on this basis. In addition a referral has been made to the public health department of Hackney council. At the last inspection a requirement was made that the seal around the first floor bath be replaced, and the bathroom be redecorated. The manager advised by e-mail after the site visit that the seal has been replaced but the Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 22 bathroom has not been redecorated. The requirement has therefore been partially restated. The home does use the clinical waste collection scheme and a list of collection dates was seen. The clinical waste is appropriate stored for collection outside of the house, but accessible to the contractor. The home has a separate laundry room and the floor has an impermeable surface. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 23 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 and 36. Service users experience adequate quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Staff have some competency and qualifications, but they are not adequately trained or supervised. EVIDENCE: When we arrived in the morning there were two bank staff working at the home. There were no other staff present. A permanent member of staff came on duty in the afternoon. Unfortunately we were not able to gain access to staff recruitment, training and supervision records because they were locked away and only the deputy manager and manager have the key. Neither were present on the day of the inspection. The staff member we spoke to said he needed to update his health and safety and food hygiene training. He said that all staff have had medication training, although his was two years ago and his first aid training was in 2006. He said that he was currently undertaking an NVQ 3 qualification.There was evidence Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 24 that staff have induction as a check list was seen. There was also proof that volunteer A had induction. Following the site visit the manager was asked to supply by e-mail evidence regarding recruitment and that staff are adequately trained and supervised. He supplied information regarding training which indicated that there is a serious and significant shortfall in staff training including the following examples: Staff not had first aid training since 2002 Staff not had manual handling training since 2001 Fire training not done since 2001 Medication training not done since 2004 Three staff are currently working towards NVQ 3 qualification. Staff training is not adequate and a requirement has been made. The manager supplied e-mail information regarding staff supervision. He stated the most recent supervision dates for five staff as being 4/3/08, 19/3/08, 17/4/08 12/6/08 and 1/07/08. Staff must have regular recorded supervision meetings with their manager at least six times a year. The dates above demonstrate that the frequency of supervision is falling short, and a requirement has been made. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 25 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 and 42. Service users experience poor quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Service users views are taken into some account but overall the home is not well run. Health and safety are promoted to an extent. EVIDENCE: The manager of the home has been in post for around nine months and is now registered with the CSCI. There was not sufficient positive evidence to say that the home is well run. Indeed this inspection has resulted in a very high number of statutory Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 26 requirements. It was noted that some systems are in place to support smooth running. We noted from incident reports that a medication error occurred on 24/11/2007. This was not reported to the CSCI and a requirement has been made. Any event in the home which adversely affects the well-being or safety of any service user must be reported under Regulation 37 and the manager is referred to this regulation. Apparently the home has not had a working computer for at least two weeks due to the moving of head office and the delivery of the wrong computer. The home has been affected by organisational change which has not been managed without disruption. Person in charge visits are undertaken on the home by senior managers, although these were not recorded on a monthly basis. Residents have in house meetings. Some service users attend People First. No other evidence of quality assurance was available. Daily recording for service users was very brief, usually just one entry for the whole day, a.m. or p.m. An example being an entry on 7/8/08 which stated spent the afternoon listening to music in the lounge, seemed happy and content. We noted that daily records might or might not mention a visit from a volunteer. We understand from staff that the records exist alongside tick lists which had been unavailable for a month due to the home not having access to a working computer. Staff told us that there are no admin shifts allocated to them, so they have to do their administrative work and care for service users at the same time. As mentioned earlier staff are also responsible for keeping the home clean. The record keeping in the home was inadequate and a requirement has been made. The home has a health and safety policy but it was dated 2005 and therefore needs to be updated. We inspected the arrangements for the COSHH. The cupboard where the products were stored was not locked. It contained a variety of cleaning and other products, also old cans of paint. Some products for example a large bottle of fabric conditioner were not stored in the cupboard. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 27 There were not data sheets available for the products which were stored in the home and these must be obtained. A member of staff told us that the fire alarm is tested weekly and that there is a three monthly fire evacuation practice. We checked and this was last done on 26/6/08 and before that in March. On 26/6/08 an outside contractor tested the fire protection system. The staff member said that the evacuation route is to the front of the house or the back if necessary. We noted an absence of Fire Exit signs. Fire exit signs must be posted to show people the evacuation routes. We noted smoke detectors on the ground and first floors. A staff member told us that the home does not test smoke detectors. We were not able to locate a Fire Assessment for the house and have required the manager to forward this to us. A staff member told us that the tumble drier needs attention. Tumble driers have a potential to star fires and must be in good working order. At the previous inspection a current certificate for the electrical installation of the house was not available for inspection. No current certificate wa seen on the site visit at this inspection so we proof afterwards by e-mail from the manager. He has not be able to provide any evidence that there is a current certificate, and the requirement has been restated. We noted that portable appliance testing (PAT) was undertaken by an outside contractor in June 2008. Also we saw a gas safety certificated dated 2008. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 28 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 x 2 2 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 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 x 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 3 x 2 2 x Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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. YA 1. Standard YA2 Regulation 14(2)(b) Requirement The manager must undertake a reassessment of need for service user A and any other service user whose assessment information is over three years old. The registered person must ensure that all care plans are reviewed at least every six months and must be accessible to all staff at all times to ensure that all staff can be confident that the support and guidance they are offering to people is current. Both elements of this requirement are restated previous timescale of 15/10/07 not being met. Timescale for action 01/10/08 2. YA6 15(1 & 2) 01/10/08 3. YA6 12(2) 4. YA9 13(4) Key documentation relating to 01/10/08 service users i.e. their care plans, must be signed and dated by the service user and a representative of the service. Risk assessments must identify 01/10/08 a full range of possible risks to individuals (previous timescale DS0000010268.V368463.R02.S.doc Version 5.2 Page 30 Evering Road (41) of 15/10/07 not met). 5. YA9 13(4) A risk assessment must be undertaken on service user B being left unsupervised in the home. If the practice is deemed to be too risky it must stop. Risk assessments must be reviewed regularly and they must show evidence of who has reviewed them (previous timescale of 15/10/07 not met) Risk assessments must give guidance on how to minimise risks, and this guidance must be followed. Key documentation relating to service users i.e. their risk assessments, must be signed and dated by the service user and a representative of the service. The manager must ensure that service users are supported to access the community and to take part in appropriate leisure activities. The manager must get clarity around whether or not service user A or any other service user should have regular physiotherapy in the home. If service user A or any other service user needs physiotherapy this then this must be documented on the care plan and provided with a proper programme. The therapy must be recorded. 11. YA20 13(1) The keys to the medication cupboard must be kept on the senior member of staff on shift DS0000010268.V368463.R02.S.doc 01/10/08 6. YA9 13(4) 01/10/08 7. YA9 13(4) 01/10/08 8. YA9 12(2) 01/10/08 9. YA14 12(1)(b) 16(2)(m) 01/11/08 10. YA19 12(1)(a) 01/11/08 10/09/08 Evering Road (41) Version 5.2 Page 31 at all times. 12. 13. 14. YA20 YA22 YA23 13(1) 22 13(6) Discontinued medication must be disposed of by being returned to the pharmacist. The complaints policy must be updated to reflect the correct contacts details for the CSCI. The home must have their adult protection policy to hand, and it must also keep a copy of the local authority policy to be followed in conjunction. The manager must protect the service users from all kinds of abuse including emotional abuse. The manager must submit to the CSCI information on all volunteers who visit the home, where they come from, what qualifications they have, whether they have satisfactory Criminal Records Bureau (CRB) checks, and what training they have had prior to volunteering at the home. 16. YA23 13(6) Volunteer B must have or have or revisit training in the protection of vulnerable adults. The staff member who was working with volunteer B on 17/8/08 with service user B must renew his/her adult protection training. Service uses must not take on staff support roles. The manager must submit to the CSCI information on all volunteers who currently visit the home, where they come from, what qualifications they have, whether they have DS0000010268.V368463.R02.S.doc 01/10/08 01/10/08 01/10/08 15. YA23 13(6) 10/09/08 01/10/08 17. YA23 13(6) 01/10/08 18. 19. YA23 YA23 13(6) 13(6) 10/09/08 01/10/08 Evering Road (41) Version 5.2 Page 32 satisfactory Criminal Records Bureau (CRB) checks and what training they have had prior to volunteering at the home. 20. YA23 13(4)(b) The manager must ensure that the home has readily accessible missing persons information for all service users, including a photograph of the person. The manager must ensure that the home is kept clean and hygienic. The manager must address urgent refurbishment issues as follows: The heater cover in the sitting room is metal and quite buckled. It must be replaced. The seats of the dining chairs are torn and must be replaced. 23. YA27 13(4) 23(2)(c) 01/11/08 The registered person must ensure that the suitability of all the existing toilet facilities in the home must be evaluated, that the toilet facilities provided must be robust enough to meet the specific needs of people using them and that they must be kept in good repair to promote the health, safety and comfort of those who use them (previous timescale of 31/10/07 not met). The registered person must ensure that the entire shower area on the ground floor is refurbished to ensure it meets the health, safety and comfort needs of people using it (previous timescale of 31/10/07 not met). DS0000010268.V368463.R02.S.doc 01/10/08 21. 22. YA24 YA24 23(2)(d) 23(2)(c) 01/10/08 01/12/08 24. YA27 13(4) 23(2)(d) 01/10/08 Evering Road (41) Version 5.2 Page 33 25. YA27 13(4) 23(2)(d) The registered person must ensure that the first floor bathroom is redecorated or refurbished for the health, safety and comfort of people using I (it (previous timescale of 15/10/07 not met). 01/10/08 26. YA35 13(4)(c) The manager must ensure that 18(1)(c)(1) staff receive adequate training. This must include up to date first aid training and refreshment of basic core topics including: Health and safety Food Hygiene People moving people Adult protection 01/12/08 27. YA36 18(2) 28 YA37 37 Staff must have regular recorded supervision meetings with their manager at least six times per year. Any event in the home which adversely affects the well-being or safety of any service user must be reported under Regulation 37. The manager is referred to this regulation. 01/11/08 01/10/08 29 YA41 17 30 31 YA42 YA42 12 13(4)(c) The daily records for service 01/11/08 users, kept in the home must be adequately detailed and comprehensive. The health and safety policy of 01/11/08 the home must be reviewed as it was written in 2005. The manager must ensure that 01/11/08 data sheets are kept for all COSHH products stored in the home. Poisonous substances like paint must be locked away. Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 34 32 YA42 23(4) The manager must ensure that Fire Exit signs are posted to show service users, staff and visitors the evacuation routes in case of fire. The manager must forward to the CSCI electronically or in hard copy a copy of the homes Fire Assessment. Smoke detectors in the home must be tested at least every three months and the results recorded. The manager must ensure that the tumble drier is in good working order to ensure the safety of service users, staff and visitors. The registered person must ensure that the electrical installation in the home is tested and that documentary evidence of this is kept for inspection. This is to ensure that people living and working in the home are properly protected in this area (previous timescale of 15/10/08 not met). 01/10/08 33 YA42 23(4) 01/10/08 34 YA42 23(4) 01/10/08 35 YA42 23(4) 01/10/08 36 YA42 23 (2)(c) 23(4) 01/10/08 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. 2. Refer to Standard YA6 YA20 Good Practice Recommendations Care plans should be standardised. The manager should ensure that balances of medications are brought forward on MAR sheets to facilitate stock audit. DS0000010268.V368463.R02.S.doc Version 5.2 Page 35 Evering Road (41) Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Evering Road (41) DS0000010268.V368463.R02.S.doc Version 5.2 Page 36 - 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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