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Inspection on 03/09/07 for Evering Road (41)

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

This inspection was carried out on 3rd September 2007.

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

The inspector found 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.

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

What the care home does well

The service provides sensitive and personalised care to people with a range of complex needs including some with significant physical disabilities and communication needs. Staff are working hard to further develop means of communicating with people and have accessed different healthcare professionals to assist in meeting people`s needs on an individual basis. People who live in the home enjoy a wide range of appropriate activities and this has included the opportunity for people to enjoy a holiday abroad this year if they wanted to.

What has improved since the last inspection?

At the last key inspection ten requirements were made in the following areas: records relating to a safeguarding adults allegation; two areas relating to redecorating and/ or repair of identified areas in the home; flooring in people`s bedrooms; two areas relating to replacement or maintenance of fittings in the home; keeping the home hygienic and odour free; staff recruitment; staff supervision and monitoring visits by the provider organisation. At the subsequent random inspection six of these requirements had been complied with leaving four that were restated. The restated requirements from that random inspection were in the following areas: two areas relating to the physical environment in the home; staff recruitment and records of the provider organisation`s monitoring visits. I was pleased to see that these four requirements had been complied with at this inspection although the physical environment of the home remains a concern. This is again referred to in the relevant sections of this report and further requirements made.

CARE HOME ADULTS 18-65 Evering Road (41) 41 Evering Road Stoke Newington London N16 7PU Lead Inspector Peter Illes Unannounced Inspection 3rd & 5 September 2007 09:00 th Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Evering Road (41) DS0000010268.V349376.R01.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 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 Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th September 2006 Brief Description of the Service: 41 Evering Road is a residential home that 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 with a dedicated and well qualified staff team to live happy and fulfilling lives in the community and participate within. The home promotes service users rights, responsibilities and individual choice, encouraging independence and involvement in running the home. The home offers service users meaningful educational and recreational activities, promotes their ethnic cultures and provides opportunities for personal development. The home respects service users’ privacy and endeavours to support them in a way they prefer to be supported. 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. The provider must make information available about the service, including inspection reports, to people living in the home and to other stakeholders. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last key inspection of the home was undertaken on 6th September 2006. An additional random inspection was undertaken on 29th January 2006 to test compliance with the requirements made at the 6th September 2006 inspection. Reference is made to both of these inspections with regard to requirements made, and the provider organisation’s compliance with these, within the relevant sections of this inspection report. This inspection took approximately ten hours over two days. The manager of the home, Ms Anna Bohach was present at the home towards the end of the first day’s inspection activity and for all of the second day’s inspection activity. There were five people living in the home and one vacancy at the time. No new people had been admitted to the home for a number of years. The inspection activity included: briefly meeting and speaking independently to one person living at the home; meeting and speaking to the other four people living in the home although communication was severely limited with them because of their communication needs; detailed discussion with the manager; independent discussion with four staff members; independent discussion by telephone with a reviewing officer from London Borough of Hackney, the placing authority for all five people living in the home and independent discussion by telephone with a speech and language therapist. Further information was obtained from: feedback forms from a relative, a GP and a social care professional; an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection; a tour of the premises and documentation kept at the home. What the service does well: The service provides sensitive and personalised care to people with a range of complex needs including some with significant physical disabilities and communication needs. Staff are working hard to further develop means of communicating with people and have accessed different healthcare professionals to assist in meeting people’s needs on an individual basis. People who live in the home enjoy a wide range of appropriate activities and this has included the opportunity for people to enjoy a holiday abroad this year if they wanted to. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Ten requirements were made at this inspection in the following areas: Care planning; risk management; five areas relating to the physical environment; reviewing the need for the use of agency staff; the home having a manager that is registered with the Commission and an identified health and safety issue. There remain substantial concerns from this inspection about the physical environment within the home. The majority of these have implications for the health and safety of people living in the home as well as for their comfort and these are described in more detail in the body of this report. Failure to act on requirements that relate to the health and safety of people living in the home may lead to the Commission taking enforcement action against the registered person. The registered provider, the manager and the staff team may wish to refer to the Commission’s key lines of regulatory assessment (KLORA), to consider how they may additionally further enhance the overall quality of care in the home. Please contact the provider for advice of actions taken in response to this Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 7 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.V349376.R01.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.V349376.R01.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): 1&2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has information in appropriate formats to assist prospective new residents and their representatives to make informed choices about living at the home. Once admitted people’s needs are reviewed to assist the home in effectively addressing their changing needs. EVIDENCE: The home had a satisfactory statement of purpose and a pictorial service user guide that were seen and were satisfactory. The home has an admissions policy and procedure for the admission of prospective residents but no new people have been admitted to the home for a number of years. The L.B. of Hackney is the placing authority for the five people currently living at the home and that authority block purchases all six of the home’s places. The files of three people living at the home were inspected and these showed that people’s needs were being reviewed on a regular basis. Evidence was seen of the involvement of other health and social care professionals in this process when deemed necessary. A speech and language therapist who had undertaken an assessment of one person’s needs in October 2006 was spoken to independently. She stated that she had only limited involvement with the home but that staff had made a number of referrals in Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 10 recent months to her department. Evidence was seen of annual reviews being undertaken by L.B. of Hackney including two that had been undertaken since the last random inspection and one booked for later in September 2007. There was some evidence that the home were monitoring the changing needs of one person and that discussions were starting with the placing authority about future options regarding this. I received a feedback card and also spoke independently to a reviewing officer from L.B. of Hackney who felt that overall the home was aware of people’s changing needs. He indicated that the home prioritised people’s changing needs and dealt with them although issues that he felt the home considered a lower priority could sometimes take some time to deal with. Further comments from the reviewing officer are included in other sections of this report. Evering Road (41) DS0000010268.V349376.R01.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 & 9 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are recorded in their care plans although these need to be kept up to date and accessible to all staff to maximise their usefulness. People benefit from being supported to take as many decisions for themselves as they can in their day-to-day lives. People are also supported and guided in relation to taking appropriate risks to assist them to safely achieve their aspirations. However, to maximise protection to all in this area, guidance to staff needs to be improved. EVIDENCE: The three people’s files inspected contained clear care plans that were informed by current assessment information including risk assessments. The plans showed identified needs and gave guidance to staff on how to address these needs. However, on the first day of the inspection some of the care plans seen on people’s files showed no evidence that they had been reviewed over the past year and one was dated 2005. I was concerned about this as the only Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 12 member of staff on duty for a significant period of that day was an agency member of staff. On the second day of the inspection more up to date care plans were available for some people living in the home. However, these updated plans had been held electronically and agency staff could not access these. Although the care plans seen on the second day were more recent, and I was told they were current, they did not all show evidence that they had been reviewed in the last six months. A requirement is made that all care plans must be 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. The home has introduced person centred plans for people living at the home and these are called Essential Life Plan’s. The plans are in accessible format and show people and events that are important to the individual, their aspirations, how they like to spend their time, the sorts of support they need and how it should be offered. The manager stated that the provider organisation had recently employed a person centred planning coordinator and it was hoped to develop this system further with individuals living at the home. The home operates a key worker system with permanent members of staff undertaking this role. However, there were no consistent records available for key worker sessions or evidence of how the key worker’s knowledge was shared with other staff. The manager stated that the reason some of the documentation inspected on the first day of the inspection, such as care plans and risk assessments were not always up to date might have been because key workers had taken them away to amend. She did go on to acknowledge that this was not acceptable and that she would be talking to staff about this. Feedback from a reviewing officer from the placing authority indicated that he felt that some key workers could be more proactive and be clearer about what their role is in supporting/ advocating for the individual and in developing better progression paths for individuals. A good practice recommendation is made that the home further reviews its key worker and person centred planning systems to provide greater clarity in the role of key workers and to further develop positive and achievable outcomes for people living in the home. Four of the people living in the home have complex needs including communication needs. They all have some restrictions imposed on them and records inspected showed that they had agreed needs for staff supervision both within the house and when out in the community. The home has satisfactory systems for assisting people manage their finances. The provider organisation is the appointee for four people living in the home although arrangements are being made for the relative of one person to become the appointee for that person. The fifth person manages their own money, including their own bank account although the home helps that person manage their day to day cash. Since the last inspection the home has involved an external benefits advisor to ensure that people living at the home are maximising benefits they are entitled to. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 13 The three files inspected on the first day of the inspection contained risk assessments. However, as with some care plans, some of these were not up to date. On the second day of the inspection more up to date risk assessments for some people were available although one of those concerned a specific risk but did not show evidence that other risks had been assessed. Given my observation of the person concerned and their level of functioning there were other areas of risk that, in my judgement, did need assessing. The risk assessment format itself was satisfactory identifying the specific risk and giving an appropriate level of guidance for staff on how to minimise that risk although not all clearly identified who had reviewed them and when. A requirement is made that risk assessments must: identify a full range of possible risks to that individual, give guidance on how to minimise these, be regularly reviewed, show evidence of who reviewed them and when and that the risk assessments must be accessible to all staff at all times. This requirement is made for the protection of both residents and staff. It was noted that since the last inspection the home had commissioned specialist risk assessments from an external consultant for three people with particularly complex needs regarding their moving and handling needs. These were detailed and gave very clear guidance to staff on how to best meet the individuals needs in this area. The manager stated that recommendations in the risk assessments on the need for some more specialist equipment to be purchased are being implemented by the home. The three people concerned have very complex needs regarding moving and handling and the home is commended for obtaining this specialist input. Evering Road (41) DS0000010268.V349376.R01.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 & 17 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home enjoy having access to a wide range of appropriate activities within the local community and beyond. Contact with relatives is promoted and encouraged, which people living at the home benefit from. Their rights are responsibilities are respected and promoted within their daily lives. People also enjoy healthy and nutritious meals that they enjoy. EVIDENCE: Four of the five people living at the home attend external day services, two of them 2 days a week and the other two 4 days a week. One of these people attends a specialist day service some distance from the home to assist meet their specific needs. Evidence was seen from the files inspected that the home liaises with the different day services including involvement in day service reviews. Evidence was obtained, including from the placing authority’s reviewing officer, that liaison with the day services was currently effective. The fifth person chooses not to attend day services and confirmed this when Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 15 spoken to. An activity chart for each person living at the home was displayed in the home. In addition to people’s attendance at day services this included activities for people both inside the home and in the local community. Activities included hand and foot massage, exercise programmes, occupational therapy input, trips into the community, attendance at a weekly evening social club and inside activities including arts and craft based sessions. The manager also stated that people also attended occasional visits to clubs further a field in the evening such as the “Beautiful Octopus” in Deptford and the “Wild Bunch” in Holloway, which they very much enjoyed. In addition two people with complex needs, supported by the home’s staff, enjoyed a weeks holiday in Majorca in July 2007 and two more people with complex needs were due to go on a week’s holiday to Crete later in September 2007, again to be supported by the home’s staff. The manager stated that these holidays were arranged through a specialist travel firm that were aware of people’s specific health and other assessed needs. The manager also went on to state that specialist holiday insurance that covered people’s assessed needs was taken out as part of the package and that significant preparation went on to minimise undue risk to people. A range of photographs was seen of people and staff on holiday in Majorca and they appeared to be very much enjoying themselves. These included pictures of one person in the sea on a large amphibian wheelchair and also of another person enjoying themself in the hotel swimming pool. The home is commended for arranging these holidays and providing positive outcomes for people through these. It was also noted that the fifth person, who is more independent, was offered support to go on a holiday of their choice but declined to go anywhere this year. Four people living at the home have regular although varying contact with their families and this is important to them. Evidence was seen of family members having contact with the home, including visiting, and of people visiting their families. A fifth person has no contact with their relatives and the manager stated that the home was in the process of looking for an independent advocate for them. The manager stated in the Annual Quality Assessment Audit (AQAA) that people living in the home have the opportunity to experience elements of their ethnic culture and encourage their relatives to make contacts and suggestions to support this. Some evidence was seen of this including in the care plan of one person who was being supported to develop more positive images of their particular ethnic background. Staff were observed interacting sensitively and appropriately with people living in the home including communicating with them using a variety of verbal and non verbal communication. This included bank and agency members of staff observed during the inspection communicating effectively with people living in the home. The manager stated that staff were continuing to further develop effective means of communication including verbal, pictorial, using objects as points of reference and specific physical prompts and gestures to meet individual’s needs. There are a number of appropriate limitations placed on the Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 16 people accommodated and details of these were seen recorded on files inspected. People living in the home are encouraged to choose the menu for the following week at regular weekly residents meeting. They are supported to do this using a range of pictorial menu cards and both the records of the residents meetings and staff spoken to indicated that this was a positive process. A menu for the current week was seen displayed in the kitchen and showed a range of nutritious and healthy meals with specific slots for culturally diverse meals. The food stored in the home reflected the menu, was within its sell by dates and was appropriately labelled where it had been removed from its original packaging. There was a large bowl of fresh fruit on display in the kitchen on both days of the inspection. One person was observed being assisted to eat their lunch on the first day of the inspection and appeared to be thoroughly enjoying both the meal and the interaction with the staff member. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences although this may be further improved in an identified area. The home is working hard to appropriately meet people’s mental and physical healthcare needs, including through referrals to a range of community based health professionals. Clearer recording may assist the effectiveness of this process further. People living at the home are protected by robust medication policies and procedures. EVIDENCE: Four of the five people living in the home have significant support needs regarding their personal care. Evidence was seen from records in the home and from discussion with staff that serious efforts are made by the home to provide appropriate personal care in the way that people prefer. An example seen of this is that the home has involved a physiotherapist to provide specialist guidance for people, including how to under tasks appropriate to personal care, including moving and handling tasks. It was noted however that all the people living in the home are men and both the majority of permanent Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 18 and bank staff are women. I was informed that there has been no issue raised about women staff supporting the men with their personal care and I found no evidence that this was causing any difficulties for either staff or the people concerned. However, a good practice recommendation is made that the home considers how to recruit more male staff to further promote the home’s ability to be able to provide more gender specific personal care if needed. The fifth person has more independence skills and only needs appropriate verbal prompts regarding their personal care. People living at the home are all registered with a GP and a feedback card received from a GP indicated that they were satisfied with the support given by the home to address people’s healthcare needs. Evidence was seen on files or in other documentation inspected that people are actively supported to attend a range of appointments with relevant healthcare professionals as required. These appointments included with the following healthcare professionals: GP, psychiatrist, psychologist, physiotherapist, speech and language therapist, dentist and a range of hospital appointments. However not all of these appointments were recorded in the healthcare section of people’s files as is expected by managers of the service. As stated above, I was able to find evidence of health care appointments that were not recorded in the health care section of the person’s, file from other documentation and records seen. The manager felt that this was an area that key workers could also improve on. A good practice recommendation is made that records of appointments with healthcare professionals, and the outcomes of these appointments, are recorded on people’s files. This is to further assist staff in being aware of people’s healthcare appointments and can contribute to promoting their wellbeing. Medication was appropriately stored and each person had a medication profile on their medication file. The medication and MAR charts for three people living at the home were inspected and were correct. The home had up to date records of medication received into the home and any medication disposed of. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home and their representatives are able to express their views and concerns and have these appropriately dealt with. People living at the home are also protected by satisfactory safeguarding adults policies and procedures that staff are aware of. EVIDENCE: The home has a clear complaints procedure and an accessible procedure that were both seen and gave the information required in this standard. This included that complaints could be raised with CSCI if the person remained dissatisfied with how the home had dealt with it. Three complaints had been made to the home since the last inspection. The records of these were sampled and evidence seen that these had been dealt with satisfactorily. The Commission had not received any concerns or complaints about the service in that time. The home has a satisfactory safeguarding adults policy and also has a copy of the London Borough of Hackney’s safeguarding adults procedure, the local authority for the area the home is situated in. At the last key inspection a requirement had been made that the home’s safeguarding adults procedure must be fully complied with in every instance. This was related to an identified allegation prior to that inspection. At the following random inspection this requirement was seen to have been complied with. There have been no allegations or disclosures of abuse made to the home or the Commission since Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 20 the last random inspection. Evidence was seen that the provider organisation provides regular training regarding safeguarding adults and staff spoken to were aware of the actions they needed to take should an allegation or disclosure of abuse be made to them. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 21 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, 28 & 30 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Many parts of the physical environment of the home need substantial improvement to ensure it meets the needs of the people who work and live in the home. People who live in the home, staff and visitors benefit from the home being generally clean and tidy. EVIDENCE: One person lives in a self contained flat and the other four people live in the main part of the home on the ground and first floors. There was one vacancy at the time of the inspection. On the first floor of the main part of the home there are 3 bedrooms, a bathroom/ toilet, a separate toilet and the staff office that is also used as a sleeping-in room. On the ground floor there are 2 accessible bedrooms, a kitchen, a lounge/ dining room, an accessible shower room and toilet and the home’s laundry facilities. All of the ground floor accommodation, except the laundry area, is wheelchair accessible. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 22 At the last key inspection six requirements had been made about the environment of the home in the following areas: repair/ redecorate areas of the home that had been damaged; repair of the toilet seat in the first floor toilet; appropriate flooring in people’s bedrooms, repair or replacement of bath seats; grab rails in the ground floor shower room and that the home must be kept free from offensive odours. At the random inspection four of these requirements had been complied with leaving two that were restated. These two requirements were to replace the toilet seat in the first floor toilet and to ensure that the grab rails in the ground floor shower room were securely fitted. At this inspection these two requirements had been complied with. Since the last inspection the Commission has been copied into correspondence and a complaint from the home to the registered social landlord (RSL), Family Mosaic, which provides the accommodation and housing services to the provider organisation. This was regarding delays to repairing a faulty boiler although this had been replaced by the time of this inspection. The manager stated that she continued to experience great difficulty getting the RSL to repair and maintain the home in a proper and timely manner. A number of significant shortcomings were noted regarding the environment of the home at this inspection that in my judgement, were unacceptable, especially given the complex physical needs of four of the people living in the home. Bedrooms seen were generally comfortable, had been personalised to the wishes of the people living in them and contained a range of appropriate aids and specialist equipment that the individual needed. The seal around the bath in the first floor bathroom was badly stained, pitted and was a potential health and safety hazard, the bathroom itself was in need of redecoration or refurbishment. A requirement is made that the seal around the first floor bath is replaced and the bathroom redecorated or refurbished for the health, safety and comfort of people using it. I was told that the ground floor shower room/toilet had recently been redecorated although this was not immediately apparent to me. The shower area is wheelchair accessible and included a “wet room” style floor rather than a conventional shower tray. The grouting and sealant in the shower area was badly stained and in need of replacement. The metal grill of the drain in the shower floor was corroded and rusty and was a potential health and safety hazard and needed replacing. A requirement is made that the entire shower area is refurbished to ensure it meets the health, safety and comfort needs of people using it. The toilet in the same ground floor shower room had a broken toilet seat. I was informed that this is replaced on a regular basis but had been broken again immediately prior to this inspection. In view of ongoing concerns about the toilet facilities from the previous two inspections a requirement is made 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. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 23 Failure to act on requirements that relate to the health and safety of people living in the home may lead to the Commission taking enforcement action against the registered persons. The manager stated that the home did not have a planned redecoration or maintenance programme and that the repair of any faults had to be negotiated with the RSL after they occurred. I was informed that the RSL was due to undertake a survey of the home in October 2007 to consider a total refurbishment of the home. The decorations in all of the rooms in the home looked tired to varying degrees and will need attention in the near future. The kitchen was accessible with height adjustable counters. Although the kitchen was serviceable, and no immediate health and safety hazards were identified, the units receive continuous heavy use and a specific good practice recommendation is made that the home considers refurbishing this area. A further requirement is made that the provider organisation ensures that a planned and costed programme is put in place to ensure that the home is refurbished where necessary, redecorated and maintained to ensure that the home is comfortable and is safe for the people who live and work in it. It is the legal responsibility of the registered organisation, i.e. Hackney Independent Living Scheme, to ensure that the premises are safe and fit for purpose, regardless as to who owns the property. The contract or service level agreement with the RSL must reflect that maintenance and redecoration is addressed as a matter of urgency, in order to comply with regulatory requirements. The home was generally clean and was free from offensive odours at the time of the inspection. A requirement had been made at the last inspection that the home is kept hygienic and free from offensive odours and this requirement was being complied with. The home had adequate laundry equipment that met the needs of people living there. However, it was noted that the plinth that the laundry equipment was standing on was damaged, porous and was a potential health and safety hazard. A requirement is made regarding this. The home has adequate infection control procedures that staff spoken to were aware of. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 24 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): 32,33, 34, 35 & 36 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff deployed to meet people’s needs although further work is needed to ensure that continuity of care is maintained. The home’s recruitment practises contribute towards the protection of people living in the home. People are supported by staff who are appropriately trained in areas relevant to their needs. People are also supported by staff who are well supervised to assist them further in meeting needs of people living in the home and in their own personal development. EVIDENCE: The manager stated that all new staff are supported to undertake the learning disability award framework (LDAF), and then complete the national vocational qualification (NVQ) level 2 in care. Evidence of this was seen in some documentation in the home and confirmed by staff spoken to. Of the four permanent support staff two have completed LDAF, NVQ level 2 in care and are working towards NVQ level 3 in care. One permanent support worker has completed LDAF and is working towards NVQ level 2 in care and one permanent support worker is undertaking a Diploma in Social Work. I was Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 25 informed that the senior support worker is negotiating with the provider organisation to undertake NVQ level 4. The staff rota inspected showed a minimum of two staff members on duty for the morning and afternoon shifts and one waking and one sleeping in staff on duty at night. The manager’s hours are in addition to this. Staff on duty during the inspection matched those recorded on the rota. In addition to the manager’s post the home has five permanent staff, four of these are support workers and one a senior support worker. This is not enough staff to cover all the shifts during the week and the permanent staff are supplemented by a pool of bank support workers from the provider organisation. Evidence was seen that the bank workers used at the home are familiar with the needs of the people living there. A bank worker that was on duty on the morning of the first day of the inspection was in charge of the shift. I spoke to her independently and she presented as competent and was clearly very familiar with the home, the people living there and the home’s routines. On that morning the bank member of staff needed to go out for two hours to take a person living at the home to a specialist day service that is situated in another borough. The second member of staff on duty was an agency member of staff. This member of staff was also spoken to independently, presented as being competent and aware of the needs of the people living in the home and had worked regularly at the home over a period of time. It was noted however that agency staff did not have access to the home’s computer system and therefore to some up to date records that were held electronically. A requirement is made regarding this in the Individual Needs and Choices section of this report. Agency staff were also deployed on two other shifts during the inspection and I was informed that one of these was not familiar with the needs of the people living at the home. This member of staff was due to start work on the afternoon shift on the first day of the inspection but was late arriving for their shift. The other permanent member of staff on the afternoon shift needed to go out, to collect the person from their out of borough day service. This left the manager covering this part of the shift , approximately two hours, on her own or until the agency member of staff arrived. The manager stated that the high use of agency staff at the time of the inspection was not usual and was partly exacerbated because of the summer holidays. My judgement was that properly planned use of permanent bank staff who are familiar with the needs of the people living in the home to supplement the permanent staff, can meet the needs of people living at the home. I also noted that additional bank staff were effectively utilised at the home for planned events, including this year’s holidays abroad. However, especially given the complex needs of the majority of people living in the home, the current high use of agency staff needs reviewing. A requirement is made that the home reviews the numbers of staff permanently employed by the provider organisation that are available to work in the home so that all shifts can be covered on a planned basis by those staff and to make sure that the use of agency staff is kept to a minimum. This is so that people living in the home can have continuity in care and support provided by staff that have the skills and knowledge to meet their needs and who are Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 26 competent. A good practice recommendation is also made in the Personal and Healthcare Support section of this report regarding the gender mix of staff working in the home. At the last key inspection a requirement was restated that the home ensures that staff files kept in the home contain all information as specified in Schedule 2 of the Care Homes Regulations. This requirement was restated at the subsequent random inspection. No new staff have been employed at the home since the last inspection. The files of three permanent staff members were inspected at random and evidence seen that the requirement had been complied with. The files seen all contained: a copy of each staff member’s proof of identity including a recent photograph, two written references including a last employer reference, employment history, entitlement to work where appropriate, health declaration and evidence that the person had a current criminal record bureau clearance and protection of vulnerable adults clearance. The provider organisation had also devised a robust checklist for the required documentation that assisted in ensuring copies of the required documentation was now kept in the home. The provider organisation employs a training coordinator who monitors both permanent and bank staff’s training needs. Evidence was seen that staff receive induction and foundation training before proceeding to LDAF and NVQ training as described above. Evidence was seen from documentation and from staff spoken to that staff training is kept up to date. Staff also receive more specialist training as required. A speech and language therapist spoken to independently confirmed that she had recently provided staff training in dysphagia, this relates to people’s ability to swallow and related tasks such as eating. At the last key inspection a requirement was made that staff receive regular supervision that is documented and at the subsequent random inspection this requirement was seen to have been complied with. At this inspection evidence was seen that staff receive supervision at least every two months and staff spoken to confirmed that this was recorded and that they found supervision helpful. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 27 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 & 42 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from it being well managed on a day to day basis although further action is needed to comply with legislation in this area. The views of people living in the home and of their representatives are sought regarding the quality of life in the home although their views need to be acted on in an identified area. Health and safety procedures assist in protecting people living at the home, staff and visitors although some further work is needed in an identified area to maximise this protection. EVIDENCE: I was informed that the registered manager of the home went on maternity leave approximately 18 months ago then took a subsequent period of unpaid leave before resigning in May 2007. The current manager has covered the post Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 28 for the majority of the time the registered manager has been away. However, she stated that she had successfully applied for and been appointed as a permanent manager at another of the provider organisation’s homes and will be moving to that post in due course. The current manager presents as having the necessary skills, knowledge and experience to become a registered manager and is currently undertaking her registered manager’s award. There was also evidence that the manager has worked hard to provide effective management to the home during the time she has been in post. This included feedback from staff and external health and social care professionals spoken to independently and from initiatives such as taking very dependent people on holiday abroad. However, this was my first inspection of this service and I was disappointed to find that the home has not had a manager registered with the Commission for over eighteen months. A requirement is made that the provider organisation must ensure that an application for registration is made to the Commission in respect of a suitable manager for the home. This is to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. The home seeks the views of people living in the home and of a range of stakeholders to help assist in improving the quality of care in the home. However, evidence was seen from documentation in the home, including review meetings and from the complaints book, that a number of these stakeholders remain concerned and dissatisfied about the quality of the physical environment of the home. The manager, and I am informed the provider organisation, have made ongoing representations to Family Mosaic, the registered social landlord (RSL) that provides and maintains the premises, about the physical environment of the home that has continued to remain unacceptable over time. In my judgement it is little use in a service having a quality monitoring system if the registered provider is then unable to act on clear concerns from people living in the home and other stakeholders. Requirements are made regarding the fabric of the building in the Environment section of this report and must be acted on by the registered provider as a matter of priority. At the last random inspection a requirement was restated that the required unannounced monitoring visits are consistently conducted and that subsequent reports are made available on site to staff and for the purpose of inspection. At this inspection satisfactory records of these visits were seen and the requirement had been complied with. A range of health and safety documentation was inspected. Satisfactory documentation was seen regarding gas safety and portable appliance testing although the home did not have a current electrical installation certificate available for inspection. A requirement is made that the home ensures that the electrical installation is tested and that documentary evidence of this is kept for inspection to ensure that people living and working in the home are properly protected in this area. The home’s fire log was inspected and Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 29 contained evidence that the fire fighting equipment had been serviced and of a current fire plan and fire risk assessment. Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 1 28 2 29 x 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 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 4 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(1 & 2) Requirement Timescale for action 15/10/07 2. YA9 13(4) 3. YA24 23(2) 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. The registered person must 15/10/07 ensure that risk assessments: identify a full range of possible risks to that individual, give guidance on how to minimise these, be regularly reviewed, show evidence of who reviewed them and when and that the risk assessments must be accessible to all staff at all times. This requirement is made for the protection of both residents and staff. The registered person must 15/10/07 ensure that a planned and costed programme is put in place to make sure that the home is refurbished, redecorated and maintained as necessary to ensure that the home is comfortable and safe for the DS0000010268.V349376.R01.S.doc Version 5.2 Evering Road (41) Page 32 people who live and work in it. 4. YA27 13(4) The registered person must ensure that the seal around the first floor bath is replaced and the bathroom redecorated or refurbished for the health, safety and comfort of people using it. 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. 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. The registered person must ensure that the plinth that the laundry equipment stands on is replaced to maximise infection control procedures. The registered person must review the numbers of staff permanently employed by the provider organisation that are available to work in the home so that all shifts can be covered on a planned basis by those staff and to make sure that the use of agency staff is kept to a minimum. This is so that people living in the home can have continuity in care and support provided by staff that have the skills and knowledge to meet their particular needs and who are competent to do so. The registered person must ensure that an application for registration is made to the DS0000010268.V349376.R01.S.doc 15/10/07 5. YA27 13(4) 31/10/07 6. YA27 13(4) 31/10/07 7. YA30 13(4) 15/10/07 8. YA33 18(1) 15/10/07 9. YA37 8 15/10/07 Evering Road (41) Version 5.2 Page 33 10. YA42 13(4) Commission in respect of a suitable manager for the home. This is to comply with legislation and to verify to the Commission that the appointed manager is qualified, competent and experienced to run the home. The registered person must 15/10/07 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. 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 YA6 Good Practice Recommendations The home should further review its key worker and person centred planning systems to provide greater clarity in the role of key workers and to further develop positive and achievable outcomes for people living in the home. The home should consider how to recruit more male staff to further promote the home’s ability to be able to provide more gender specific personal care if needed. The home should consider recording appointments with healthcare professionals, and the outcomes of these appointments, in one place on people’s files. This is to further assist staff in being aware of people’s healthcare appointments and can contribute to promoting those people’s wellbeing. The home should consider refurbishing the kitchen to make it a more pleasant environment for the use of both people living in the home and for staff. 2. 3. YA18 YA19 4. YA28 Evering Road (41) DS0000010268.V349376.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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.V349376.R01.S.doc Version 5.2 Page 35 - 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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