Inspection on 05/06/07 for Faircross Avenue

This inspection was carried out on 5th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Faircross Avenue 13/06/06

Faircross Avenue 10/11/05

Faircross Avenue 14/06/05

Faircross Avenue 20/01/05

Faircross Avenue 28/09/04

Faircross Avenue 27/02/04

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 08/07/2008.

CARE HOME ADULTS 18-65 Faircross Avenue 100 Faircross Avenue Barking IG11 8QZ Lead Inspector Mr Roger Farrell Unannounced Inspection 5th June 2007 10:00 Faircross Avenue DS0000027898.V340064.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 Faircross Avenue DS0000027898.V340064.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. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Faircross Avenue Address 100 Faircross Avenue Barking IG11 8QZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 591 5655 0208 471 6959 nasserkass@aol.com Nasser Kassouri Marie Jose Noelle Harris Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only (Code PC) to service users of the following gender: ‘Either’, whose primary care needs on admission to the home are within the following categories: Learning Disability (Code LD) The maximum number of service users who can be accommodated is: 3. 23rd January 2007 2. Date of last inspection Brief Description of the Service: 100 Faircross Avenue is a registered care home providing accommodation and support to three people who have learning disabilities. It is a compact midterrace property, a short walk from shops and transport links of Barking town centre. All three residents have lived at this house for over ten years and are well settled. The owner, Mr Kassouri was the manager, but in January 2006 another person was appointed to this lead post. Marie Harris is now the registered manager. She has bought the neighbouring house, and is taking a lead business role in increasing the number of places by two, and improving the facilities overall. The current range of fees are between £2,827.56 and £4,735.45 per month. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started with an unannounced visit on Tuesday 12 June 2007 when the inspector was at the home for five hours. This included giving the manager a list of records he would like to have copies of by the following week. He returned on Friday 15 June to complete his checks with the manager. He again found the manager helpful and cooperative. By the second visit she had copied nearly all the paperwork requested by the inspector. On the first day the inspector gave an overview of the changes that have been introduced in how care services are monitored. This included most inspections being unannounced; the manager having to complete an annual selfassessment called an ‘Aqaa’; the importance of telling the Commission about any major changes or incidents; and from next year – the ‘quality star rating’ for each service being made public. Mr Kassouri, the owner visited and met with the inspector. The need to submit an application regarding the new partnership arrangement was stressed. The inspector very much appreciates the welcome he receives from the three residents, and the comments they make. The inspector sent out questionnaires to the families of the three service users, but on this occasion did not receive any returns. The registered persons’ were sent an ‘Aqaa form on the 2 May 2007. This is the information the Commission ask for once a year about the running of the service. At the visit five weeks later the manager said she had not seen this request. It was discovered that the owner no longer checks e-mails on the number he provided to the Commission. A further form was sent to the manager, which she was asked to return in two weeks. This was not received until eight weeks later. Over the past year the manager has made sure that information sent to the Commission is of a better standard, such as ‘action’ and ‘improvement’ plans. However, the inspector would like to see improvements in meeting the agreed deadlines as this helps reports to be provided quicker. The Commission are still sending reports and some other correspondence to the owner by recorded delivery. This includes all items that may be used in future legal proceedings. What the service does well: When Faircross Avenue was originally registered it was classed as a ‘small home’. Care homes with less than four residents did not have meet the stricter rules, such as having bedrooms of a certain size; separate staff facilities like an office and sleep-in room; and a linked-up fire alarm system. Soon after the law was changes five years ago, the owner said he hoped to upgrade and expand Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 6 the home by incorporating the house next-door. Once he had bought that house his first sets of plans were not approved by the local council. A good example of progress towards meeting minimum standards is staff training. When he was the manager, the owner Mr Kassouri made little effort on this matter, generally relying on the fact that staff had done some of the necessary courses with other employers. For the first time, the current manager can show she is taking this matter seriously. She now has a record showing that staff are going on courses covering basic topics, and a couple are doing proper qualifications. There are also better service user files. Also, residents are being helped to attend college courses What has improved since the last inspection? What they could do better: As the registered owner and registered manager, Nasser Kassouri and Marie Harris need to make sure they are keeping each other informed. There have been some important gaps in their communication. For instance, a letter and new certificate was sent to Nasser Kassouri in March 2007 saying he was now the sole owner, and confirming that Marie Harris had been approved as the manager. However, when the inspector visited on 5 June Marie Harris said that she was anxious as she had not heard about the outcome of her registration assessment. The inspector arranged for a replacement certificate to be sent, but it was found that the owner had received the originals, but he had not passed this on or told the manager about confirmed registration. The delay in returning this year’s ‘Aqaa’ referred to above is another example of poor coordination. New requirements have been set stressing the registered persons’ legal responsibility to share information. Faircross Avenue DS0000027898.V340064.R01.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. Faircross Avenue DS0000027898.V340064.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 Faircross Avenue DS0000027898.V340064.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, 3, 4 and 5. Quality in this outcome area is now raised to ‘adequate’, a step up from the previous bottom score of ‘poor’. This judgement has been made using available evidence including a visit to the home. The manager is still working to improve the main policies, making sure these are a true description the service and accommodation provided in this home. In the past they have used general policies you can buy, or adopted ones from other organisations. Ahead of her application to be the registered manager she did update the important ‘statement of purpose’. This will be revised again as part of the application to change the owner details. This important legal document sets out how they will support the people they are licensed to care for. There also has to be a ‘service users guide’ that tells residents about the help they can expect. It is unlikely that there will be any vacancies before the two new places are ready. The manager now has a form ready to be used when it is time to consider having a new resident. The evidence is that the manager is better prepared to deal with referrals, making sure that any new person fits in with this well-established household group. EVIDENCE: It is important that care homes have an accurate document that describes the type of service user they are registered to care for, and how they will support their needs. This is called a ‘statement of purpose’. The manager says she will work with the owner to revise this before sending in their application to change the details about who owns the home. Nasser Kassouri and Marie Harris have Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 10 now formed a business partnership, with the company trading as “Faircross Care Home”. The inspector was told that this application would be sent to the Commission by the end of July 2007. The inspector again stressed that this must clearly set out details of the staff complement (number and type of posts), and the level of shift cover (the number of staff on each shift). All three residents have lived at this house since 1989, having moved there with the previous owner. Mr and Mrs Kassouri had worked at the home before buying it six years ago. The manager has now finalised a seven-page assessment form, and is aware that it must cover all items set out in Standard 2.3 of the ‘National Minimum Standards’. She repeated her assurances that a major consideration would be that any new resident would be someone who was likely to get on with the three existing residents. The manager promised that she would complete her revision of the general policy on assessments and move-ins making it specific to this home. The requirement set on assessment in the last report has revised to only include the need to finish the policies. At an earlier visit the inspector was shown a tick-list assessment form that was being completed with the help of a community psychiatric nurse who has known the three residents over a number of years. There is now some evidence that these fresh assessments were being used, such as a task list aimed at helping one resident safely make himself a cup of tea. Residents’ files do have copies of the ‘contract of residence’ that have been signed. The manager has also been trying to make sure that there is evidence of the original or most recent updated principal contract conditions and agreement with the councils who sponsor each resident. She said she has written to the sponsoring councils to confirm there are still valid service contracts. This requirement has been carried forward to make sure this responsibility is clarified as part of the expected application about the change of ownership. Faircross Avenue DS0000027898.V340064.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 and 9. Quality in this outcome area is ‘good’’. This judgement has been made using available evidence including a visit to the home that involved looking at the ‘service user files. These files are now better organised, with front index sheets. The manager has introduced some new worthwhile forms. She recognises that more work is needed to make sure these records are upto-date, though some of the examples seen at this visit had been improved within the last two weeks. Since Marie Harris took over properly as the on-site manager there has been much better coordination of day-to-day support. She continues to make sure that basic care standards - such as preparing proper meals; keeping the house reasonably clean; and ensuring the residents have sufficient clothing – are guaranteed. Reports from before she took over said that Nasser Kassouri was failing to meet such basic needs. EVIDENCE: This home had struggled over a number of years to set up and operate a worthwhile record of support planning and monitoring. Various initiatives were started, such as the ‘Statement of Support and Action Plans’ set up over three years ago. These had bullet point entries under twenty-one or more headings, and provided good practical advice on assisting residents with day-to-day living needs. The intention to develop ‘person centred planning’ sheets never happened. Nasser Kassouri as the manager and ‘key-worker’ to all three Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 12 residents was spending considerably less time at the home than he claimed. That generation of care plans were not kept up-to-date, and it was difficult to see how service users were being helped beyond providing basic assistance with daily domestic routines. Last year the acting manager explained how she intended to introduce a new style of practice records. However, progress was very slow, and the owners were therefore served with an ‘Immediate Requirement Notice’ for a failure to comply with Regulation 15 of “The Care Homes Regulations 2001”. Two weeks later the manager sent examples of the new style care plans. Progress in this important area has continued. All three residents have reasonably good day-to-day living skills. For the first time in years there are now ideas being considered to help residents develop new skills, such as one person learning how to make himself a cup of tea. Marie Harris’ priority was to restore satisfactory daily care routines, but she now setting up plans that show initiatives to help improve practical skills. The ‘Functional Assessments’ carried out last year with the help of the community psychiatric nurse who has worked with the residents over many years are now showing some signs of being worthwhile. It has been very helpful to have one key health care worker like the CPN who has provided continuity over many years. Equally, the inspector has seen signs of real progress. For instance, one service user is showing an increase in confidence and is much more relaxed when there are visitors in the house. Help with making choices, such as clothes styles are showing results. All three residents were well groomed at these recent visits, confirming that they now are helped to decide what style of clothes they buy. She has also started to improve other sections, such as the risk assessments covering when residents go out alone. Another positive finding is that the manager has made sure that all service users have had a main review. Whilst there is still more work to be done, the requirement covering support plans has now been recorded as satisfactory. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including a visit to the home that involved looking at what activities are taking place. As in all sections of this report, there is good evidence that the manager has kickstarted improvements. However, she agreed that the range of activities and help with using community facilities still needs further development. The good news is that the acting manager is making sure that the quality of meals and kitchen hygiene remains at the much-improved standard she introduced last year. EVIDENCE: Previous reports have been critical of the lack of help given to residents to be involved in social and leisure activities. The last report said that the ‘weekly programme’ on display, and the ‘activity plans’ in the care plan files were considerably out of date, and there was little evidence that the programmed ‘in-house’ activities were taking place according to these plans. Other than going to local shops and parks, there was little evidence of other supported day activities. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 14 There is now a new four-week ‘home activity schedule’. This is largely made up of domestic chores and personal care, such as - ‘wash and shave’, ‘tidy bedroom’, ‘empty bins’, ‘set table’, and such like. However, the manager’s search for appropriate opportunities means that each service user is attending at least one weekly educational session. This includes a computer course; pottery class; and a literacy lesson. The main fixed outside social events are still a couple evening clubs. One resident goes to church some weeks with a staff member, and occasionally the other two residents attend. There is also a monthly disco at a church hall. The manager says she is still looking at what options are available, and discussing these with residents. She has taken all residents along to local colleges to look at the courses on offer. One person uses the local library regularly. One resident needs staff with him for all outside activities. The two other residents have agreements decided in reviews about going out to local shops and facilities on their own – and there are now brief risk assessments covering these arrangements. Asked to provide details of other social activities, the list the manager provided was vague, and short - such as ‘Trip to pubs; Trip to restaurants; Trip to café; Trip to local park’ and so on. Over recent months there has been one outing up to London, and a visit to Southend the week before this inspection. The manager acknowledged that there is a need for improved effort under Standards 11 to 14. The requirements on this matter are carried forward, but the steps she has taken this year are praised. Earlier reports have described a slapdash and negligent approach to providing meals. Menu planning was not taking place, there was no day-to-day coordination of meals, with staff improvising with what food was in the cupboards, or getting take-away from the fish and chip shop. Before this manager started the owners were served with ‘Immediate Requirement Notices’ for a failure to maintain accurate food records and for lapses in standards of food hygiene. This was symptomatic of how the service was failing to meet even basic needs. Over the past year the current manager has made significant improvements in the standard of everyday care, such as making sure there are varied and wholesome meals. This has included - having a planned menu that is followed, or recording where a resident requests an alternative on the day; using fresh vegetables and having fruit available; and carrying out regular checks to make sure hygiene standards are being followed. At recent unannounced visits the meals being prepared were according to the menu, and included fresh vegetables. At this visit there was a well-stocked fruit bowl in the dining room, and a good stock of fresh vegetables and other products. The fridge was clean, as were other parts of the kitchen. The improvements in kitchen hygiene are confirmed in the last report by an environmental health inspector following an unannounced check last year. The manager has also made sure that food is no Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 15 longer stored in the dilapidating shed at the end of the yard. Two residents again told the inspector that there has been a big improvement in meals over the last yea. At the last visit one resident said - “It has got better…. Yes, we do get asked what we want.” At this recent visit he added – “ I only ever go and buy sandwiches when I choose to…the food is still fine and you are asked (what you would like.)” Another resident said that that they have roast dinners at least once a week, which is his favourite. Faircross Avenue DS0000027898.V340064.R01.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, 20 and 21. Quality in this outcome area has been raised to ‘good’. This judgement has been made using available evidence including a visit to the home that involved discussing contact with medical services. The manager has made sure physical health needs are followed through, and there are clearer tracking details. The improved stability in the team means that residents are getting better help with day-to-day support needs, such as personal hygiene and clothes care. . EVIDENCE: The deterioration in basic care standards was highlighted when the Commission received anonymous complaints at the start of last year about the poor standard of residents’ clothing, such as shoes with holes. Since Marie Harris took over day-to-day responsibility there has been considerable improvement. One anonymous complainant wrote again saying things had got better. At unannounced visits over the past year the inspector has seen how residents’ personal appearance has improved as a result of better encouragement with personal care and help with having appropriate clothing. This was again the case at this recent unannounced visit. The range, and standard of clothes care is much better. One resident said – “These shoes are fine, and I have two other new pairs upstairs. When you go (shopping) with Marie she makes sure you make up your mind.” Another resident who uses few words is now making choices, showing that he likes sports wear. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 17 There is a new washing machine. One resident has good self-care skills; another needs guidance; whilst the third person needs supervision with areas such as getting dressed and using the bathroom. The home changed its pharmacy supplier last year. It now uses the Boots ‘monitored dose system’, supplied with printed instruction and recording sheets. Medication is stored in a filing cabinet in the dining room. However, last year’s main report listed a range of errors to do with managing medication. The registered persons were served with three ‘Immediate Requirement Notices’ relating to Regulations 13(1);13(2); and 18(1)(c)(i) of “The Care Homes Regulations 2001” for these failings. They were told to ask their pharmacist to visit the home from time to time to check on the medication arrangements. This has happened, with three checks having been carried out, the last one being on 15 November 2006. The manager is able to show how she has carried out the recommendations listed in the reports of these visits. She reported that there have been no known errors in the administration of medication since the inspector’s last visit. The pharmacist also provided a training session a couple of weeks after the ‘Immediate Requirement Notices’ were served. There is a file that has the policies and procedures covering the ordering, storage and administration of medication. Medication is still stored in a lockable filing cabinet in the dining room. The pharmacist asked for this to be secured to the wall. The manager said that a purpose designed drugs cabinet would be fitted as part of the building conversation. The manager is aware that the Commission has its own pharmacy inspector, and he carries out unannounced audits. The manager was able to give a detailed account of the medical treatments two residents have had in the last year, including one short hospital admission. She said there is still a good working relationship with GP with whom all residents have been registered since they moved to this house nearly ten years ago. The inspector saw examples of ‘medical reviews’. She was able to show that all residents have had dental checks and eye tests in the past year. She is now keeping individual tracking sheets for contacts with the GP, and other health care workers. Faircross Avenue DS0000027898.V340064.R01.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. Quality in this outcome area has been raised to ‘good’. This judgment has been made using available evidence including a site visit to the service. The manager has made sure that that the necessary information is available to follow if there is a complaint or allegation, and has told staff about their responsibility to follow the guidelines. She is also keeping much better accounts covering residents’ personal money. EVIDENCE: The manager can demonstrate compliance with previous requirements about having information available covering complaints and protection issues. There is a complaints’ log is available, which records the two minor matters from last year, such as residents not agreeing on which tv channel to watch. There have been no further entries since the last inspection. There is information on display in the dining room on how to make complaints. At the inspection in June 2006 the owners were served with an ‘Immediate Requirement Notice’ for failing have available up-to-date accounts of service users personal monies handled by staff and the owners, covering all transactions and balances, in compliance with Regulation 17(1)(a) and Schedule 4, para 9 of “The Care Homes Regulations 2001”. Placing authorities were advised to read inspection reports, and discuss issues at subsequent reviews. This included asking for accounts covering residents’ personal monies. The manager is able to give an account of personal spends and balances since she took over responsibility last summer. She holds each person’s bankbook, and has pin details. She can give a description of how residents’ personal money is now tracked. Fees are paid into the new partnership’s business account. The manager has helped each resident open a personal bank account. Personal money is withdrawn mostly each week, and kept in individual cash Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 19 tins. Each transaction is signed for by the resident, and receipts and withdrawal slips are stapled to the account sheets. She does weekly checks of the cash tins, and says there have been no discrepancies since she took over control of this area of responsibility from the owner. The manager goes with each resident to their bank once a week to transfer their rent contribution and withdraw their personal money. She explained how she has spoken to one resident’s social worker about him having access to a legacy held under a guardianship arrangement by a relative. She has also drawn up ‘Financial Guidelines’, last revised in April 2007. She says she is following all advice given in the last report under this heading, including - arranging for periodic audits of each person’s bank account and cash accounts, and provides each resident’s care manager with a summary report on the management of accounts at the main annual review; making sure there is double signing for each transaction; and including checks on the handling of money as part of the owners’ ‘monthly visit reports’. There is adequate information available at the home on the steps that must be followed if there is an allegation or suspicion of abuse. A pack called ‘Say No to Abuse’ is on display. There are copies of the main guidance called ‘No secrets’, and the local protection procedure. All staff have signed to say that they have been given a copy of the General Social Care Council’s ‘code of practice’, and are aware of the phased programme of enrolment. Complaints and protection have been added as topics on the induction list. Faircross Avenue DS0000027898.V340064.R01.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, 25 and 30. Quality in this outcome area is ‘adequate’. This judgement has been made using available evidence including a visit to the home that involved looking at all areas. Improvements have been made to the inside of the house. This has included painting walls, providing new bedroom furniture, and fitting some new radiators. However, major upgrading is part of the improvement plan that will incorporate the next-door property which the manager says will be completed this year. EVIDENCE: Residents are provided with a poor quality of accommodation when judged against the ‘National Minimum Standards’. This includes two of the bedrooms being very small; the lounge being used as the staff bedroom; the dining room mainly being used as an office; and an outside toilet. The front and rear exteriors have peeling paint Over a number of years Mr Kassouri has said it was his intention is to upgrade the home, including incorporating the next-door house. Planning permission was not granted for the initial scheme involving rear extensions at both levels with the ambition of adding five additional places. A scaled down version believed to be within planning guidelines was put forward a year ago. This includes increasing the size of bedrooms, installing showers and wc’s; creating facilities for staff; and adding two additional places. At this recent visit the Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 21 inspector was shown a recent letter from the planning department saying they had now received all the necessary paperwork. They were due to hear if planning consent was necessary, or whether a ‘change of use’ certificate would be okay. The letter said they would have a decision by mid-July. The manager said that the work would commence once the planning department gave the go ahead. The owners have said that the upgrading scheme will improve the building throughout. This has been the reason for not significantly improving the existing facilities. Earlier in the year inspectors gave goodwill advice on the latest set of plans. This included the need to have an enclosed stairwell to protect against fire spread. Advice about getting early-stage approval from the fire authority was repeated. She is keeping a list of all such work. Since the registered manager has become involved in the business side some improvements have been carried out. This has included repainting most interior surfaces; getting new bedroom furniture, fitting some new radiators, replacing some household appliances, clearing rubbish from the garden, and fixing a leak to stop rainwater getting into the dining room. The manager has also ensured much better household cleanliness. She has also made sure the office equipment is working, including the computer. There is now a maintenance log and monthly building checklist. All three residents are ablebodied, therefore there is no need for any adaptations. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 22 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): 31, 32 and 35. Quality in this outcome area has been raised to ‘good’. This judgement has been made using available evidence including a visit to the home that involved looking at staff files to monitor vetting and training. There is now a relatively stable team. The manager needs to have a clearer plan on training in core areas, and support for gaining qualifications. The owner was told that they must be able to show that they are operating within employment law, and said that they hoped to issue all staff with employment contracts by the end if June 2007 – a sample copy of which was shown to the inspector at this visit. EVIDENCE: At this visit the staff team consisted of – acting manager (35hrs); one full-time support worker (35hrs); and three part-time support workers (22hrs x 2, 16hrs x 1). A page has been added to the ‘statement of purpose’ giving shift cover details. This is normally one support worker on duty between 10am and 6pm; followed by a support worker on from 6pm to 10pm, who then does a sleep-in, and is on duty between 8am and 10am the following day. The acting manager’s hours are normally 9am to 4pm Monday to Friday, and she provides on-call back up. Rotas now show more regular shift patterns, with two days off each week. Gaps in the rota are usually covered by part-time workers doing extra – but there was no evidence of the lengthy stretches seen previously. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 23 All support workers had started within the last year, though one is a popular worker who had returned having previously worked with the residents for a number of years. Legal action has previously been taken against the owners for a failure to present staff records, and last June they were served with a further ‘Immediate Requirement Notice’ for a failure to comply with Regulation 19/Schedule 2, para 7 and 8 of “The Care Home Regulations 2001” for not showing that they were carrying out the necessary checks. At a meeting in November 2006 a sample of files were checked. These were generally satisfactory. Subsequent checks have also been okay, with the manager confirming that all CRB checks are now done through their trade association. The inspector had asked a number of times why there were no ‘contracts of employment/terms and conditions’ on staff files. At this visit the manager showed him a sample contract, saying they would be issued and signed within the next four weeks. The requirement on this matter has been repeated. Each staff file now has a training log sheet on their file. They now use a training organisation in Hornchurch. All staff are listed as having attended sessions in the following core topics - handling medication; food hygiene; moving and handling; general health and safety; adult protection; and fire response. The expectation is that at least 50 of staff have a relevant care qualification. The full-time support worker has an NVQ at Level 2, and is due to start a Level 3; one part-time support worker is currently doing NVQ Level 2. The staff member who has returned is a retired nurse. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 24 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, 40, 42 and 43. Quality in this outcome area has now been raised to ‘adequate’. This judgement has been made using available evidence including a visit to the home that involved looking at day-to-day management, and how the registered persons’ fulfilling their responsibilities. There has been a problem with them providing applications regarding change of manager and ownership arrangements within reasonable timescales. The Commission is still awaiting an application to confirm the new ownership arrangement between Mr Kassouri and Ms Harris. Earlier, examples were given where confusion has arisen due to poor communication between them. Nevertheless, the manager can show improvements in important areas such as having the right safety certificates and accounts for the handling of residents’ money. EVIDENCE: The operation of this service is not confirmed by its current registered status. Mrs Kassouri has withdrawn as one of the registered owners, but an application regarding the new company partnership is now overdue. The Commission have been told that Marie Harris will have lead business responsibility for the upgrade and expansion. An application regarding the change of ownership must be provided to the Commission without delay. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 25 As stated in the summary, the manager has ensured better compliance with a range of regulations that have in the past resulted in the serving of ‘Immediate Requirement Notices’. This includes having available paperwork that shows more systematic health and safety monitoring, such as - in-house checks of fire equipment and drills; general electrical and gas certificates; and satisfactory reports from the fire authority and environmental health. The range of certificates asked for at this recent visit were satisfactory. The policies and procedures are generally commercially available versions that have not been adapted to this service beyond inserting the name of the home. The manager has now adapted some, and is gradually working her way through the list. Last year the owner was served with two ‘Immediate Requirement Notices’ for a failure to comply with Regulation 24 and 25 of “The Care Home Regulations 2001” for not fulfilling the responsibilities to monitor the service and plan improvements. An improvement plan was subsequently received, which gave forecasts about the upgrade and expansion. An action plan was received outlining progress with outstanding requirements. Satisfaction questionnaires were sent to residents’ main family links and two returns were received with favourable ratings and comments. There are better, but still brief two-page ’monthly reports’ saying what aspects of the service and facilities have been checked. Copies of the owner’s reports must be sent to the Commission until such time as the registered manager is confirmed as an approved owner. Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 2 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 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 2 X 3 2 Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 14 Requirement Have available a policy that sets out how a prospective resident will be assessed and introduced to the home. This item has been carried forward from the previous report. Have available copies of the principal contract agreed with each sponsoring agency that details the terms and conditions of residency. Timescale for action 10/09/07 2 YA5 16 10/09/07 3 YA13 YA14 This item has been carried forward from the previous report. 16(2)(m),(n) Consult with service users, and arrange a suitable programme of leisure and social activities. Make suitable staff cover arrangements to enable these activities to take place. Maintain a record of such activities. This matter has been repeated over two or more reports. Maintain the exterior of the building in a good state of DS0000027898.V340064.R01.S.doc 10/09/07 4 YA24 23(2) 01/01/08 Faircross Avenue Version 5.2 Page 28 repair, including repainting surfaces that have flaking paint. This item has been carried forward from the previous report. Include in the ‘Improvement 10/09/07 Plan’ the timescales by which it is intended to provide residents with private and communal space that meets the standard set out under Section 6 of the NMS. Agree with all staff a statement 10/09/07 of terms and conditions covering their employment. This item has been carried forward from the previous report. Review the policies and procedures, making sure these are relevant to the service provided in this setting. This matter has been repeated over two or more reports. Send the Commission copies of the ‘monthly reports.’ This needs to include action taken to achieve compliance with requirements, and progress with the building ‘improvement plan’. This matter has been repeated over two or more reports. 5 YA25 24 6 YA34 17(2) 7 YA40 12(1)17 10/09/07 8 YA43 26 10/08/07 Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 30 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 Faircross Avenue DS0000027898.V340064.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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