Inspection on 06/04/05 for Faraday House

This inspection was carried out on 6th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Faraday House 18/03/09

Faraday House 04/06/08

Faraday House 31/05/07

Faraday House 06/04/06

Faraday House 04/10/05

Faraday House 09/09/04

Faraday House 30/04/04

Faraday House 15/01/04

Faraday House 07/07/03

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

CARE HOME ADULTS 18-65 Faraday House 16 Faraday Road Acton London W3 6JB Lead Inspector Sarah Middleton Announced 6 April 2005 9.40am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Faraday House Version 1.10 Page 3 SERVICE INFORMATION Name of service Faraday House Address 16 Faraday Road, Acton, London W3 6JB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0208 248 4599 Mrs Soloni Gopal, Mr Runjith Gopal Mr Runjith Gopal Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (0) Faraday House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: NO Date of last inspection 17/09/05 Brief Description of the Service: Faraday House is a home for three service users with mental health needs. The home is situated in a residential area and in close proximity to Acton town centre, a mainline railway station and major roads into London. The Proprietors/ Registered Managers and their immediate family reside at the home, occupying part of the ground floor and top floor of the building. Service users are accommodated in single bedrooms. There is a small lounge, bathroom and separate toilet for service users on the first floor. There is a small garden to the rear of the home. The home offers twenty four support and care to the service users, accessing local resources such as the Community Mental Health Team. Other community ammenities, such as shops and libraries are also available near to the home. Faraday House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over eight hours, from 9.40AM- 4.40Pm and was announced. A tour took place of the home where the service users access, as part of the home is lived by the Registered Manager and their family members. There had been several requirements from the previous inspection, of which nine Immediate requirements had been issued, as they had been outstanding from earlier inspections. Care records and a sample of policies and procedures were viewed. Three of the four staff and the two service users currently residing at the home were spoken with. What the service does well: What has improved since the last inspection? The home now has policies and procedures in place to safeguard the service users. The home has developed a form so that the staff team would carefully assess any new potential service user, gathering as much information about them to make an informed decision about their suitability to reside at the home. Faraday House Version 1.10 Page 6 There is recognition of the work needed to raise the standard of the home and steps are slowly being taken to address this. The home is beginning to review the care offered, through conducting a survey in the form of questions, seeking the views of the service users. There is also the start of completing risk assessments, with the home attempting to consider some of the obvious risks associated with the individual service user. However less obvious risks do need attention and the home needs to consider what these are and record this. What they could do better: There has been recognition of the importance of detailed care plans and the home has gone some way to improve the care plans. However, these did not offer the level of detail required to fully support and understand the service users needs. Highlighting ways to stimulate and encourage a service user in everyday life was not evident in the two care plans viewed. There was a lack of structured and unstructured activities for the service users. Providing service users with a variety of opportunities could have a positive outcome on the service users mental health. Both service users spoken to could not describe any activities they did, other than play chess and watch television. The home’s communal lounge is small and the furnishings and décor need to be reviewed, so as to provide a warm, spacious and homely atmosphere for those living there. The home had several requirements that needed attention immediately. Failure to act on these may result in enforcement action by the CSCI. A problem identified at this inspection was service users finances. Both service users had been having difficulties, for different reasons, in accessing their money. This resulted in the Registered Manager paying out of their money a personal allowance to each service user. This could lead to serious concerns about exactly what money is owed to the Registered Manager if it is not recorded clearly and accurately. The home must liaise immediately with the relevant professional, such as a Social Worker, if there are any concerns about a service users situation. Faraday House Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Faraday House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Faraday House Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 5 Systems are in place to assess potential new service users who might be referred to the home. People who use the service receive terms and conditions to enable them to know what they can expect from the home. EVIDENCE: The home has devised an assessment tool to use when a new service user is referred to them. This was detailed, for example it looked at the diagnosis, medication and health needs. The home is aware of the need to gather as much information from their assessment and the assessment from other professionals in order to best meet the needs of service users. The home has improved through developing terms and conditions for the service users. Although the Registered Manager had omitted to include the fees. Action should be taken to rectify this. Faraday House Version 1.10 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Although there has been some improvement in information recorded in care plans more detail is required. Risk assessments were also present but only outlined main risks, with no details of individual potential risks. EVIDENCE: The two service users care plans were viewed and there had been some work towards giving details as to the service users areas of need and where they might need prompting. However, little progress had been made to ensure all aspects of health, personal and social care needs are identified and planned for. Without sufficient specific details the individual plans would not offer the staff team or any new staff member the actual appropriate way to support and motivate the service user. One care plan outlined potential aggressive behaviour, without describing in any detail how this aggression manifests. It was not clear if it was verbal or physical aggression. There were no signatures from either staff or service users to indicate if the care plans had been completed with the service user. Faraday House Version 1.10 Page 11 Without this evidence it is not clear if the home consults with the service user about their needs and aspirations. In addition the home could not locate any reviews of the two service users. This was in relation to any held outside of the home, at a local Community mental health team or within the home. There was not a daily recording of what the service user had been doing or how they were that day; details that had been written were insufficient. Discussion with staff suggested they were aware of the needs of the two service users, even though there was a lack of detail and guidance on the care plans. Service users could be at risk, particularly with regard to their mental health needs if the structure is not put in place. Risk assessments were present, but did not include other risks and how to manage risk. In the case of one service user who requires escorting outside in the community, there was little detail outlining what to do in the event the service user might wander off alone. Preventative measures must be considered, but not so that the service user remains mainly within the home, without the opportunity to access local facilities. Faraday House Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12,13, 14, 15, 16 and 17 The activities offered both in the home and outside were limited. There was little detail to suggest what activities service users took part in on a regular basis. EVIDENCE: The service users spoken to individually could not expand on any activities they did throughout the day. One service user stated they rarely go out. Staff explained that one service user is fairly independent and goes out into the community when they so desire. Within the home activities such as playing chess and watching television is on offer. The other service user needs to be accompanied due to various mental health needs. However there was little evidence, from this service user and staff, of any opportunities to go out and take part in activities. Faraday House Version 1.10 Page 13 Both service users seemed keen to discuss living in the home. One stated they would like to cook but do not get the chance to prepare a meal. Both service users stated they can cook a meal but all meals are provided for by the staff. Discussions took place with staff with regard to offering opportunities to service users to prepare meals. Risk assessments would need be carried out to recognise the level of support each individual needs in order to make decisions about their lives. Menus indicate that a variety of well-balanced meals are offered to the service users. One service user commented that they no longer have a front door key. They did not state why. Staff offered an explanation, as the service user often loses the key. However the reason was not noted within the individual’s care plan. The two service users stated they do not have friends. One service user said they would like to get in contact with their children. They have not seen them for almost twelve years. Staff are looking into assisting this service user to make contact again. Support is on offer, if service users wanted to see friends or family. Staff were seen to interact positively with service users. Faraday House Version 1.10 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Systems in place for service users enable them to access suitable health care resource. Evidence of multi-disciplinary working was evident, thus offering a holistic approach in supporting the service users. EVIDENCE: Staff prompt service users to carry out independently their own personal care. There is not a need for direct personal contact, but reminders are needed to ensure service users carry out these tasks. Both service users have a local GP and access the local community mental health team. One service user is seen weekly by a member of staff from this team to monitor their mental health. Staff support and attend these meetings. Medication was viewed and all was satisfactory. The home uses the Boots system, whereby prescribed medication has been placed in secure individual boxes for the different times and days. One service user administers their own Insulin, with the supervision of staff. The home does not have controlled drugs on the premises. Staff have received appropriate training on medication and administration. Faraday House Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The complaints procedure seen enables service users to express concerns and to have these dealt with. The process of managing the service users finances was poor, due to ongoing difficulties in accessing money. Systems must be put in place in order to protect the service user and to avoid any possible financial abuse. EVIDENCE: Both service users were aware to complain to the Registered Manager or staff if they had any concerns. They did not seem aware of the CSCI and that they could contact this organisation should they have a concern about the home. There was evidence that both service users, for different reasons, had been having difficulties in accessing their personal money. This was being looked into by both the home and Social Workers. However in the meantime the Registered Manager had been giving service users money from their accounts. This had been occurring for several months. This is not acceptable for the protection of vulnerable adults. Whilst recognising the impact on a service user if they have no money to purchase items of their choice, the implications for continuing this practice are severe. Discussions took place with regard to the risk for both service user and Registered Manager should this continue. The matter must be sorted out and service users must be able to access their money, with the necessary support from staff. Faraday House Version 1.10 Page 16 The severity of the situation was recognised and the need to notify the relevant Social Worker, who would need to act immediately, was acknowledged by the Registered Manager. Faraday House Version 1.10 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26 and 27 The environment is satisfactory, providing service users to live in a homely and safe environment. Improvement with regard to the décor in the small communal lounge is needed so as to make sure service users live in comfortable surroundings throughout all parts of the home. EVIDENCE: The service users do not access all areas of the home, as the proprietor’s family live in part of it. The bathroom was clean and airy and there is a separate toilet. All bedrooms are single and furnished to reflect the individual styles of the service user. One service user stated they liked their room but did not worry about the little things that were in it. For example although there was net curtains up at the windows, there was no main curtain. In addition there was no duvet cover on the duvet. The service user spoke about other matters being important to them but not these items that were missing. Faraday House Version 1.10 Page 18 Staff spoken with confirmed this service user did have curtains and a duvet cover, but they had not put them up yet. The communal lounge was possibly limited in size, with three high backed chairs to sit on. Only one tray was seen for service users to use when eating a meal. The room was dark, due to the décor, which was dark stripped wallpaper. One service user commented that it felt “..like a prison, looking at the walls”. The Registered Manager and staff were surprised as to the service users views of the lounge. There is a notable difference between the lounge the staff use, which is larger and brighter in decor and the small communal lounge the service users access. The communal spaces should be large enough to use as a recreational space and to eat meals in. Currently this communal lounge is a poor reflection of the home and does not offer the ideal space three service users would need. It does not suggest a comfortable area to relax in or eat meals in and if all three service users sat in the room, they would be very close to each other. The bedrooms do offer private space, but there must be consideration with regard to any future potential service user and the communal space the home currently offers. The limited opportunities to access a large suitably furnished lounge could lead to frictions amongst service users, if they do not have the adequate space to relax and eat in. Faraday House Version 1.10 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 and 36 There has been limited progress in identifying relevant training for staff to meet service users needs. Individual training plans on staff had not been carried out. EVIDENCE: Discussions took place on the ongoing difficulties there had been in finding courses or seminars on mental health and alcoholism. There was no written evidence of the steps the Registered Manager had taken to identify any suitable training. Without the home investing in current theories and concepts on mental health, alcoholism and risk assessments then staff will fall behind on current practices. This could have a detrimental effect on the service users, who require support and understanding from a team that recognises the complexity of their needs. The Registered Manager must ensure that the staff team do not isolate themselves from the lack of knowledge on current practice. Furthermore the Registered Manager must undertake a Managers qualification to keep up to date and be able to successfully carry out their important role. Faraday House Version 1.10 Page 20 Although supervision took place, there was no individual training plan for each staff member. It was not clear who had attended what course or when. There must be support for staff to have aims and objectives met in their own learning. This learning would benefit the service user as their lives could be enhanced with guidance and encouragement from staff who recognise their various needs. Faraday House Version 1.10 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40 and 43 The Registered Manager has made some attempts to improve the management and running of the home. However, a review of the home’s financial and business plan must take place. EVIDENCE: The Registered Manager has not begun a Management qualification, but has spoken of enrolling within the next six months. This must occur to ensure the running of the home is consistent with current practice that could improve the lives of the service users living at the home. The Deputy Manager aims to complete the NVQ Level 4 by the end of 2005. The home has purchased documentation to assist them in reviewing the home. However, this has not been carried out and needs to do so to consider how the home meets the needs of the service users and areas they can improve on to provide the best quality of care of those who live there. Faraday House Version 1.10 Page 22 The findings of any review of the whole home must be available for both service users and the CSCI, to demonstrate the home’s commitment to reflect and improve on the care that is offered. The home has worked hard to complete relevant policies and procedures to safeguard service users rights and best interests. These documents guide staff when supporting vulnerable adults living in the home. The home demonstrated has developed a basic business plan, but there were no details on finances and the viability of the home within this. This is necessary to ensure the service users are living in a home that is safe and financially secure. The two service users interviewed made positive comments about the staff team and felt able to talk to them should they have any concerns. Faraday House Version 1.10 Page 23 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 x x x Standard No 11 12 13 14 15 16 17 2 1 1 1 3 3 3 Standard No 31 32 33 34 35 36 Score x 2 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 2 3 x x 2 Faraday House Version 1.10 Page 24 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 15 & 17 (1) (a) Requirement Care plans must indicate how to support, motivate and encourage service users in every day life. The Registered Person must make these available for the Inspector at CSCI at the next inspection. (Previous timescale of 10/10/04 not met) Service users care plans must provide evidence that staff have consulted with the service user with regard to decisions made about their lives. Individual choices and a record of decisions taken by staff should be noted on each individual care plan. The home must ensure detailed risk assessments are completed on each indivdual service user. (Previous timescale of 1/12/04 not met) Service users are provided with the opportunity to develop skills in the home, for example to prepare food. Service users must have the opportunity to take part in activities that are appropriate to meet their needs. The home must ensure it offers Version 1.10 Timescale for action 3/5/05 2. 7 15 3/5/05 3. 9 13, (4) (b) (c) 23/5/05 4. 11 16 (h) (m) 16 (m) (n) 30/6/05 5. 12 30/6/05 Faraday House Page 25 6. 13 16 (m) 7. 14 16 (n) 8. 23 13 (6) 9. 24 23 (2) (e) (g) (i) 10. 32 18 (c ) (i) (ii) & 17 (2) 11. 35 18 (1) (a) 12. 37 9 (2) (i) information about learning rescources and groups, whereby service users can interact with the local community. Service users must have the opportunity to engage in a range of activities, that is reviewed regularly to ensure oppportunities meet changing needs. Service users must be encouraged to access leisure pursuits. Staff must assist, where necessary,to idenitify activities that interest and stimulate service users. The Registered Person must not assist service users financially when the service users await for their own personal money to be be made available to them. Appropriate arrangements must be put in place, in consultation with the service user and relevant professional, to ensure service users receive an allowance, whilst their finances are being sorted out. The Registered Person must ensure the communal areas are adequate in size for recreational use and to dine in. In addition the decor in the lounge must be reviewed to maintain a reasonable standard. The Registered Manager must ensure that staff are appropriately trained in areas such as mental health and alcohol related issues. These courses must be identified and evidence recorded when staff attend training. All staff must have an individual training and development plan. (Previous timescale of 15/11/04 not met) The Registered Person must Version 1.10 30/6/05 30/6/05 11/4/05 1/6/05 4/7/05 6/5/05 3/10/05 Page 26 Faraday House 13. 39 24 14. 43 25 undertake a relevant managers qualification to ensure they are suitably qualified and aware of current theories and practice. (Previous timescale of 1/1/05 not met). The Registered Person must ensure a regular review of the home, including service users opinions, is carried out.The findings of the review must be made available to both service users and CSCI. A Business and Development plan for 2005/06 must be available for inspection. (Previous timescale of 1/2/05 not met) 1/8/05 2/5/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 17 16 & 26 Good Practice Recommendations Service users should be weighed regularly and this should be documented on the care plans to ensure good health is maintained. It should be noted on an individuals care plan if they are unable to have their own key to the main front door and to their own bedroom. Faraday House Version 1.10 Page 27 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Faraday House Version 1.10 Page 28 - 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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