Inspection on 13/06/05 for Flaxen Road

This inspection was carried out on 13th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Flaxen Road 12/11/07

Flaxen Road 18/01/07

Flaxen Road 17/02/06

Flaxen Road 02/02/05

Flaxen Road 12/07/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Dalemead

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

CARE HOMES FOR OLDER PEOPLE 1 Flaxen Road 1 Flaxen Road Chingford London E4 9TF Lead Inspector Kristen Judd Unannounced Inspection 13th June 2005 at 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service 1 Flaxen Road Address 1 Flaxen Road, Chingford, London, E4 9TF 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) 020 8524 4422 020 8524 9656 London Borough of Waltham Forest Ms Mary Lee Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2004 Brief Description of the Service: 1 Flaxen Road is a purpose built, single storey bungalow style building with wheelchair access. It was built in 1989 and houses 24 elderly frail people, including dementia. Access to the grounds are through electric gates with intercom system. There are 24 single rooms each with its own sink unit, and one with en-suite facilities. The premises is divided into two units, each with 12 bedrooms, a lounge, dining area, kitchenette, bathroom, 3 toilets and a shower room. There is a main kitchen where freshly cooked meals are provided daily, including special diets and cultural foods where requested. Service users are encouraged to join in activities, which also include those suitable for people with dementia. Outings are provided and the staffing level allows service users to go out escorted. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and was completed in one day starting at 9.35am. The inspector was accompanied by Fay Bennett, Regulatory Inspector. This inspection followed up the requirements made at the unannounced inspection held on 22nd February 2005. The inspectors spoke with service users, relatives, staff and the registered manager during the inspection. A tour of the environment was undertaken and samples of records were examined. At the time of this inspection there were two vacancies. There have been 14 requirements made following this inspection. An immediate requirement notice was issued in relation to medication. Verbal feedback was given at the end of the inspection and a comment card left for completion. It was noted that the management received the verbal findings positively, and responded positively to resolve and further develop those areas where action is now required. The inspectors wish to thank the management team, staff and service users for facilitating this unannounced inspection and actively contributing to the regulatory process What the service does well: What has improved since the last inspection? What they could do better: Care planning and risk assessment must improve so that staff know what to do for each resident to meet their individual needs. An immediate requirement was issued stating that a system needed to be put in place to monitor the effective stock control and storage of medication. The inspector acknowledges that this had been appropriately responded to at the time of wring this report. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 6 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. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 4&6 The inspector believes that staff are clear about the service and what is expected to be provided to service users. However pre admission assessments should be fully completed prior to people moving into the home to ensure that the service provision can meet all assessed needs. EVIDENCE: Individual records are kept for each of the residents; records for the most recent admissions were inspected. Through the tracking of care it was noted that the pre admission forms were brief not fully completed, in particular relevant information such as social interests/history were missing from one file. Additionally the assessment was not fully completed - for example the outcome of the assessment was missing. As a result it was not clear whether an accurate assessment could be made to determine if the home could meet the service users needs. The home does not provide intermediate care. If, at a future date, the registered provider should wish to provide such care, consideration would need to be given to staffing levels, appropriate staff training and the provision of dedicated space for this purpose. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8&9 The inspector believes that staff are meeting service users needs. However this must be reflected in the individual service user plans and must be supported by comprehensive risk assessments to ensure that service users and staff are not put at undue risk. EVIDENCE: Staff were observed during the inspection treating service users with consideration and respect. Through the tracking of information there was little evidence to show that information available prior to admission had been transferred to the individual care plans. Such information must be used to ensure that the correct care is provided to meet service users needs. The care planning system is one that is normally seen in homes for people with learning disabilities and this is reflected in the pictorial format. The previous inspection noted that there needed to be improvement in the individual service users plans to reflect the service users needs. The home is in the process of implementing new care plans however this has not been completed in line with the given timescales. A sample of the new plans were seen however it was noted that the plans were not fully completed or relevant information from the 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 10 previous plan had not been transferred and so did not accurately reflect individual service users needs. Plans were not consistent for example one care plan indicated that the service user had no needs with regards to moving and handling however there was a note for staff to ‘ensure correct handling techniques used.’ There was also a lack of information regarding individual health needs with respect of continence and the support required by staff. For example there were no records for one service user who required assistance with specialised equipment to state what support was needed and how often. Through the tracking of an incident regarding a service user trying to get out of a window, it was noted that the information was not on the service users plan, and no risk assessment was in place. At the time of inspection none of the service users had pressure sores, although some service users had been deemed at risk and appropriate pressure relieving aids were in place. The staff are vigilant when providing personal care to report any redness, which is treated by the doctor or any skin breakages, which are referred directly to the district nurse. Concern was raised as records showed that eye-drops were administered to one service user for nine days after expiry date. There were no accurate records maintained of stock held and inspection of medication (tablets), noted inaccuracies in numbers. Errors were made on the record sheets, which made it unclear as to whether medication had been given. In addition, the temperature rose in the medication room to 29.82°C during the inspection. Medications being stored stated that temperatures should be below 25°C. An official notice was issued at the time of inspection. The inspector acknowledges that at the time of writing this report the notice had been responded to appropriately. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 &15 The inspector observed and was satisfied that staff provide service users with the opportunity and support to take part in activities in the home which provides variation and interest for service users an is appropriate to their needs. EVIDENCE: 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 12 There was evidence of a structured activity programme, in addition to individual needs being addressed during the inspection. The registered manager and staff team were very focused on ensuring the service users are continually stimulated during the day. On arrival at the home the manager took the inspectors and introduced them to each service user. The inspector chatted with all the service users, the inspectors noted that the manager was well aware of the up to date situation of each individual service user. Service users were quite positive and appeared very settled. Staff were observed already providing manicures for the service users. The inspectors had the opportunity to speak with a relative who was complimentary of the staff and the care provided to her father. The relative commented that staff were always available to discuss any issues and staff would always contact families if staff had concerns. Staff were observed interacting with all of the service users throughout the inspection. Service users were seen to move around the home without any restrictions. Menus seen reflected that the breakfast, lunch and evening meals provided were healthy and appetising. On the day of inspection the meals were all home made with fresh vegetables. The inspector saw the food storage facilities; fresh, frozen and dry stocks were appropriately stored. However in the satellite kitchens foods were dated with the dated received into the home and not the date of opening. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16&17 The homes management of complaints appears sufficiently robust which provides confidence in the system. EVIDENCE: There is a leaflet provided by the Local Authority available in the home stating the complaints procedure, which has three stages and a 28-day timescale for dealing with complaints. Request for copies of the complaints procedure is written in 6 languages. No complaints had been received about the service. Staff files are held at the local authorities personnel department and so were not inspected on this occasion. Service users finances were seen which were being recorded accurately and were deemed correct. There is an adult abuse incident reporting form to be used for incidents of abuse or suspecting abuse. The format is comprehensive requesting relevant information. The inspectors were informed that there had been no allegations made. This standard will be inspected fully at the next inspection. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25&26 It is the view of the inspectors that the environment is suitable for this service provision however the garden area should be free from hazards and well maintained to enable service users to go out side independently. EVIDENCE: A tour of the premises was conducted. There is a maintenance programme planned for the surrounding gardens and paths. The works should be completed by the end of the summer. This is an outstanding issue from previous inspections. Additionally there are a number of areas requiring attention: The flooring in the dining area on the pink side must be repaired to ensure that there is no tripping hazard. The radiator in the toilet on the pink side must be secured to the wall. The sink in the toilet on the yellow side requires re sealing. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 15 Additionally it remains outstanding from the previous inspection that some of the rooms and bathrooms require paintwork to be ‘touched up’. It was particularly of issue in rooms Y3, Y7, Y11 and the bathroom on yellow side. All of the individual rooms seen had been personalised and were comfortable. On arrival to the home there was an unpleasant odour in the large lobby area, this was also noted in a few of the service users rooms. The inspectors acknowledge that this improved during the day. There is a small laundry facility, which was clean and tidy. As mentioned concern was raised to the temperature noted in the medication room. Additionally the conservatory areas and the sitting areas were also becoming warm, the home does have fans situated around the building. However suitable ventilation should be provided to ensure the comfort of service users and storage of medication. There was evidence of appropriate aids and adaptations available for service users. The inspector was satisfied that the registered manager was fully aware of the care that could be provided and made appropriate referrals for service users if their needs indicated that they required nursing care. There was evidence of signs and pictures throughout the building to help service users’ with orientation. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 It was the inspectors view that the home has an effective staff team who appeared to work well together to provide a good level of care to service users. EVIDENCE: Rotas indicated that staffing levels are satisfactory and there are sufficient staff on duty to meet the needs of the service users. There is always at least four staff and one senior on shift. At night there are two staff one of which is a senior. On the day of inspection there was also an additional staff member who was training, the inspectors noted that the rota did not reflect the additional support. Staff were seen interacting well with service users, relatives spoken with during the inspection confirmed that the home was always run in this manner. Throughout the inspection, the atmosphere was very calm and activities were observed to be going on. Service users appeared content and those spoken to stated they were happy with the service they received from staff. Staff files are held at the local authorities personnel department and so were not inspected on this occasion. The inspector was informed that there had been no new staff employed since the previous inspection. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,36&37 It is the view of the inspectors that the home is well managed however recordings being inconsistent reflect poorly on the service provision. EVIDENCE: The inspectors were satisfied that the home is managed in an open and positive way. The staff and service users were friendly, open and appeared comfortable within the care home. Service users were seen to benefit from the ethos, leadership and management approach of the home. Some of the recording was inadequate this area needs further improvement. Inconsistencies were noted in recordings of service users care, for example one service had three different entries with regard to a service users mobility and level of support required. Through case tracking inconsistencies with recording were noted and changes in assessed care needs were not transferred to other documentation such as individual care plans. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 18 Records regarding incidents were seen however as stated this information did not trigger the care plan being updated or a risk assessment being developed. The reports regarding the monthly unannounced monitoring visit were seen however there were no visits undertaken for May 2005. The inspectors were informed that the manager had completed an unannounced night visit to monitor staff. This is deemed good practice. The manager stated that staff were seen undertaking the night duties as directed. The manager and members of the senior team are responsible for provision of supervision however records seen indicated that this is not being completed to the minimum standard of six times a year. One staff member had no recorded supervision at all on file. The service users’ finances were seen which were being recorded accurately and were deemed correct. 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 1 3 2 3 3 3 2 2 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 2 x 3 2 2 x 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 20 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 OP4 Regulation 14.1(a) Requirement The registered manager must ensure that pre admission assessments are completed accurately and these needs are used to develop the service users individual plans. The registered manager must ensure that an appropriate format of care planning is adapted to enable staff to expand on all aspects of health, personal care and social care needs of service users. (Timescale 31/5/05 not met). The registered manager must ensure that the newly implemented individual care plans accurately reflect all of the service users needs The registered manager must ensure that all of the service users health care needs in particular continence management and issues regarding moving and handling are clearly documented on individual service user plans. The registered manager must ensure that all unnecessary risks to the health and safety of service users are identified are Timescale for action 31/7/05 2. OP7 15 31/8/05 3. OP7 15.2 31/8/05 4. OP8 15.2 31/8/05 5. OP9 13.2( c) 31/8/05 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 21 so far as possible eliminated. 6. OP19 23.2(o) The paths surrounding the building and especially outside service users’ rooms must be repaved as a matter of urgency and the handypersons’ hours must be increased to ensure proper maintenance of both the building and the garden. This is the responsibility of the London Borough of Waltham Forest and it is incumbent on the Registered Manager to bring this to their attention. (Timescale of 31.8.04 not met) The registered manager must ensure that all paintwork is maintained to a good state of repair. (Timescale 31/4/05 not met) The registered manager must address the minor repairs as reported in this report. The registered manager must ensure that temperature levels in the home are maintained at comfortable levels for service users. The registered manager must ensure that all areas of the home are free from odour at all times. The registered manager must ensure that staff rotas accurately reflect who is working in the home. The responsible individual must ensure that monthly unannounced visits are completed and reports must be available for inspection. The registered manager must ensure that all staff working in the home are suitable supervised and records are maintained. The registered manager must ensure that all records are accurately maintained. 31/7/05 7. OP19 23.2(b) 31/7/05 8. 9. OP19OP21 OP25 23.1.2 23.2(p) 31/7/05 31/7/05 10. 11. OP26 OP27 23.2 18.1 31/7/05 31/7/05 12. OP33 26 30/6/05 13. OP36 18.2 31/7/05 14. OP37 17 31/7/05 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 22 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 Good Practice Recommendations 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1 Flaxen Road G56 G06 S58687 Flaxen Road V231478 130605 Stage 4.doc Version 1.20 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!