Inspection on 04/05/06 for Fouracres Care Services

This inspection was carried out on 4th May 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 34 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fouracres Care Services 04/04/07

Fouracres Care Services 16/01/06

Fouracres Care Services 19/05/05

Fouracres Care Services 14/02/05

Fouracres Care Services 26/07/04

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 Fouracres Care Services 47 Fouracres Enfield Middlesex EN3 5DR Lead Inspector Jane Ray Key Unannounced Inspection 4th May 2006 11:30 Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fouracres Care Services Address 47 Fouracres Enfield Middlesex EN3 5DR 0208 292 4823 0208 216 1306 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) Mrs Philomena Chikwendu Okoron-Kwo Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home must not admit anyone with a physical disability who is unable to descend the stairs without assistance in the event of an emergency. The home is not suitable for wheelchair users. Service users should not be allowed in the office in the loft room. The registered persons must ensure that an appropriate balance of female and male staff is maintained to reflect the gender of the service users. 16th January 2006 Date of last inspection Brief Description of the Service: Fouracres is a small home registered to provide a service to four service users who have a learning disability. Ms Philomena Chickwendu Okoron-Kwo owns the service. At the time of the inspection the registered manager post was vacant. The service is an end of terrace house with three floors. The ground floor consists of a kitchen, lounge/dining area and one bedroom. On the first floor there are three further bedrooms and an office/sleep-in room. On the top floor in a loft conversion there is an office area. The home is located in a quiet residential area of Enfield and is a short distance from local shops and public transport. The stated aims of the home are to provide support to people with special needs in a safe and secure environment’. The weekly fees in the home range from £850 to £1866 per week. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 4 May 2006 and was unannounced. The inspection lasted for five and a half hours. The inspection was the main annual inspection and looked at how the service was performing in terms of meeting the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was only able to meet one of the four service users. Two service users were staying with relatives at the time of the inspection and one was enjoying a long day trip to Kew Gardens. The inspector as part of the inspection was able to meet and speak to the registered provider, the deputy manager and a care worker. The inspector did a tour of the premises and also looked at the service user case notes, staff records and other health and safety documentation. What the service does well: What has improved since the last inspection? At the previous inspection that took place in January 2006 there were five requirements relating to staff training and quality assurance. None of this action has been completed. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 6 What they could do better: The inspector identified that there were many areas of concern at this inspection where the home did not meet the National Minimum Standards or associated regulations. Many of these potentially have a direct impact on the safety and welfare of the service users. The service will therefore be closely monitored until a permanent manager is in post and all these issues are addressed. The outstanding requirements from the previous inspection related to training including food hygiene, first aid, medication and understanding mental health. Immediate requirements were given at this inspection to provide this training for all the staff team. There was also an outstanding requirement to complete a quality assurance exercise. A number of requirements were made in relation to the care and support given to the service users. This included ensuring they all access meaningful activities and use a range of community based leisure facilities, that they all have a contract with the home, that their care plans were reviewed and reflected decisions made at care plan review meetings, that individual behavioural guidelines are in place agreed with a multi-professional team, that any restrictions are agreed with the service user and other care professionals and recorded, that there is a record of how they are supported to manage their finances, that they are supported to have regular meetings and express their views about the home, that they are supported to develop independent living skills, to ensure healthcare appointments are recorded and to ensure everyone has dental checks, that they have individual comprehensive risk assessments in place, that they are supported to check their weight and that a healthy diet is provided in the home. A number of requirements were also given in relation to staff recruitment and training. This included ensuring all staff have the correct recruitment checks and that staff working without a CRB disclosure are properly supervised, that staff have training that includes an induction, NVQ in care, working with people who have complex behaviours, adult protection and fire safety training, that all staff have regular supervision and that regular staff meetings are arranged. Requirements were also made to improve health and safety in the home including carrying out some building repairs, ensuring the electrical installations, electrical appliances, gas system, fire equipment is serviced, ensuring regular fire drills take place and there is a fire safety risk assessment and that the home is properly insured. There were also serious concerns about the medication administration and this needs to be improved by recording all medication entering the home, ensuring PRN medication is clearly labelled and guidelines are in place, that there are no gaps on the MAR sheets, that missing medication is fully investigated, that a Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 7 medication fridge is provided and the temperature of the medication cabinet is monitored. There also needs to be a record of complaints in the home so they can be monitored. 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. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 the following standard(s): 2,4 and 5 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. The service users are assessed prior to their admission to the home. Service users and their relatives are invited to visit the home prior to their admission. Service users need to all be given a contract between the home and the service user stating what the home will provide. EVIDENCE: Four service user case notes were inspected. They all contained records of the assessment provided by the care manager to the home as part of the service users admission process. Three of the four service users had very comprehensive assessments and the other service user had some basic information. In addition the home has started to carry out their own assessment as part of the care planning process. The registered provider and care staff explained that the service users were able to visit the home as part of the admission process. Two visited for the day with relatives and one did an overnight stay. Four service user case notes were inspected and only one had a contract between the home and the service user stating what the home will provide and the fees for the placement. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 the following standard(s): 6,7,8 and 9 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. Service users can make decisions in the home but where restrictions are in place this is not fully recorded to show that this has been agreed with the service user and other care professionals. Care plans and risk assessments are poorly developed and do not indicate clearly how the service users are being supported to develop their skills and what progress is being made. EVIDENCE: The care plans were inspected for the four service users. One service user has lived at the home for over a year and the other three service users have been at the home for between three and four months. The care plan documentation is a format that staff clearly find hard to complete as shown by the poor standard of recording. The care plans cover all aspects of the service users life and identify goals in each area. There is no record of any of the care plans being reviewed and so it is not possible to tell whether the service user is making progress in meeting the identified goals. For example one service user had a goal to attend occupational therapy at Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 11 Chase Farm Hospital to improve his independent living skills. The staff explained that this input had taken place and had now stopped but this was not recorded in the care plan. The deputy manager explained that due to staff changes two of the service users did not have a key worker at present. One service user said he did not know the name of his key worker and his case notes had the name of an old key worker and not his present key worker. It was observed during the inspection that some restrictions are in place, for example the front door is locked and staff hold a service users cigarettes. The service user spoken to said that his cigarettes are held by staff to ensure he does not smoke too much. The care plans and risk assessments do not clearly explain why these restrictions are felt to be necessary and whether they are agreed with the service user and other care professionals. All the service users have complex behaviours that include aggressive, demanding and withdrawn behaviours. These all need to be managed very carefully and consistently. There are no guidelines available in any of the service users case notes about how they should be supported with their behaviours. This was demonstrated in the inspection by an incident with one service user who was being demanding about wanting money to go and buy a drink. This service user has issues about budgeting money. The care worker did not know whether some money should be given and had to refer the matter to the deputy manager when there should have been a clear approach understood by all staff on how to address this situation that occurs on a regular basis. All the service users have had care plan review meetings with their care managers and the minutes of these meetings had not arrived. The deputy manager was able to describe the main actions agreed at the review meetings but these were not incorporated into the service users care plan. For example the action for one service user was to increase his structured activities and this was not part of his care plan. The service user risk assessments are not in adequate detail and do not cover all the necessary areas of risk. For example one service user has a history of arson and this was not included in his risk assessment. Another service user has insulin dependent diabetes and the risk assessment does not cover the risks of hypo’s and what action staff should take. Another service user has a history of being very verbally abusive to staff and this is not covered in her risk assessment. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 12 The deputy manager explained that one residents meeting took place in April 2006 and was not recorded. This was the first meeting for several months and these meetings need to take place regularly to ensure the service users can contribute their ideas about the running of the home. The deputy manager explained that for three of the service users their relatives act as their appointees and for the other service user her DSS benefits are still being resolved by her care manager. There is no record in the service user case notes about the arrangements for their finances and their ability to look after their own cash. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The service users have the potential to enjoy a wider range of structured activities and to further develop their independence and this is not being promoted by the home in a consistent and professional manner. Service users are supported to maintain close relationships with their relatives. Service users are not receiving adequate support to eat a healthy and nutritious diet. EVIDENCE: Service user case notes and daily logs were inspected and the staff and service user were interviewed. Service users are encouraged to help with domestic activities in the home such as cleaning their rooms, doing the laundry and preparing drinks. There is however no evidence for each service user of what specific skills they are being supported to develop. One service user said he used to help prepare food but since the other service users have moved to the home the staff prepare the food. The staff when asked could describe generally what service users do in the house but could not say for each person what specific skills they are trying to develop. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 14 One service user has come to the home with a previously arranged package of college placements. One service user has been supported to attend a gardening course one day a week, which he said he enjoyed. The other service users have no structured day activities and spend their time visiting their relatives and going shopping and relaxing at home. There is no evidence that additional activities such as college courses are being arranged or that they are being supported to enjoy a wider range of leisure activities. The deputy manager explained that all the service users enjoy regular contact with their relatives and spend time visiting them and in most cases staying overnight sometimes for several days. At the time of the inspection two of the service users had been at home for several days. One of the service users is a practising Muslim and attends religious ceremonies with her family at the weekends. The home supports her to buy the appropriate meat to eat. Discussions with the staff and service user as well as reading the daily logs confirm that the routines in the home are fairly flexible based on each persons routines. In the evening service users usually go to their rooms to watch TV or listen to music. The home has a menu but the staff explained that this is not usually followed as the service users have individual needs and tastes. There is no record of the food consumed by the service users. The inspector looked at the daily logs to get a feel of what the service users are eating. Two service users appeared to be eating a great deal of convenience food such as pies, chips, pizza, fish fingers and frozen vegetables. One of these service users has a problem with her weight being too high and has just been taken to a diet club. One other service user eats mainly curries and her weight is a concern as it is too low. The home needs to stop using convenience food and keep a proper record of the food consumed. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 15 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 the following standard(s): 18,19 and 20 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. Service users are supported with their personal care according to their individual needs. The absence of comprehensive healthcare records makes it hard to establish if the service users have received the necessary healthcare input. The medication administration raises a number of serious concerns, which could place service users at risk of not having their correct medication. EVIDENCE: The staff were able to explain to the inspector how they support each service user with their personal care. Some are quite independent and just need prompting and others need more support. The staff explained that they allow one service user one and a half hours of support in the morning to get ready. The inspector observed that the service user she met was well dressed and presented and he said he had taken himself to the hairdressers that morning. The healthcare records were inspected in the four case notes. The service users did not have a log of the healthcare appointments they had attended and so it was hard to see if they were having the healthcare input required. All of the service users were now receiving input from the local consultant Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 16 psychiatrist although he had raised concerns as seen by a letter in the service users files because the first appointment he had made was at the home and some of the service users were not available and the staff were not prepared for the appointment. Two service users had no record of seeing the dentist and the deputy manager was not sure if this had taken place. Two service users were receiving input relating to their specialist healthcare needs and had been supported to attend relevant outpatient appointments. Three of the service users have issues with their weight and have not been supported to check and monitor their weight on an ongoing basis. The medication and medication administration records were inspected. The home uses the Boots blister pack administration system. The inspector had a number of concerns. The medication being received by the home is not being recorded on the medication administration sheet and so there is no audit trail for the medication. Medication has been reviewed and changed and medication that is now only to be given on a PRN basis is still in the original blister packs that staff could easily confuse although the deputy manager has stuck a note on the blister pack. There are no guidelines available for the service users explaining when the PRN medication should be administered. Some of the medication administration sheets had gaps. One service user had got a medication administration sheet prepared by the home rather than one provided by the chemist and this document was hard to follow. One service user had the procyclidine tablet for that evenings medication available in the blister pack but the tablets for the next three days had already been dispensed and the deputy manager did not know why this had taken place. The home does not have a separate fridge for one service users insulin and at the moment this is stored in the main kitchen fridge. The temperature in the medication cupboard is not recorded. Only one out of nine staff working in the home has a record of receiving medication training in the staff training records. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 17 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 the following standard(s): 22 and 23 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The home does not have a complaints record and so it is not possible to tell if complaints are being addressed appropriately in line with the homes complaints policy. Service users are currently being placed at risk as the staff have not received training on how to support service users who have challenging behaviour or training on adult protection issues. EVIDENCE: The deputy manager was not able to find any record of complaints. The service user spoken to during the inspection said that he felt able to tell the staff if he had any concerns. The staff training records were inspected for the nine staff working in the home. Only one member of staff had received training on how to support service users with complex needs and none of the staff had received training on adult protection issues. All of the service users have support from their families to manage their personal finances. Two families have passed cash to the staff to hold on behalf of the service user. The records for this cash was inspected and there is a clear record of expenditure and receipts are available. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 24 and 30 The quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to the service. The service users live in a home that is clean and homely. There are a few small improvements that can be to the health and safety of the home. EVIDENCE: The inspector did a tour of the building. The service users all have a single room and these each have a shower available. The home is comfortably decorated and furnished and was clean and tidy. There are a few areas of work needed to improve the health and safety of the home as follows: • • • • Provide a lock on the door of the under-stairs cupboard so the service users do not have access to the electric and gas meters Provide a lock on the door of the kitchen cupboard so the service users do not have access to the boiler Ensure all shared toilets have anti-bacterial soap and hand-towels available Ensure the bath in the main bathroom has a plug DS0000053227.V289869.R01.S.doc Version 5.1 Page 19 Fouracres Care Services 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The service users have their welfare and safety compromised by being supported by a staff team that has not had the necessary recruitment checks, training or supervision. EVIDENCE: At the time of the inspection the managers post was vacant. The staff team consisted of the deputy manager, six care staff and two bank workers. The rota was inspected and this showed that during the day there are two care staff on duty and at night one member of staff is sleeping in. The deputy manager explained that in the past six months there have been a number of staff changes. The deputy manager explained that one of the staff is a practising Muslim and helps to support the service user with the same religious background. There are two male staff to work with the male service user. The deputy manager explained that she had arranged one staff meeting since coming into post but there was no record of regular meetings prior to her arrival. The record of the meeting was inspected and a range of issues had been discussed. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 20 The deputy manager explained that one member of staff is a qualified nurse, one a qualified social worker, one has completed an NVQ and two members of the staff team were currently studying for their NVQ in care. The evidence of this training or ongoing training was not available in all the staff records and needs to be provided. The staff files were inspected for all the nine staff in post. Only four of the nine staff had a CRB disclosure arranged by the home. Three other staff had CRB disclosures but these were from other care providers. Three staff had only one written reference instead of two and one member of staff had no references. All the staff had valid ID and visa’s. The staff did not have written and signed contracts of employment. The staff training records were inspected and only one had a record of completing an induction. At the previous inspection it was identified that the staff needed to receive training on mental health issues as some of the service users had a mental illness in addition to their learning disability. The staff training records showed that none of the staff had received this training. None of the staff had any record of receiving individual supervision. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 The quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to the service. The service does not have a permanent manager and the home is not currently well run. Service users and other people involved with the home have not been able to give their views on the service as part of a quality assurance exercise. The health and safety of the service users is compromised by equipment in the home not being maintained and the lack of staff training. EVIDENCE: The registered provider explained that a manager is not currently in post and she is proposing to work with an agency to appoint a manager. The previous registered manager had been dismissed following an unauthorized absence. The deputy manager is trying to run the home but does not have adequate management experience. A management consultant is coming to the home on a weekly basis to support the deputy manager. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 22 The registered provider explained that the quality assurance exercise has not taken place and so the views of service users, relatives and other care professionals have not been obtained on the operation of the home. The fire safety records were checked. These showed that the smoke detectors had been checked weekly but no fire drill had taken place for over a year. The home did not have a fire safety risk assessment. The maintenance certificates were inspected and were out of date for the electrical installations, gas system and fire equipment. This means they have not been serviced on an annual basis. There was no record of the portable electrical appliances being checked. The registered provider did say that the gas, electrical appliance and electrical installation maintenance checks were booked. There was no current insurance certificate available for the home although the registered provider did state that she was paying the costs for the insurance on a monthly basis. The staff training records were inspected for nine staff. None of the staff had current first aid training, one had food hygiene training and none had fire safety training. The deputy manager said she had booked some training in May, which were 3 places for medication training, 2 places for food hygiene and 2 places for first aid training. This does not provide adequate places for all the staff who need the training. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 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. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 2 34 1 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 2 2 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 1 1 x 2 x 1 x x 1 x Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(b) Requirement Timescale for action 30/06/06 2. YA6 15(2) 3. YA6 15(2) 4. YA6 12(1) The registered person must ensure that all the service users have a contract between themselves and the home stating what will be provided to the service user and their fees. The contract must be signed by the service user or their representative and a representative of the home. The registered person must 16/06/06 ensure that the care plans are reviewed and updated to show how they are progressing with meeting their goals. The registered person must 16/06/06 ensure that the service users care plan reflects the actions agreed at the care plan review meeting. The registered person must 30/06/06 ensure clear guidelines are recorded for each service user stating how they will be supported positively with their complex behaviours. These guidelines must be discussed and agreed with other DS0000053227.V289869.R01.S.doc Version 5.1 Fouracres Care Services Page 25 relevant care professionals. 5. YA7 12(1) The registered person must ensure that where restrictions are placed on service users that these are fully recorded in their care plans and risk assessments and there must be evidence that the restrictions have been agreed with the service user, their representative and other care professionals. The registered person must ensure that the service users assessment and care plan includes a clear record of how each service user is supported to manage their personal finances and includes details of who acts as their appointee and arranges their DSS benefits. The registered person must ensure that the service users are supported to have regular meetings so they can contribute their ideas about the organisation and running of the home. The registered person must ensure that each service user has a comprehensive risk assessment that addresses all the risks identified in their initial assessments. The registered person must ensure that each service user is supported to develop their independent living skills and that this is recorded in their care plan, which is regularly reviewed to reflect the progress they are making. The registered person must ensure that each service user is supported to develop a meaningful programme of activities linked to their DS0000053227.V289869.R01.S.doc 30/06/06 6. YA7 12(1) 16/06/06 7. YA8 12(2) 31/05/06 8. YA9 13(4) 30/06/06 9. YA11 12(1) 30/06/06 10. YA12 16(2)(m)(n) 16/06/06 Fouracres Care Services Version 5.1 Page 26 11. YA13 16(2)(m) 12. YA17 16(2)(i) 13. YA19 13(1) 14. YA19 12(1)(a) 15. YA20 13(2), 18(2)(a) 16. YA20 13(2) individual interests accessing colleges, day resources, cultural centres. The registered person must ensure that each service user is supported to access a wider range of community based leisure activities. The registered person must stop using convenience food in the home and promote a healthy eating menu. The registered person must also keep a record of the food consumed by each person in the home at all mealtimes. The registered person must keep a log of all the healthcare appointments attended by the service users and ensure they have all had a dental check. The registered person must ensure that all the service users are supported to check their weight on a regular basis and a record must be kept of their weight. The registered persons must ensure that staff receive training on the administration of medication from a qualified trainer. This requirement is restated from two previous inspections and is an immediate requirement at this inspection. Timescale of 01/04/06 not met. The registered person must carry out the following action to improve medication administration in the home: • Ensure all medication entering the home is recorded on the MAR sheet • Ensure PRN medication DS0000053227.V289869.R01.S.doc 31/05/06 31/05/06 31/05/06 31/05/06 16/06/06 15/05/06 Fouracres Care Services Version 5.1 Page 27 17. YA22 22(1)-(8) 18. YA23 13(6) 19. YA23 12(1) 18(1)(c) is in a blister pack that clearly states that the medication is only to be administered PRN • Ensure that where a service user is prescribed PRN medication that there are clear written guidelines on when the medication should be given approved by the relevant care professionals • Ensure the MAR sheets do not have any gaps and if medication is refused or given by relatives then this should be recorded • Ensure that the MAR sheets used are printed by the pharmacist and not produced by the home • Investigate the missing medication for one service user and replace as required • Provide a separate fridge for medication • Record the medication cupboard temperature on a daily basis The registered person must 31/05/06 keep a record of complaints received in the home and the action taken to resolve the complaint The registered person must 15/07/06 ensure that all the staff receive training on adult protection issues. The registered person must 15/07/06 ensure that all the staff receive training on how to positively support service users who have challenging DS0000053227.V289869.R01.S.doc Version 5.1 Page 28 Fouracres Care Services behaviours. 20. YA24 23(2)(b) 13(3)(4) The registered person must carry out the following building work: • Provide a lock on the door of the under-stairs cupboard so the service users do not have access to the electric and gas meters • Provide a lock on the door of the kitchen cupboard so the service users do not have access to the boiler • Ensure all shared toilets have anti-bacterial soap and hand-towels available • Ensure the bath in the main bathroom has a plug The registered person must ensure that there are certificates available to confirm that 50 of the staff team have started or completed the NVQ level 2 or 3 in care training. The registered person must ensure that regular staff meetings take place. The registered person must ensure that no more staff come into post until all the recruitment checks have been completed. The registered person must ensure that staff without a CRB only work with supervision until their CRB disclosure is in place. This is an immediate requirement at this inspection. The registered person must ensure that all staff have two written references and that where staff have come into DS0000053227.V289869.R01.S.doc 31/05/06 21. YA32 18(1)(c) 16/06/06 22. 23. YA33 YA34 21(1) 19(1)-(5) 31/05/06 10/05/06 24. YA34 19(1)-(5) 05/05/06 25. YA34 19(1)-(5) 31/05/06 Fouracres Care Services Version 5.1 Page 29 26. YA35 27. YA35 28. 29. YA36 YA37 30. YA39 31. YA42 32. YA42 post already with only one reference that a second reference is obtained. 18(1)(c) The registered person must ensure that all staff have a completed induction and a record of this is placed in their staff training record. 18(1)(a)(c) The registered persons must ensure that all the staff are trained on understanding mental illness. This requirement is restated from two previous inspections and is an immediate requirement at this inspection. Timescale of 01/04/06 not met. 18(2) The registered person must ensure that all staff receive regular individual supervision. 8(1) The registered person must ensure that a manager is appointed who has the appropriate skills and experience. 24(1)(a)(b)(3) The registered persons must ensure that service users and their representatives are consulted about the quality of the service provided through a quality assurance survey. This requirement is restated from the previous inspection. Timescale of 01/05/06 not met. 13(4) The registered person must ensure the electrical installations, portable electrical appliances, gas system and fire safety equipment has been serviced and certificates are available to confirm this work is complete. 25(2)(e) The registered person must ensure that a current insurance certificate is DS0000053227.V289869.R01.S.doc 30/06/06 16/06/06 16/06/06 30/06/06 30/06/06 16/06/06 31/05/06 Fouracres Care Services Version 5.1 Page 30 available. 33. YA42 23(4) The registered person must 16/06/06 ensure that regular fire drills take place, that a fire safety risk assessment is prepared by a competent individual and that all the staff receive fire safety training. The registered persons must 16/06/06 ensure that all staff receive training on food hygiene and first aid. This requirement is restated from two previous inspections and is an immediate requirement at this inspection. Timescale of 01/04/06 not met. 34. YA42 18(1)(a) 13(3)(4) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA6 Good Practice Recommendations The registered persons should ensure the care planning format is designed so that the staff are able to complete the documentation. The registered persons should ensure that each service user has a key worker and that staff and service users understand the role of the key worker. Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Fouracres Care Services DS0000053227.V289869.R01.S.doc Version 5.1 Page 32 - 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!