Inspection on 28/01/08 for Friern Residential Care Home

This inspection was carried out on 28th January 2008.

CSCI found this care home to be providing an Poor service.

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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Friern Residential Care Home 02/06/09

Friern Residential Care Home 30/09/08

Friern Residential Care Home 29/04/08

Friern Residential Care Home 12/06/07

Friern Residential Care Home 28/11/06

Friern Residential Care Home 26/06/06

Friern Residential Care Home 20/02/06

Friern Residential Care Home 26/09/05

Friern Residential Care Home 07/01/05

Friern Residential Care Home 26/05/04

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

CARE HOME ADULTS 18-65 Friern Residential Care Home 26-30 Stanford Road Friern Barnet London N11 3HX Lead Inspector Jane Ray Key Unannounced Inspection 28th January 2008 10:00 Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friern Residential Care Home Address 26-30 Stanford Road Friern Barnet London N11 3HX 020 8368 6033 F/P 020 8368 6033 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) Mr Vevegananthan Thambirajah Mrs Bijaye Luxmi Thambirajah Mrs Bijaye Luxmi Thambirajah Care Home 18 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (18) of places Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One exception for over 65 years Date of last inspection 20 November 2007 Brief Description of the Service: Friern Residential Care Home is a private care home, which opened in 1989 and is registered to provide care to eighteen adult men and women who have mental health problems. Mr & Mrs Thambirajah are the registered providers and jointly own the home. Mrs Thambirajah is the registered manager and Mr Thambirajah is the deputy manager. The providers have made the decision to only have sixteen residents as they are using two double bedrooms as single bedrooms. The stated aims of the service are to meet resident’s needs in a friendly and efficient way and to strive to preserve and maintain resident’s dignity, individuality and privacy. The premises have been converted from three adjoining houses. All bedrooms are on the ground and first floors. There are sixteen bedrooms. One of the single bedrooms on the ground floor and first floor have been arranged as selfcontained flats with their own kitchen and bathroom. There is one main kitchen. There are also two lounge areas and two dining rooms. To the rear is a garden and patio area. The home is in a quiet residential part of Friern Barnet, close to shops, and transport links. The fee range for residents living in the home is £450 - £800 per week depending on their needs. A copy of this report can be obtained direct from the provider or via the CSCI website (web address can be found at page two of this report. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The inspection took place on the 28 January 2008 and was unannounced. The inspection lasted for five and a half hours and was the second key annual inspection. A random inspection also took place on the 20 November 2007. The inspection looked at how the home was performing in terms of the key National Minimum Standards for Younger Adults and the associated regulations. The inspector was able to speak to and observe the support given to a number of the current residents. The inspector was also able to spend time talking to the manager as well as the assistant manager. The inspector did a tour of the premises and also looked at a range of records including resident records, staff files and health and safety documentation. The home had provided the inspector with a completed self-assessment questionnaire (AQAA) prior to the inspection. The inspector also returned to the home the following day to issue a code B notice, in order to remove copies of information linked to an enforcement process. What the service does well: The home provides a good standard of support to a group of residents in relation to their mental health care needs. The residents feel that they are supported to access healthcare professionals to address problems linked to their mental health. They also feel that they are able to make some choices in their daily lives particularly if they are able to leave the home independently. The residents recognise the benefits of the support they receive from the staff working in the home and one person said, “this is a very good home”. The home has a well-established and very stable team of staff who are being supported by a manager. The staff demonstrated a good knowledge of the people living in the home and were able to recognise their individual needs, especially in relation to their support needs. The residents were also observed to have a good relationship with the staff. The home is clean and there are a number of communal lounges and dining areas the residents can access. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The inspection has identified a number of areas of improvement for the service. In terms of improving standards of support for the residents it is required that each person has a contract in place, that care plans are holistic and issues of future moves and relationships are addressed, that residents views are actively sought in residents meetings, that residents risk assessments are accurate and reflect care practice in the home, that residents are supported to achieve high standards of personal care and that they are also supported to attend a wider range of learning opportunities and are provided with a structured programme of activities where appropriate. The environment in the home also needs to improve by refurbishing the whole property, decorating throughout, replacing carpets some curtains and net curtains, replacing old and worn furniture and ensuring all furnishings match and providing mattress protectors. In terms of safeguarding resident’s monies, they need to be supported to set up accounts and their DSS benefits need to go into these accounts. There also needs to be somewhere secure in the home to store petty cash and other valuables and each persons monies where they are deposited must be held separately and must be accessible at all times. The complaints procedure must be in a user-friendly format and complaints raised by residents must be addressed. Staffing issues need to be addressed including ensuring that adequate numbers of staff are working in the home. Staff must have a criminal records Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 7 disclosure and this omission has resulted in enforcement action. Staff must have current permission to work in the country where this is needed and all have a completed contract of employment. They must also be supported to have supervisions to an appropriate standard. Health and safety in the home needs to be improved by ensuring an electrical installation check has been completed. A quality assurance exercise must be completed seeking the views of residents, relatives and care professionals on the operation of the home. The manager also needs to be supported to ensure she keeps herself updated and has the training and support to be able to perform her job fully. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2,3,4 and 5 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be assessed and that the service can meet their needs. Where possible they are also offered a chance to visit the home in order to help them decide if the service is where they want to live. EVIDENCE: The statement of purpose and service user guide were inspected. The statement of purpose was very comprehensive but also very long. It was noted that this document, contained information that would be better located in the homes other operational procedures. The service user guide was available in the home and contains a lot of useful information for the residents. At the random inspection it was found that since the last key inspection one new resident had moved into the service. The case records were inspected and these showed that the home had received adequate information from care professionals as part of the admission process and had also gone out to do Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 10 their own assessment. The manager and assistant manager said the resident had visited the home three times with the care manager as part of the process of ensuring the service could meet the persons needs. The inspector discussed the current needs of the people living in the home with the care staff. They felt they had received the training necessary to meet the needs of the residents. The manager and deputy manager are both nurses with training in mental health and they provide considerable support and expertise for the staff team. The inspector looked at the contracts between the home and the residents for four of the current people who live in the service. Three had a contact in place that included all the necessary information and were correctly signed, the resident who most recently moved to the home still needed to complete a contract. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7,8 and 9 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home feel able to make choices about their daily lives but need further support to explore larger decisions about their lives. The care plans need further work to ensure they are holistic and that risk assessments accurately reflect limitations that are in place. EVIDENCE: Four case notes for the people living in the home were inspected. Each person has detailed individual care plans. These highlight their individual support needs and have been signed by the resident to confirm they have read the care plans. Everyone living in the home had their care plans reviewed on a six monthly basis following an in depth internal review. Each resident also had an individual recorded discussion with his or her key worker approximately every two months. Two residents spoke to the inspector in detail about their Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 12 experiences of living in the home. They both talked about their relationship with each other and how they would like to move but remain together. The care plans for both the residents were inspected and did not cover their relationship even though it was well established. One of the residents had discussed moving on with his care manager, but the manager explained that this person was no longer in post and so the matter had not been addressed. The other resident had no record of discussing her future plans with a care manager. This means that the changing needs of these residents may have not been addressed. One of the residents had only moved in to the home during the last few months. The other residents had all had a record of a CPA review meeting. The record of this meeting had been prepared by the home and was available in the resident’s case notes. The manager said they had asked the care professionals to send the official minutes of the meeting. The people living in the home all had a key worker and from discussions with them they generally knew who their key worker was and the support they could receive from that person. It was observed that the staff were communicating very effectively with the residents and clearly knew how to respond to their requests. One resident said, “the staff are very nice”. The staff were observed to be very calm and patient at all times. The four residents whose case notes were inspected all included individual risk assessments covering areas of potential risk. These were very detailed and where restrictions needed to be imposed the reasons were recorded. It was observed that one resident went out independently but returned to the home having bought some alcohol. His risk assessment said that he needed to be supported by staff when out of the house and was at risk of alcohol abuse. The assistant manager explained that this risk assessment needed to be updated. The manager said that any concerns would be discussed with the care manager. There was however evidence of inconsistency between recorded risk assessments and practice. The inspector read the record of the monthly residents meetings. These had recorded discussions mainly about food and were also an opportunity for the staff to pass information to the residents about things that are happening in the home. There was limited evidence of the residents contributing their ideas or suggesting what they would like to see happen. Action points agreed at the meeting had not been recorded at the end of the minutes so that they can be followed up at the next meeting. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 11,12,13,14,15,16 and 17 People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to develop their skills but would benefit from being supported to access a wider range of activities in the community. EVIDENCE: At the random inspection in November 2007 it was observed that the people in the home were using their independent living skills. This included cleaning their bedrooms, or helping to clean other areas of the home, doing their laundry and preparing snacks and hot drinks. At this inspection the manager explained that there is a rota available for residents to assist in the kitchen. The manager explained that five of the residents go either on a part-time or full-time basis to the local Mind day service. One resident said that he enjoyed Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 14 the activities on offer at this centre. One other resident goes to another day service on a regular basis. When asked the manager said that none of the residents currently attend college or go to any services that support people to progress towards employment. The manager explained that two of the resident’s need to be supported by staff to attend a day service or other activities outside the home. There is no evidence that this is happening on a regular basis and it was observed that one of the residents appeared to be very active and enjoyed interacting with the staff. The case notes showed there was not yet a structured programme of activities in place for this resident. The residents have a number of religions and the AQAA said that, “the care planning process considers each individuals cultural and religious background”. One resident said that they did not want to go to a place of worship but did choose “particular food that suits my preferences”. Another resident said, “I am not interested in my religion”. Two residents talked to the inspector about their relationship with each other. They said that they are able to “spend time with each other in private”. The manager explained that many of the residents have family and friends who either visit them at the home, or the resident goes to spend time with them. One resident told the inspector how his mother visits him and they go shopping for clothes. At the random inspection the inspector looked at the menu, inspected the kitchen and food storage areas and spoke to staff and residents about the food. The residents meet weekly to choose the food for the week. Individual preferences in terms of culturally appropriate food are available. Several residents said that they thought the food was very good. The menu was observed to be reasonably healthy and fresh fruit and vegetables were available. The staff confirmed that most meals are home cooked. During the key inspection the residents said they enjoyed the lunch. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will receive personal and healthcare support particularly based on their mental health needs. The residents are not getting appropriate levels of support to maintain their standards of personal care. EVIDENCE: It was observed during the inspection that about two or three of the people living in the home were poorly presented, wearing dirty, torn or cigarette burnt clothing. One resident told the inspector that she has a shower every day. The manager explained that some residents choose to spend all their money on cigarettes and do not have money left to buy new clothes. One resident who was wearing clothes with cigarette burns said he had lost two pairs of trousers in the home and would like to buy new clothes but was anxious about going out. The manager said staff could support him to buy new clothes. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 16 The healthcare records were inspected for four people living in the home. They had all been supported to access the GP and attend appointments with their psychiatrist. Dental and optical checks had also taken place. The resident who had most recently moved to the home still needed an optical check and his psychiatric input was being changed from his previous placing authority. The residents were also being supported to check their weight on a monthly basis. Where people had specialist needs, for example one person had diabetes then they were attending appropriate out patient clinics. The home uses a blister pack medication system. None of the residents selfadminister their medication. The random inspection identified a number of areas for improvement, which included recording medication received in the home, preparing guidelines for administering PRN medication and ensuring staff who administered medication had the appropriate training. The manager explained that the five staff who had completed medication training now had certificates available and the inspector saw two if these certificates in the staff records. The home has also prepared a medication profile with a photo of the resident for each person living in the home. The medication administration records were observed to be completed correctly. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were inspected. People using this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that the correct systems are in place should they need to complain and that staff training is in place to protect them from the risk of being abused. Arrangements are not in place to ensure resident’s monies are handled appropriately and their valuables are safeguarded. EVIDENCE: At the random inspection it was observed that the home had a copy of the Barnet safeguarding vulnerable adult procedures. The assistant manager said that she had attended the training provided by Barnet Social Services. Since this last inspection the assistant manager had trained three further staff and had planned training for two night staff. The staff records that were inspected all included a record of the staff completing safeguarding vulnerable adult training. The revised complaints procedure was inspected. This is now accurate but would benefit from being put into a user-friendly format for the residents to access. Since the last inspection the Commission had received a complaint from a resident in the home complaining about another resident. When this was discussed with the manager, she was aware of the issue but had not Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 18 addressed it formally through the homes own complaints procedure. No complaints had been recorded in the last year. The inspector felt that the home would benefit from recognising more issues that arise as complaints and addressing them using the process so that the residents know their concerns had been addressed. The last random inspection had identified that most of the residents did not have a bank account and their DSS benefits were paid into the company account. A requirement was given to support the residents to have their own account. The timescale for this to be completed had not yet been reached and this timescale is extended at this inspection to ensure the requirement is met and that DSS benefits are paid into the resident’s own account. The manager has written to the DSS to start this process. The random inspection also identified that the records of each person’s monies were not clear. The home has devised a new form to record personal monies but this also needs to be implemented and the requirement timescale is also extended for this. The four case notes that were inspected showed that work had taken place as part of the care plan to record the support given to each resident to help them manage their monies. At this inspection it was observed that where residents pass their spending monies to the manager for safe keeping that these monies are not held separately for each person. There is also not a safe available in the office to ensure monies and other valuables are secure. The manager was observed passing spending monies to one resident from her handbag. This also creates an issue as it means the resident has to wait for the manager to arrive before receiving his monies. It was also observed for this resident that he had been given monies at the weekend but had not been asked by staff to sign his records to confirm receipt of these monies. This is poor practice as it does not allow his monies to accounted for appropriately. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24,25,27,28 and 30 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are benefiting from living in a clean and a spacious environment. The building and furnishings need to be updated through a comprehensive programme of refurbishment to ensure the residents are living in a comfortable and homely environment. EVIDENCE: The inspector toured the building with the assistant manager. The inspector was able to look in a number of bedrooms. It was observed that some rooms had been decorated and other communal areas and bedrooms needed this work to take place. Since the random inspection some new mattresses, new curtains, new bedding and lighting had been provided. There was however furniture that was damaged or worn throughout the home. There was also a Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 20 need to ensure that furniture is matching and that curtains and bedding matches the decoration. Most of the carpets were worn and damaged. Some bedrooms were very bare and residents needed support to make them more personalised. The new mattresses were plastic and needed a mattress protector as the lower sheet was lying directly on the plastic. The inspector noted that all the residents had keys to their rooms, although some choose to leave them unlocked. Residents can leave the home as they wish but were asked to inform the staff that they were going out. The dining rooms and lounges were spacious and a new television had been provided in the second lounge. A smoking room was available and this room had a tiled floor and hard chairs that would not be damaged by the cigarettes. The home has two domestic washing machines and dryers. The tumble drier was in use and wet clothes were no longer being dried on radiators. The home has an enclosed rear garden. The inspector noted that the home was clean and free of unpleasant odours. Since the last inspection the home has provided a computer for staff to access in the downstairs office. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 33,34,35 and 36 were inspected. People using this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a stable and experienced team of staff. The standard of care and safety of the residents is however compromised by inadequate staffing levels and incomplete recruitment checks. EVIDENCE: At the random inspection the manager explained that the staffing structure consists of a manager, deputy manager, assistant manager, two senior carers and a team of care staff. The rota showed that in the morning there can be two or three staff supporting the residents. On the day of the inspection it was observed that three care staff were needed to meet the needs of all the residents, especially as a person who has recently moved to the home needs considerable individual attention. It was therefore required that there were three care staff working every morning and that the manager is not included in these numbers as she is carrying out management tasks and not providing Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 22 hands on support. At this inspection there were only two care staff working in the home at the time the inspector arrived. The manager and a third member of staff arrived about an hour later. The assistant manager explained that one of the care staff who was meant to work in the morning had phoned in sick before the shift and the manager had been made aware of this. She had still proceeded to do the shopping with another carer and left the home with only two staff on duty. At the random inspection it was noted that at night there were two waking staff. Since the last inspection a woman had been employed to work three nights a week. On the other nights there were two men working, who have been employed in the service for a number of years. The manager explained that none of the female residents needed assistance with personal care during the night. She said she was working towards having female staff working on all the nights. The assistant manager explained that the cleaner only works three times a week and on the other days the care staff do all the cleaning duties, which reduces the time available to support the residents. Six staff files were inspected to see if the appropriate recruitment checks were in place. Two of the six staff did not have a criminal records disclosure completed by the current care provider in place. The staff rota was inspected for the week of the inspection and both these staff were working in the home. It was observed that one of the staff was working at the time of the inspection and the other was scheduled to work later in the week. The manager when asked confirmed that the rota accurately reflected the staff working hours. The staff records showed that one of these staff had started working in the home in 1991and had an old police check as well as a disclosure from another care provider dated the 16 July 2002. The second member of staff had a record of commencing employment at the home in 2005 and had a disclosure from another care provider dated 3 March 2005. The manager said she had not clearly understood the rules for criminal record disclosures and the transfer of information between care providers. THE COMMISSION WILL BE TAKING ENFORCEMENT ACTION. The six staff records all included two references and identification. One member of staff did not have documentation to confirm permission to work in the country. This member of staff had a letter from the home office dated February 2006 saying that an application to remain in the country had been received. The manager said she had no current information on this matter. The six staff all had a contract of employment. One did not include a rate of pay and two had not been signed by the employer. A number of contracts were clearly out of date and had not been updated. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 23 The induction records were inspected for seven staff. The home uses an induction programme based on the skills for care guidelines. Since the random inspection the staff have worked towards completing their induction and this work is almost completed. Since the last inspection the manager has arranged training on mandatory health and safety topics. The manager showed the inspector new appraisal formats that are going to be used for all staff that will identify training needs and inform an ongoing programme of training. The random inspection identified that staff were not having adequate individual supervision. The manager showed the inspector new supervision formats, that have been developed. These need to be implemented and the requirement time-scale is extended to enable this requirement to be completed. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 were inspected. People using this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst a registered home manager is in place, there is scope for her to perform at a higher standard. Further work is needed to update the quality assurance system so residents can be assured their views will be considered when monitoring the quality of the service. Further work is needed to ensure residents are protected by fully robust health and safety measures. EVIDENCE: The registered manager was on duty at the time of the inspection. She is a qualified nurse and demonstrated considerable knowledge about mental illness and supporting people with mental health issues. There are however concerns Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 25 about her overall competency as she left the home without adequate staff on the morning of the inspection and had also not ensured staff had the correct recruitment checks in place and did not have up to date knowledge of the system for completing criminal record disclosures. Both these actions potentially placed a group of vulnerable residents at risk. The inspector saw the home had questionnaires available to complete an annual quality assurance exercise. The manager and assistant manager both confirmed this work had not taken place in the last year. The inspector was able to see certificates to confirm that since the last inspection all the staff had completed health and safety training including first aid, food hygiene, infection control and fire safety. The random inspection collected evidence to demonstrate that fire safety in the home is appropriate with weekly fire alarm checks and fire drills every two or three months. The fire alarm had been serviced. The home had a fire safety risk assessment and emergency plan. The current certificates were available to confirm the maintenance for the portable electrical appliances and gas appliances. The electrical installations had still not been serviced and this is outstanding from the previous random inspection. The current insurance certificate was inspected and was satisfactory. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 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 1 25 3 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 X 32 x 33 1 34 1 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 x LIFESTYLES Standard No Score 11 3 12 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 x 2 x x 2 x Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 27 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 The registered person must ensure each resident has a completed and signed contract between themselves and the home. The registered person must ensure care plans are appropriately reviewed to support each person to have a holistic person centred care plan that looks at all aspects of their lives including relationships. The registered person must also support the two residents who would like to think about living elsewhere to take this forward with their care managers by organising review meetings. The registered person must ensure the residents meetings are used to seek peoples views on the running of the home and that any agreed action is recorded and reviewed at the next meeting. The registered person must ensure that the documented risk assessments reflect the care practice in the home. The registered person must DS0000010441.V358734.R01.S.doc Timescale for action 15/02/08 2. YA6 15(1)(2) 31/03/08 3. YA8 12(3) 31/03/08 4. YA9 13(4) 31/03/08 5. YA12 16(2)(n) 31/03/08 Page 28 Friern Residential Care Home Version 5.2 6. YA18 12(1) 7. YA22 22(2) 8. YA23 20(1) 9. YA23 16(2)(l) ensure that residents are supported to access a wider range of learning opportunities such as college and supported employment. Where residents are unable to leave the home independently a structured programme must be in place to ensure they are supported to attend the day service in accordance with their care plan. The registered person must ensure that each resident is given the support they need to maintain a good standard of personal care. If the resident needs support to buy clothes this input must be made available and where possible the resident must choose their own clothing. The registered person must ensure that the complaints procedure is prepared in a userfriendly format for the residents and that complaints from the residents are investigated using the complaints procedure. The registered person must ensure each resident has their personal finances safeguarded by opening their own account. DSS benefits must be paid into the resident’s own accounts and not a company account. Any money held on behalf of the resident must be clearly recorded and any expenditure must have a receipt or be signed for by the resident. This timescale is extended from the previous inspection. The registered person must ensure that a safe is provided for the storage of resident’s valuables and monies and that each person’s monies are held separately. Residents must be DS0000010441.V358734.R01.S.doc 15/02/08 28/02/08 31/03/08 28/02/08 Friern Residential Care Home Version 5.2 Page 29 10. YA24 11. YA33 12. YA34 13. YA36 14. YA37 able to access their monies whenever they wish to do so. 23(2)(b)(c) The registered person must undertake a complete refurbishment of the home including decoration throughout, new carpets, replacing all worn and broken furniture, replace net curtains and remaining old curtains, ensuring all furnishings match each other and provide mattress protectors. 18(1)(a) The registered person must ensure there are adequate staff available to meet the needs of the residents by ensuring a minimum of three care staff working on the morning shift and that the manager is not included in this number. This requirement is restated from the previous inspection. Timescale of 05/12/07 was unmet. 19(1)-(5) The registered person must ensure the staff are fit to work in the home. All staff must have a current visa giving permission to work in the country where required. All staff must also have a completed contract of employment. This requirement is amended and restated from the previous two inspections. Previous timescales of 20/09/07 and 31/12/07 were unmet. 18(2) The registered person must ensure all staff are receiving regular individual supervision. This timescale is extended from the previous inspection. 10(3) The registered person must ensure the registered managers practice is kept up to date with regard to the management of the home. DS0000010441.V358734.R01.S.doc 31/07/08 15/02/08 28/02/08 28/02/08 31/03/08 Friern Residential Care Home Version 5.2 Page 30 15. YA39 24(1)-(3) 16. YA42 13(4) The registered person must 31/03/08 ensure an annual quality assurance exercise is completed. The registered person must 28/02/08 ensure that a current electrical installation check is in place. This requirement is amended and restated from the previous inspection. Timescale of 31/12/07 was unmet. 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 YA1 YA33 Good Practice Recommendations The registered person should review the statement of purpose and remove information that would be better located elsewhere to create a shorter document. The registered person should increase the number of hours of work for the cleaner to enable the care staff to spend more time with the residents. Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Friern Residential Care Home DS0000010441.V358734.R01.S.doc Version 5.2 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. 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