CARE HOME ADULTS 18-65
Friern Residential Care Home 26-30 Stanford Road Friern Barnet London N11 3HX Lead Inspector
Linda Kapambe Key Unannounced Inspection 28th November 2006 10:00 Friern Residential Care Home DS0000010441.V321069.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.V321069.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.V321069.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.V321069.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One exception for over 65 years Date of last inspection 26th June 2006 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 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 fourteen single and two double bedrooms. One of the single bedrooms on the ground floor and first floor have been arranged as self-contained flats with their own kitchen and bathroom. There are two kitchens, one of which is the main kitchen and the other for snacks. 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 - £590 per week depending on their needs. The provider must make information available about the service, including inspection reports, to service users and other stakeholders. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day on November 28th 2006. A senior care worker and registered manager assisted with the inspection. The inspector talked with a selection of staff and residents formally and informally. A tour of the house took place and a variety of records were looked at, including care plans, training records and health and safety documents. What the service does well: What has improved since the last inspection?
There is now an adequate supervision system in place and appropriate training for staff, ensuring residents benefit from well-supported and supervised staff. Resident care plans now indicate whether they self-administer their own medication, ensuring correct records are kept of all aspects of their health care. There is evidence that residents are consulted about the day-to-day running of the home, with democratic discussions taking place; ensuring their participation in all aspects of life in the home. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 6 What they could do better: 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.V321069.R01.S.doc Version 5.2 Page 7 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.V321069.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Robust assessments are being carried out with prospective residents to the home and the home is providing comprehensive information to enable prospective residents and their relatives to make an informed choice. EVIDENCE: The deputy manager carries out the assessments of prospective residents to the home. The assessment forms of the most recent residents to the home were seen and contained information on the resident’s medical history, current diagnosis, personal care, communication skills and other relevant information pertaining to the residents. Evidence provided by looking at residents files and speaking with residents, confirmed that they are involved in the planning of their care. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are being consulted about the day-to-day running of the home and the reviewing of policies. EVIDENCE: The current and changing needs of the residents are continually assessed. The staff are ensuring that all residents receive at least one main review of their care needs per year. Evidence was seen that health care professionals involved in the resident’s care are present at their main review. Several review records were viewed and all contained information on the residents’ physical and mental health care needs, activities that residents are involved in, how residents are motivated by the staff and the residents goals. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 10 The staff team are ensuring that residents are able to make decisions through holding regular residents’ meeting every two weeks. The minutes of the most recent meetings were seen. Minutes included the resident’s views on the new smoking policy where a democratic vote was held. Individual decisions were also seen in the keyworker one to one sessions with residents. Residents spoken to said they are supported to make their own decisions. Risk assessments were seen in each resident’s file. The risk assessments covered a range of everyday risks to the individual resident and how the staff would support the resident in managing the risk. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is, good. This judgement has been made using available evidence including a visit to this service. The staff team are supporting residents in their personal relationships and in everyday living skills within the home and in the community. However residents and staffs health is potentially being put at risk due to the length of time perishable foods are left in the fridge without any indication of when it was opened or when to be used by attached. EVIDENCE: Residents are supported to make choices about further education, employment and continuing any activities they did prior to coming in to the home. However the consensus of those I spoke to was they often didn’t always feel well enough to commit to long courses or employment. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 12 Residents were observed entering and leaving the home. Are plans and risk assessments detail the choice of activity residents participate in. Residents are supported to go out and make use of the local facilities, and have access to various forms of public transport. Residents’ files contained information about their family and friends. When spoken to, a support worker stated that some residents’ family and friends visit quite regularly. Residents spoken to that had family and friends that visit confirmed that they are made to feel welcome and can visit as often as they like. Residents were seen helping with household chores, there is a rota in the kitchen so that individuals know when it is their turn to help out in the kitchen, which includes the preparation of meals. Staff were seen to be supportive and both residents and staff interacted well with each other. Residents spoken to said privacy is respected and staff ask if they want to enter your room. As mentioned, residents are aware of the rules around smoking and now have a designated area to do so. A tour of the kitchen revealed that staff are still not labelling open food items with dates it was opened and when the food should be used by. Food items that should not of been in the fridge were out of date loafs of bread by three days and rotten tomatoes. When this was fed back to the manager she appeared surprised and said it was the job of the night staff. It was suggested that she stress the importance of food hygiene to all staff, especially as this is a recurring requirement. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support in this home is offered in such a way as to promote and protect resident’s privacy, dignity and independence. EVIDENCE: All residents are allocated a key worker who ensures consistency and continuity of support. The individual working care plans, which set out preferred routines, likes and dislikes as well as preferences, achieves this. Residents are supported to manage their own healthcare based on an assessment process. All residents are registered with a GP. An inspection of care records identified that service users have the input from other health care professionals. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 14 Residents support needs vary when it comes to administering medication, some self medicate and this is recorded on their care plan. The Medication Administration Records (MAR) sheets of all of the residents were viewed and were being correctly completed. All staff receive medication training and medication is discussed and recorded as a standing item as part of staff supervision. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system with evidence that service users are listened to and acted upon. The home’s policies and procedure protect service user from harm. EVIDENCE: The home has a complaints policy and procedure. Residents spoken to said that they knew whom to approach if they had any concerns about living in the home. They said that they felt comfortable approaching their key worker, the manager or airing their views in the house meeting. There is a system for recording and monitoring complaints. There are policies and procedures for reporting and responding to actual or suspected abuse. Training records and speaking to a senior member of staff confirmed that staff have completed Protection of Vulnerable Adults training. The Risk assessments are in place when service users are vulnerable. Any restrictions on behaviour is discussed and documented. Staff have the experience and training to manage physical and verbal aggression by the service users. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 16 Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being maintained and kept, in a clean and hygienic standard. EVIDENCE: While touring the home a number of maintenance issues were identified. Even though the bedroom was not in use it contained broken and damaged furniture. Another bedroom had peeling wallpaper and damage to the wall above the skirting board. There was a damp patch in the hallway; the inspector was informed someone was coming to see to it next week. The bathroom suites were old and needed updating. The sealant around the bath was dirty and coming away from the walls. One of the bathrooms had an old toilet seat that was cracked and unhygienic another had a toilet roll holder hanging off the wall. Baths and sinks were dirty. A dirty tablecloth had been left on the table; I was informed by the senior worker that showed me around
Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 18 that it had been there since the night before. Chairs are covered in unappealing throws. Net curtains stained by smoking had not been washed or replaced for some time. Even though the manager said she had recently redecorated the homes décor appeared dark and depressing and the decorations e.g. pictures were not contemporary for a care home for adults. There were no offensive odours in the home, however the home was not clean and hygienic even though the home has a cleaner. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff that have the knowledge and skills to meet their needs. EVIDENCE: Throughout the inspection, staff were indirectly observed carrying out their duties. They were observed sitting with residents having discussions and overheard reminding residents of appointments. Staff spoken to were able to explain their roles and responsibilities and the needs of the residents. The staff files looked at confirmed a thorough recruitment process. Staff files viewed contained a variety of training certificates such as: health and safety, food hygiene and Protection of Vulnerable Adults (POVA). The Personal Identification Number (PIN) for the registered manager, who is a
Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 20 Registered General Nurse (RGN), was seen and was up to date. The training that staff are receiving is appropriate for the work that they perform in the home and to meet the needs of the residents. Staff are now receiving regular and recorded supervision by a competent senior member of staff. Contents of the supervision records were seen, and addressed the different areas of the care staff work with the service users. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. . The manager has the background experience and knowledge to manage the home effectively. The views of the residents are sought and acted upon but need to be published and made available for those who took part and interested others. EVIDENCE: The registered manager and deputy manager have owned and managed the home since 1989. The registered manager has a National Vocational Qualification (NVQ) level 4, a Registered Managers Award (RMA) and is a
Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 22 Registered General Nurse (RGN). The deputy manager is a Registered Mental Nurse (RMN). Since the last inspections requirement, that the home devise a suitable method of obtaining residents views there is now a quality assurance and monitoring system in place. There are individual forms to collect the views of service users, relatives, staff and professionals. It was discussed that these views once collated become an annual development plan for the home, based on a systemic cycle of planning- action- review, reflecting aims and outcomes for service users. The results of which should be published and made available to those who took part and any interested parties. The staff are ensuring that all health and safety checks are carried out regularly. Fire drills and tests have been occurring regularly and safety certificates such as gas, and water were up to date. Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 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 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 1 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 16 (g) (h) Requirement The registered persons must ensure that perishable foods are not left in the fridge unlabelled without any indication of when it was opened or when it should be used by. (Timescale of 13/07/06 not met). The registered persons must ensure that the home has a planned maintenance and renewal programme for the fabric and decoration of the premises, with records kept. The registered persons must ensure that furnishings and fittings are of a good quality and that the home is bright, cheerful airy and clean. The registered persons must ensure that the home is kept clean and hygienic throughout and systems are in place to control the spread of infection. The registered persons must ensure that there is an annual development plan for the home, based on a systemic cycle of planning- action- review, reflecting aims and outcomes for service users. The results of
DS0000010441.V321069.R01.S.doc Timescale for action 28/11/06 2 YA24 23 (2abc) 01/02/07 3 YA24 23 (2abc) 28/11/06 4 YA30 23 (2d) 28/11/06 5 YA39 24 (1a,b) (2) (3) 26/07/07 Friern Residential Care Home Version 5.2 Page 25 which should be published and made available to those who took part and any interested parties. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Friern Residential Care Home DS0000010441.V321069.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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
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