Inspection on 29/04/08 for Friern Residential Care Home

This inspection was carried out on 29th April 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 12 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 28/01/08

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 London N11 3HX Lead Inspector Duncan Paterson Key Unannounced Inspection 29th April 2008 10:00 Friern Residential Care Home DS0000010441.V361097.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.V361097.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.V361097.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friern Residential Care Home Address 26-30 Stanford Road London N11 3HX 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) 020 8368 6033 F/P 020 8368 6033 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.V361097.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One exception for over 65 years Date of last inspection 28th January 2008 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 one of three deputy managers. 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 £474.74 - £800 per week depending on their needs. A copy of this report can be obtained direct from the provider or via the CSCI website. Friern Residential Care Home DS0000010441.V361097.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. This key inspection took place on 29 April 2008. Two inspectors carried out the inspection. We spoke with the people using the service, the staff on duty and the manager. A standard form, the Annual Quality Assurance Assessment (AQAA), was returned to CSCI by the manager. This was taken into consideration. We also looked in detail at five people’s care arrangements using our case tracking method. The inspection also involved the assessment of a range of the home’s records, procedures and forms as well as observation and a tour of the premises. Questionnaires were received from many of the people living at the service. What the service does well: What has improved since the last inspection? What they could do better: This inspection has identified three major issues which need to be resolved in order to provide better outcomes for people using the service. The manager has delegated some of the management tasks too liberally and not followed up on them. This has resulted in an unevenness to the service and situations such as one deputy manager supervising another deputy manager with the manager not having an oversight of the process. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 6 Second, the manager has retained responsibility but then not effectively managed the situation. For example, the management of people’s personal finances has been retained by the manager. However, this has become disorganised. One person was not receiving additional benefits and the records of money handling were unclear. Advice and assistance would be of use to the manager in this situation. Thirdly, although there has progress with meeting outstanding requirements there has been slow progress in some areas such as the opening of bank accounts for people using the service. We are taking enforcement action in this area. This inspection has also highlighted the need to continue to improve the home’s physical standards as well as the opportunities provided to people to take part in a range of meaningful and appropriate activities. Additional improvements are needed to the staff supervision arrangements and to the quality assurance system. 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.V361097.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.V361097.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): 123&5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are equipped to meet people’s needs including that of race, religion and culture. A sensitive, welcoming atmosphere has been created. Improvements have been made to the information available to people resulting in clearer, easier to read documents. EVIDENCE: There is a range of information available for people providing details about the service. The service users’ guide, for example, is on display in one of the lounges along with the last inspection report and other information about the service. The service users’ guide is now easy to read and clearly set out. It contains a shortened and simplified version of the home’s complaints procedure. In response to a recommendation at the key inspection of 28 January 2008 the statement of purpose is being revised. The manager told us that this work was not yet complete. We were advised that no admissions of have been made since the last key inspection. The majority of the residents have lived at the home for a number of years so it was not possible to fully assess standard 2 “Needs Assessment”. However, we used the case tracking process to look in detail at the care Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 9 arrangements for five people living at the home. We spoke to each person and inspected the care plans and other written information relating to the people. We saw that case files contained a great deal of information including assessment of needs. We also saw that each person’s needs had been reviewed both internally at the home and by professionals such as health care professionals. Overall, staff have the ability to meet people’s needs. The skill mix within the staff team is such that there are a number of very experienced staff available. The manager is a trained nurse and a number of other staff have many years experience of providing mental health services. However, there are some specific areas where staff could improve and thereby provide improved outcomes for people using the service. These include developing opportunities for people and including people more in decision making. They will be addressed in the following sections of the report. The manager stated in the returned Annual Quality Assurance Assessment (AQAA) that the service had incorporated individual preferences into the service such as food and festivities and through support for people such as assisting one person to attend a mosque. This was backed up by what people told us and through the home’s own quality assurance survey. People responding to that commented that food provision met their cultural needs. A person we spoke with felt that their religion was respected by staff and others. During the case tracking we were able to see that each person we looked at now has a signed contract on their case file. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 & 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The improvements made to the care plans, the individual one to one work with people and the pleasant, friendly atmosphere have provided people using the service with some positive experiences of care and the possibility of greatly improving their quality of life. Such work has been let down by the need for the service to develop ways of supporting people towards greater independence, choice and decision making. EVIDENCE: We used the case tracking method to look in detail at the care provided to five people. This involved inspecting the care plans, speaking with the five people as well as staff and, where possible, external people such as health care professionals. We noted that the care plans had been updated since the last key inspection of 28 January 2008. A requirement had been given then to review care plans to make them holistic and able to cover all aspects of their people’s lives including relationships. We found that there had been additions to care plans Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 11 about personal relationships. However, not all the care plans we saw had been updated to include personal relationships. A recommendation is given that this task is completed. We identified that there had been reviews carried out by local authorities as well as Care programme Approach (CPA) reviews. These reviews are lead by health professionals. We noted that there was a need for a closer tie up between these reviews and the internal care home reviews. For example, to make sure decisions made at a CPA review are added to the internal care plan. It may be possible that such decisions are not updated until the next scheduled care plan review and therefore decisions may be missed, albeit temporarily. A recommendation is given that when there is a change the internal care plans are updated following the review. During the inspection we considered how the service empowered people to make their own decisions. We noted that there has been some improvement in involving people using the service. For example, there are records of meetings held every two weeks where people using the service meet with staff to discuss arising issues and upcoming matters. There are also records of meetings to discuss food provision and menu choices and we saw records of individual meetings between key workers and people using the service. We also observed a great deal of informal interaction between staff and people using the service. For example, people would often come to the office and ask staff a question or converse with staff in the communal areas. However, we identified that the service had not yet fully made headway with extending choice and decision making to people. For example, one person told us that he did not go out of the home and that the manager bought him everything he needed. Another person told us that he had all his washing done for him. Some people assist with meal provision but the vast majority of meals are prepared by staff for people using the service. Additionally, as will be discussed later in the report, we found that some of the people using the service had little control over their finances with the manager carrying out all responsibility for money management herself. It was not unusual for people using the service responding to the surveys to state that they only “sometimes” made decisions about what they did each day. The introduction of advocates for people would assist with the development of decision making amongst the people using the service. The service has set itself goals in the area of increasing independence for people using the service. In the returned AQAA the manager stated that the plan for improvement in the next 12 months included the promotion of staff skills, “that respect and maintains residents’ dignity, build self-esteem, confidence and independence”. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 12 We noted that each person had a risk assessment as part of their care plan and that these were subject to regular review. Files are held within locked cabinets in the office. People using the service told us they were familiar with their care plans and the findings of reviews. And that they had one to one sessions with their keyworker. One person told us that his keyworker was working with him on using public transport with the aim of encouraging him to travel further from the home than the immediate area around the home. Friern Residential Care Home DS0000010441.V361097.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): 12 13 14 15 16 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. There have been improvements to activity provision resulting in a greater range of activities being available. People like the food provided but ways will need to be found to assist those people who wish to cook their own food. EVIDENCE: There has been some proactive work in this area since the last key inspection. We discussed opportunities for learning and community involvement with the manager. She told us that people using the service were involved in a number of activities such as voluntary work, attending the MIND day centre, attending a local college and in staff lead activities such as taking exercise in a local park. We were also told that each person using the service has a daily programme which sets out daily, tasks, activities and events. We saw examples of these on people’s files and people we spoke to referred to them. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 14 In addition, we were told that there are daily activities provided at the home and again we saw evidence of this. We discussed activities and daily routines with both the people using the service and staff. One person told us that he liked the internal activities and looked forward to them. We noted that there had been improvements since the last key inspection and that there was more going on in the home. However, we identified that these new activities were predominately group activities of the type involving writing and discussions although there were some one to one work such as one person being assisted in going out of the home and using public transport. It will be of benefit to people to have a wider variety of internal activities perhaps with an external facilitator to run some sessions. We observed lunch, visited the kitchen and discussed food provision with the staff and residents. Lunch was served to 11 people in the dining area. There was a choice and the meal, although simple, was attractively presented. Residents told us that they liked the food provided. Staff told us that none of the residents cooked their own food. However, we were told that residents assisted with meal preparation and were able to make their own drinks and snacks. We observed one of the residents assisting with the preparation of the evening meal. The menus we saw had a variety of meals and we saw evidence of meetings where residents put forward their views as to what food they wished to eat. We also noted from the service quality assurance report that residents had answered questions about food provision. The responses were generally positive but six people felt that they were not given the opportunity to cook for themselves. One person commented that there were, “too many people in the kitchen at breakfast and other meals”. Friern Residential Care Home DS0000010441.V361097.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): 18 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. More attention has been given to the people using the service in respect to their personal care, needs and wishes. People are being encouraged to take up appointments with health care professionals although this work needs to be ongoing and the recording of such visits needs to be more thorough. EVIDENCE: We discussed the arrangements made for the provision of personal care with both the people using the service and with staff. Some of the people we spoke with had specific concerns or arising issues about personal care and we passed these on to the manager. Generally, people were happy with the support they were being given. A number of the people we spoke with made reference to their keyworker as an important person in their lives who helped them with activities or in discussions. It was evident from discussions with people that they were asked how care should be provided to meet their needs. We noticed that there had been some improvement in terms of people’s physical appearance since the last key inspection. For example, more attention had been given to the buying of clothes and hair care. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 16 The records kept for each person detailing what preventative health care they received are well presented. They demonstrated that each person was receiving a range of health care. However, we were told that some of the recent appointments that people had had were not recorded although we were shown evidence that appointments had taken place via the home’s diary. There is a need to keep preventative health care appointments up to date. We inspected the medication storage and recording arrangements. Overall, the arrangements are good. The Boots blister pack system is used and there were clear records for each person receiving medication. One arising issue was that of staff training. One member of staff was administering medication but there was no evidence that the person had received any training. A suitable training course must be provided. Friern Residential Care Home DS0000010441.V361097.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): 22 23 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. The complaints policy is now much more accessible and easy to read for people using the service and safeguarding arrangements are adequate. However, people using the service continue to experience poor outcomes in relation to the way their money is looked after by the service. EVIDENCE: We were shown the amended complaints procedure. This had been updated following a requirement given at the last key inspection. The procedure is now much briefer and easier to follow and will provide people using the service with an easy to follow guide on how to complain. We were shown the complaints records. We saw that there had been two recorded complaints since the last key inspection. There were reasonably clear records about the complaints and how they were investigated. However, we noted from our case tracking that there was another complaint made by a person using the service that had not been recorded as a complaint. However, we saw that there was a letter from the manager in reply to the complainant. The complaints records need to be updated to record this complaint. We were shown the Safeguarding Adults policy. Reference is made to the local authority and other relevant organisations but the overall policy is brief and may limit the information available to staff. The policy should be updated and expanded when next it is reviewed. The majority of staff have received Safeguarding Adults training but some of the newer staff have not. The Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 18 manager told us that a training session for staff will be provided in the near future. At the last key inspection a requirement was given that each person using the service must have their personal finances safeguarded by the opening their own bank account. People’s money had first been paid into a company account before cash was provided directly to the person. The records of these cash transactions had been poor and the requirement also required the provider to ensure that any money held on behalf of people must be clearly recorded with expenditure accompanied by a receipt or signed for by the person. The manager had advised us through a written response to the 28 January 2008 inspection that action had been taken to address the matter. The manager gave us a verbal summary of the current situation. She said that of the 16 people using the service three have their money looked after by relatives. She said that five people now have Post Office accounts and she has applied for accounts the remainder of the people using the service. She said that she is still discussing the arrangements with the Pension Credit department for the transfer of benefit payments so that money is paid directly into people’s accounts rather than the company account. We identified that the requirement given at the 28 January 2008 inspection had not been complied with. We are taking enforcement action in this matter. We inspected the records for four of the people using the service. We identified that the records were not being clearly recorded and that cash was not always being kept centrally. For example, for two of the records we looked at we saw that there were banknotes in the record books instead of in a labelled tin or equivalent for the individual held separately in the home’s safe. Within one person’s money record book we saw some receipts but not all expenditure had been entered in the book. For example, an item of clothing had been bought (there was a label to prove it) but there was no receipt. The money management system was poorly organised. For one person the manager said that she bought things as and when required but it was not clear what money was being used and how much was being spent. The manager said that she was buying things on the strength of the fact that money was coming in for the person via Disability Living Allowance (DLA) benefit. However, when asked to provide evidence she was at first not able to. Eventually, after a look at the company bank statements the manager was able to tell us that, in fact, a mistake had been made and that the DLA benefit was not being received. We were shown bank statements from the company accounts to provide evidence of what benefit money coming in. However, the benefits money was still being made into the company accounts. Two of the records we looked at were clearer with people having signed for receipt of money. However, the overall arrangements are unclear and need to Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 19 be reviewed. The money arrangements must be more suitably arranged in order to offer safeguards to people using the service. A review of each person’s finances must be undertaken and must include a review of the benefits being received. The money management records for people using the service must be clear and unambiguous. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 20 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 25 26 27 28 29 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although redecoration and refurbishment work has started more work is needed, especially in the communal areas and in people’s bedrooms, in order to provide people with a pleasant, comfortable environment. EVIDENCE: The manager told us through the returned AQAA and a written response to the 28 January 2008 inspection that work had started to refurbish the home. A requirement had been given at the last key inspection that a complete refurbishment of the home was needed. We toured the premises with one of the deputy managers and were able to see a number of improvements such as a newly created shower room as well as refurbished bathrooms and toilets. Work was in progress on the day of the inspection to refurbish another of the bathrooms. The office had been decorated and a new floor covering laid and one of the store rooms had been repositioned. These improvements will provide an enhanced quality of life for people using the service. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 21 The manager told us that further improvement work is planned but that completion would not be in this current financial year. However, there is important work to do as the home has become worn in parts. For example, the conservatory does not provide as pleasant a place to sit and spend time as it could do. The ceiling is discoloured and the net curtains block sunlight. Staff told us that the room can become uncomfortably hot at times. There is a need for a complete facelift for this room. On a similar theme, the kitchen would benefit from being made larger and less clinical in appearance. Some of the people using the service assist in the kitchen to prepare meals. More opportunities could be extended to people if the kitchen were larger with a different layout and easier to access. We visited four bedrooms at the invitation of residents. The decoration and furnishings were basic and largely uninviting. The rooms could be made much more attractive and comfortable through redecoration and the provision of some new items of furniture. We also visited the staff sleep-in room. This room also requires redecoration and improvement. Staff told us that it was an unpleasant place within which to spend time. Much work is required to improve the home’s physical standards and provide people using the service with improved outcomes. A timetabled plan of improvement and refurbishment is required. The plan to include the redecoration of the staff sleep in room. The coin operated telephone available for residents, which is in a cubicle in one of the lounges, is broken and is not now fixed to the wall. The telephone fixing must be repaired so that it is secured to the wall. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 22 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): 31 32 33 34 35 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff recruitment is now much better with staff only starting work when the required checks have been carried out. Staff training is varied. There have been improvements to staff supervision but further improvement is needed to establish an effective staff supervision system. EVIDENCE: Recruitment was inspected at a random inspection visit to this service on 4 April 2008. This random inspection was carried out because a statutory requirement notice had been served by us following the 28 January 2008 key inspection. At that inspection we had found evidence of recruitment which did not meet The Care Homes Regulations 2001 specifically in relation to obtaining CRB checks for staff. At the random inspection we found that the standard had improved and that the required checks had been obtained for staff including that of newly appointed staff. At this key inspection we looked at the overall staffing arrangements. We found some issues that affected the overall smooth running of the service. The night staff arrangements were complicated. We were told that there were two night staff and that the practice was that they took it in turns to spend part of Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 23 the night sleeping. Therefore, each night worker spent part of the night providing a sleep in service and part a waking night service. It is customary for night workers roles to be distinct with only one person providing the sleep in role. Often the person who sleeps in at night will also work a shift the evening before or the next morning. The night care arrangements in this service should be reviewed. The manager had delegated some of the management tasks but not retained overall control of the work and of supervising practice. For example, we found that one of the induction records for new staff did not reflect what the staff member had done. The manager had not been aware of this. Another example was that one of the deputy managers was supervising another deputy manager. A more usual practice would be for the manager to supervise deputy managers who would then be given responsibility for supervising the remaining staff. We discussed these matters with the manager who accepted that she had delegated too much and not followed up on things. Also on staff supervision we saw that the records read more as information giving to staff rather than a two way process where staff may be coached or where time was spent on individual development. We were told that staff who provided supervision had not received training. In order to improve practice we recommend that these areas be addressed. We inspected the staff training records. On the whole the records we saw provided evidence that staff had received a range of training that would greatly assist them in providing care to people using the service. There was a need for some staff, mainly the newer members of staff, to receive Safeguarding Adults training. The manager advised that one of the deputy managers, who takes the lead in this area, was to provide a training session in the near future. Friern Residential Care Home DS0000010441.V361097.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): 37 38 39 42 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has delegated too much without sufficient management control and has been ineffective in the management of people’s money. This has resulted in people using the service having no control over their finances. The quality assurance work would provide better outcomes if the areas covered were wider. EVIDENCE: As described earlier in the report (in the sections on Concerns, Complaints and Protection) we found evidence that in some areas the home was not being run effectively. For example, in looking after people’s money and in the delegation of tasks to staff. The manager has many years experience of running the home, holds relevant qualifications and has received recent relevant training. This inspection has Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 25 highlighted the need for more effective delegation of tasks as well as the need to take advice and guidance on some aspects of running the service, such as the management of people’s money. Getting these matters right will have a positive impact for people using the service. The manager gave us details of a recent quality assurance initiative where surveys had been completed by people using the service. The findings had been collated into an overall report which detailed what people had said. The report is detailed and lists the responses to questions about all aspects of the service including equalities and diversity issues and food provision. Many of the responses are positive and people are clearly happy with many aspects of the service. However, the findings suggest that more work is required in certain areas either to obtain more feedback or to detail how the service is responding to arising issues. For example, there is a split in the response as to whether complaints are taken seriously. Six people said yes and six people said no. Another example is the response to the question whether the manager involves people with changes and making decisions. The responses were weighted towards the “never” and “sometimes” end rather than the “always” end of the spectrum. Producing a report as to how the arising matters from the surveys are to be responded to will help move the service forward and respond directly to what people say about the service. In addition, there is a need to include other people such as relatives, care managers and health care professionals in the quality assurance process. Such people may be able to comment on the service. We inspected the health and safety records. We found evidence that the required servicing of equipment and checks of safety had been completed. There was a well organised fire safety system with a risk assessments as well as clear records of fire drills and checks of equipment. One matter that we did not find a record for was that of the servicing of the home’s water systems. The manager told us that this had been completed last year and there were plans for it to be completed this year. Friern Residential Care Home DS0000010441.V361097.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 X 5 3 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 3 26 2 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 2 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 3 2 X X 2 X Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 27 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 YA24 Regulation 23(2)(b)(c) Requirement A complete refurbishment of the home must be carried out. To include 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. Timescale for action 31/07/08 2 YA14 16(2)(n) 3 YA19 13(1)(b) 4 YA20 13(2) This requirement is still within timescale. Have a wider variety of 01/09/08 internal activities including, where possible, the provision of activities from an external activities facilitator, in order to improve the opportunities for residents. Keep the records of 01/06/08 residents’ preventative health care appointments up to date in order to promote health care. Make sure that all staff 01/09/08 administering medication have first received appropriate medication DS0000010441.V361097.R01.S.doc Version 5.2 Page 28 Friern Residential Care Home training. 5 YA22 22 Make sure that the complaints records include all complaints that have been made. 13(6) Provide Safeguarding Adults training to all staff who have not so far received it. 17(2)Sch4para9 Review residents’ money management and benefit receipt arrangements. Have clear and unambiguous records of financial transactions for each person. 23(2)(c) Repair the coin operated telephone attaching it to the wall. 18(1)(a) Review the night staffing arrangements setting out clearly staff roles and responsibilities at night. 18(c)(i) Make sure that there are effective staff supervision arrangements and that people providing staff supervision have received relevant training. 24 Extend the quality assurance initiative to include relatives, care managers and health care professionals. And set out in writing how the matters arising from the quality assurance initiative will be responded to. 23(2)(c) Make sure that the home’s water storage systems are serviced. 15/06/08 6 7 YA23 YA23 15/06/08 15/06/08 8 9 YA24 YA31 15/06/08 15/06/08 10 YA36 01/09/08 11 YA39 01/07/08 12 YA42 01/09/08 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 Good Practice Recommendations DS0000010441.V361097.R01.S.doc Version 5.2 Page 29 Friern Residential Care Home 1. 2 3 4 Standard YA1 YA6 YA6 YA7 The statement of purpose should be reviewed and information that would be better located elsewhere to create a shorter document be removed. Conclude the work being undertaken to update care plans to include details about personal relationships. Internal care plans should be updated immediately following CPA or local authority reviews. External advocates should be introduced and made available to people using the service. Friern Residential Care Home DS0000010441.V361097.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V361097.R01.S.doc Version 5.2 Page 31 - 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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