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Inspection on 30/09/08 for Friern Residential Care Home

Also see our care home review for Friern Residential Care Home for more information

This inspection was carried out on 30th September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The manager and staff have been able to meet the majority of the requirements given at the last key inspection. A friendly, relaxed atmosphere has been created. The manager and staff know the residents well and are in a good position to work with them effectively. New staff have been introduced smoothly and the remaining staff have experience and are able to offer continuity to residents.

What has improved since the last inspection?

The decoration of the home is nearly complete. The vast majority of residents rooms and communal parts of the home have been decorated. A new staff member has been appointed to take the lead in providing and arranging activities for residents. The manager has carried on with the change to the way of looking after resident`s money. With one exception, residents now have their own bank accounts. The improvement to staff recruitment arrangements has been sustained. There have been continued improvements to care plans and to the risk assessments in use. The manager has now taken control of staff supervision and is much more informed about day-to-day matters at the home.

What the care home could do better:

Now that there has been improvement to staff recruitment, resident finances and the management arrangements attention needs to turn to the aim of assisting residents to gain the skills to maximize their independence. This is an aim of the home and a great deal of work is needed to make sure that it happens. Specific care plan objectives are needed. Staff need support and guidance from the manager to work effectively with residents and additional input is needed to develop resident`s basic skills such as cooking, washing clothes and money management. Attention also needs to focus on resident`s quality of life. Some residents expressed frustration and discontent with the service. One of the observations of the Expert by Experience was that the service felt more of an, "institution, than a home". More needs to be done to encourage residents to do things for themselves. Some of the formal systems, such as laundry rotas, key handling arrangements and food provision need to be reviewed with changes made that reflect residents wishes. There is a lack of resources for activities. This needs to be addressed with new equipment bought for residents and a dedicated space for activities considered. More work is needed to promote healthy lifestyles among residents including healthcare, smoking reduction and healthy eating. The improved physical standards will be greatly enhanced if the manager and staff also work with residents to create pleasant, personalised bedrooms. The decorative work needs to be completed and the poor finish attended to. Te parts of the home with defects, such as the broken shower hoses, need to be repaired. The Expert by Experience felt disappointed at the quality of life for residents and felt that, "money needed to be spent on furniture, fixtures and fittings as a matter of urgency".

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Duncan Paterson     Date: 0 6 1 0 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Friern Residential Care Home 26-30 Stanford Road London N11 3HX 02083686033 F/P02083686033 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Bijaye Luxmi Thambirajah Type of registration: Number of places registered: Mrs Bijaye Luxmi Thambirajah,Mr Vevegananthan Thambirajah care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: One exception for over 65 years Date of last inspection Brief description of the care home 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 residents needs in a friendly and efficient way and to strive to preserve and maintain residents 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 self-contained flats with their own kitchen and Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 18 Brief description of the care home 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. Care Homes for Adults (18-65 years) Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place on 30 September and 6 October 2008. The inspector was accompanied by a CSCI Expert by Experience. The second day of the inspection was needed as the manager was not able to be present for a full day on 30 September. The comments from the Expert by Experience are included in this report. The inspection involved talking with residents, the manager and staff. The Annual Quality Assurance Assessment (AQAA) form was taken into consideration. The inspection also involved the assessment of a range of the homes records, procedures and forms as well as observation and a tour of the premises. Care Homes for Adults (18-65 years) Page 6 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Now that there has been improvement to staff recruitment, resident finances and the management arrangements attention needs to turn to the aim of assisting residents to gain the skills to maximize their independence. This is an aim of the home and a great deal of work is needed to make sure that it happens. Specific care plan objectives are needed. Staff need support and guidance from the manager to work effectively with residents and additional input is needed to develop residents basic skills such as cooking, washing clothes and money management. Attention also needs to focus on residents quality of life. Some residents expressed frustration and discontent with the service. One of the observations of the Expert by Experience was that the service felt more of an, institution, than a home. More needs to be done to encourage residents to do things for themselves. Some of the formal systems, such as laundry rotas, key handling arrangements and food provision need to be reviewed with changes made that reflect residents wishes. There is a lack of resources for activities. This needs to be addressed with new equipment bought for residents and a dedicated space for activities considered. More work is needed to promote healthy lifestyles among residents including healthcare, smoking reduction and healthy eating. The improved physical standards will be greatly enhanced if the manager and staff also work with residents to create pleasant, personalised bedrooms. The decorative work needs to be completed and the poor finish attended to. Te parts of the home with defects, such as the broken shower hoses, need to be repaired. The Expert by Experience felt disappointed at the quality of life for residents and felt that, money needed to be spent on furniture, fixtures and fittings as a matter of urgency. Care Homes for Adults (18-65 years) Page 7 of 32 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information available to people using the service is now clear and informative. However, the aim to develop residents skills to maximise their independence has not been met. Feelings of frustration and discontent from residents needs to be addressed by the manager. Evidence: The homes statement of purpose has been rewritten since the last key inspection of 29 April 2008. The document is clearly written. It sets out the aims and objectives of the service, staff qualifications, the arrangements for activities and how the service will address equality and diversity matters. The service users guide had also been updated earlier in 2008 and the two documents now provide residents and others with easy to read, concise information about the home. The statement of purpose identifies the promotion of independence as a key aim. The service aims to work with people to allow them to regain or learn skills to maximise their independence. In this inspection we identified that there is a need for the service Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: to translate these aims into clear actions such as having clearly written care plans for residents to work towards gaining independent skills. One of the observations of the Expert by Experience, for example, was that, everything seemed to be done for residents without much encouragement towards independence. To illustrate this, we saw rotas for residents to do their laundry on set days rather than a system that encouraged residents to take responsibility in a less formal pattern. One resident said, I never cook, staff do that. The manager and staff will need to devise ways of working with people so that independent skills can be encouraged. We made similar observations about residents money management skills and their need for more support for activities and following their interests. These topics are addressed later in the report. We identified that there had been progress made by the home in addressing previous requirements such as keeping records of health care appointments and developing care plans. We also noted that the manager and staff knew people well and were in a good position to provide informed care. However, there was some discontent expressed by residents relating to living with others in the home and with some of the rules imposed by the owners of the home. For example, one resident said that other residents caused trouble at the home, being noisy and breaking things. The resident also said that one of the owners was strict and kept, telling us what to do. We did find some of the facilities in disrepair such as blocked toilets. We were also notified a few days before the inspection of an argument between residents which involved calling the police. This has now been referred to the local authority as a safeguarding matter. The manager and staff will need to address the residents feelings of frustration and discontent. A requirement is given that the manager draws up plans for promoting harmony at the home, in particular between residents and with staff. We were advised that no new admissions of residents have been made since the last key inspection. The majority of 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 spoke with 10 of the residents and looked at a sample of care plans. Care Homes for Adults (18-65 years) Page 11 of 32 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans have been developed so that they now provide a useful means to working with residents. They now need to incorporate specific care plans objectives so that residents can be encouraged and equipped with independence skills. Evidence: We were shown a sample of the care plans. The manager explained that they had been updated and that work was underway to produce new risk assessments, which use a scoring mechanism. We also saw that the Care Programme Approach (CPA) review decisions had been added to the care plans. Overall, the care plans and risk assessments used are clearly written and detailed. However, as has been mentioned, there is a need to make more headway with promoting the independence of residents and providing them with the means to acquire new skills so that they can move on to more independent living. Many of the residents have lived at the home for a number of years and have not developed their Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: skills to an extent that they can move on. For example, residents who had particular interests, say in art or computers, were not being encouraged to develop these by having equipment or support at the home to develop their skills. There were no money management plans in place for residents so that, for example, saving could be encouraged. Similarly, although some of the residents assisted with cooking and domestic work there were no active plans for residents to go out to buy food and prepare meals. A requirement is given for the manager to address the promotion of independent skills for residents and draw up specific, timetabled care plans with objectives for the development of independent skills. We identified that there were mechanisms for residents to make their own decisions and participate in the running of the home. For example, each resident has a keyworker and there were records of keyworking meetings. There were also regular meetings where residents gave their views about food and other arising matters. There was a also a great deal of informal interaction between residents and staff. We were shown quality assurance surveys returns which residents had completed. However, given that there was discontent expressed by residents more should be done by the manager and staff to promote decision making and the involvement of residents in the running of the home. We were advised that two residents had taken up the services of an advocate which had been recommended at the last key inspection. The recommendation about this is repeated as the services of an advocate needs to be extended to more residents. Care Homes for Adults (18-65 years) Page 13 of 32 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The appointment of a member of staff to develop activity provision is a positive step and should lead to better outcomes for residents. There is a need to equip the home with resources for activities as the home is under resourced in this area. Food arrangements need a review so that healthy eating can be encouraged and residents can be involved much more in buying, preparing and cooking food. Evidence: A key development since the last key inspection has been the appointment of a member of staff who has relevant experience in activity provision. This member of staff has been given the responsibility for developing activity provision and has been active since appointment in doing so. The member of staff was able to outline plans for future work. However, the appointment has been relatively recently and work is still at a development stage. Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: It is important that activities and individual work with residents to promote their independence and improve their quality of life is undertaken as residents in this home have suffered from a lack of resources in this area. The home is poorly equipped for residents to follow their interests and activities. There is no computer access for example and residents with an interest in art, painting and animation have no equipment other than what they buy themselves. There is no dedicated room for activities even though the dining room could be used for this purpose. A number of residents told us that they wanted to develop their skills and asked us about equipment such as computer equipment. A recommendation is given that the home should be resourced with equipment for residents to involve themselves in activities including computer access. The observations and findings of the Expert by Experience endorsed this. She felt that there was a lack of support and encouragement to residents. And she reported that residents had asked her about how to get equipment as well as residents who said they were not clear what money they were entitled to. Links also need to be made with other aspects of peoples lives. It was encouraging, for example, to see that the new member of staff was assisting residents to go to the local day centre and make links with staff there. More could be done by staff to draw up programmes to promote the domestic skills of residents and a healthy lifestyle. We visited the kitchen and spoke with staff about the meals provided. We were shown menus, we observed the serving of lunch and ate lunch. The meals are nicely presented and carefully prepared. The meals served are reasonably varied and reflect peoples choices. However, there were some mixed views from residents. One person said that the food was not very good and , there is never enough. But another resident said that the, food is always good. Observations we made in the kitchen and other food storage areas was that more emphasis could be placed on providing healthy food. We did not see fresh fruit at the home, for example, and the stock of fresh vegetables was low. We also saw that the supply of milk in the kitchen fridge was low given the number of residents in the home. The food stored tended to be, in the main, of the value supermarket variety. The impression given was that much more could be done to make food and meal preparation an enjoyable experience for residents. For example, more work is needed to involve residents in the buying, preparation and cooking of food. One resident told us that he spent a lot of time in the kitchen helping. We saw other residents helping as well. However, residents skills were not being developed in this area and there were no development programmes for them to do so. Plans need to be put in place to Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: develop residents skills in this area. Care Homes for Adults (18-65 years) Page 16 of 32 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The process of recording health care appointments is now much better. However, planned programmes are needed for each resident to promote health care. Key workers need to be empowered by the manager to work with individual residents. Evidence: We identified that the home had worked to meet previous requirements and recommendations in this area. The recording of health care appointments, for example, was much better. The manager was also able to tell us of links that existed with health care professionals and the work that has been taking place to update care plans with the decisions made at CPA meetings. The manager told us of some of the issues facing the service, such as working through changes of medication. We felt that more could be done to promote healthy living and healthy lifestyles among residents. A number of the residents smoke, some quite heavily. There was no clear method or plan that staff at the home were following to address this issue. For example, links could be made with relevant health care professionals or a local smoking cessation programme put in place. A recommendation is given about this. Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: There was evidence of better use being made of preventative health care and residents told us that they had been to the dentist or GP recently. However, more could be done to promote positive health care and personal care among residents. For example, we noted that a small number of residents needed a great deal of encouragement to have showers or baths. Others may need more help to buy and maintain clothes. This was not assisted by the fact that some of the bathrooms at the home had problems with shower hoses. More detail about this is provided below. We observed that staff communication was poor in some areas. For example, staff had a different understanding of how to assist residents with laundry and some residents rooms were entered by staff without knocking. Despite a good relationship with residents we felt that staff were not taking responsibility to get things done. Staff will need direction, guidance and support from the manager in order to work effectively with residents and develop residents skills. A timetabled programme produced by the manager and agreed by staff may assist in bringing this issue to the forefront of dayto-day care provision among staff. 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. The requirement given at the last key inspection about staff training had been complied with. However, staff training is an ongoing issue as there new staff at the home. New staff will require medication training. Care Homes for Adults (18-65 years) Page 18 of 32 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents money is now much better handled although the system requires further work to make sure that it is fully open and transparent. Recent complaints had been documented properly. Evidence: The last two key inspections had identified problems with the residents money handling arrangements. Instead of residents having their own bank accounts and being in charge of their own money, their benefits were being paid directly into an account of the home owners. The owners were then giving cash to residents. This arrangement was not suitable. Requirements were given to the owners and a statutory enforcement notice was served. This inspection has identified that the owners have continued their work to provide each resident with a separate bank account into which benefits are now paid. There was one exception to this as the opening of an account had become complicated because of identification needs. Although all but one resident now has a separate bank account the owners were still having problems setting up an efficient system to recover the fees payable to them. The matter is complex. However, the managers financial system is time consuming and needs improvement. The manager advised that an invoice system was to be adopted. It will also be useful to have an external auditing system and local authority Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: involvement so that the manager can demonstrate that the system is open and transparent. Now that residents have their own accounts it will be much easier for the manager and staff to start programmes helping residents to manage their money. This will be an important part of staff preparing residents to acquire the skills for more independent living. We were shown the complaints records. We saw that there had been three recorded complaints since the last key inspection. There were clear records about the complaints and how they were investigated. We identified that the requirement given at the last key inspection about providing safeguarding training to staff had been complied with. However, the newly appointed staff will need training in this area. There had been no safeguarding matter since the last inspection. However, an incident at the home a few days before this key inspection had been referred to the local council as a safeguarding incident. The incident had involved the police being called after a disagreement between residents. Care Homes for Adults (18-65 years) Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The decorative work is now almost complete and this has improved outcomes for residents. The positive impact has been reduced by a poor finish in some parts of the home. Now the decoration is near completion attention needs to focus on providing residents with help and equipment to make their bedrooms enjoyable places to relax and take part in individual activities. Evidence: Work has been taking place during the course of 2008 to redecorate and refurbish the home. We noted at the key inspection in April 2008 that this work had progressed and we were able to see at this inspection that the work is almost complete. The vast majority of bedrooms and communal rooms have been redecorated with some new furniture provided. This work has brought an improvement to the physical standards and the outcomes for residents. The decoration of the conservatory area is particularly an improvement. A number of residents showed us their newly decorated bedrooms. They confirmed that they had chosen the colour scheme. We toured the building with a member of staff and, on the second day of the inspection, the manager. We noted that some parts of the home had not yet been decorated and that in places the finish was poor. For example, the laminate flooring Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: had not been properly edged and gaps were left leaving an untidy look. Also, the painting in a residents bedroom was poorly finished. Instead of moving a wardrobe the paint had been applied round the wardrobe leaving a ragged appearance. Radiators have not been painted in the cycle of work completed. The work that needs to take place to complete the decoration of the home should include the radiators. We identified a number of repair issues throughout the home. Two of the toilets were blocked and one toilet flush mechanism was not working. Two shower hoses were inoperative and need replacement. One residents bedroom had a broken ceiling light and some broken furniture under the bed. With the exception of the toilet flushing mechanism and the shower hoses, these matters had been repaired by the second day of the inspection. We also noted that: there was a broken wardrobe and chest of drawers in a residents bedroom; the dining room doors were sticking and not shutting properly; the carpet on the kitchen step needed replacement; and, there was a broken fridge and old coin operated telephone that needed removal. The Expert by Experience felt that residents bedrooms needed, more attention to make them comfortable places to be. She found some of the rooms, souless and sterile. She noted that some rooms were cold with thin duvets. She observed that the smoking shelter needed to offer more protection against bad weather and she found it difficult to find the entrance to the home. We also made observations about the heating, the use of keys and residents safety deposit boxes and residents bedrooms and provision of furniture. The inspection took place on a cool and windy day. A number of residents said they were cold and the heating was put on by staff. The manager had gone to a meeting so we were not clear as to how this type of matter would usually be addressed. Staff were not clear but did turn the heating on. The heating arrangements should be addressed so that residents know what to expect. Safety deposit boxes are provided in residents bedrooms. Doors to bedrooms are lockable. We spoke to residents about the key handling arrangements and discovered that very few residents had keys. Often, the safety deposit boxes would be left open and doors unlocked. The manager said that residents had originally been given keys. The arrangements must be reviewed with keys given to residents who wish them. Despite the fact that bedrooms had been decorated and some new furniture provided we saw that a number of bedrooms were a little sterile in appearance. Not many residents have personal possessions and bedrooms are not all personalised. The front door to residents bedrooms were similarly free from any personal picture or item to indicate who lived in the room. Also, many of the bedrooms did not have tables. Tables Care Homes for Adults (18-65 years) Page 22 of 32 Evidence: should be provided for residents and staff should work with residents to encourage them to personalise their bedrooms and make them comfortable places to relax. Care Homes for Adults (18-65 years) Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The improvements in staff recruitment have been sustained resulting in staff being employed who have been properly recruited. The manager has changed the induction and staff supervision arrangements so that overall control and direction is retained making it clearer for staff and residents. Evidence: Three new members of staff have started work since the last key inspection. All three staff were interviewed. All three confirmed that they had been interviewed for the job and were following an induction programme. These matters were confirmed when we looked at the staff recruitment paperwork for the three new staff. The staff files we saw provided evidence that staff had been recruited properly with all the required checks having been made. There were improvements to the system of induction since the last key inspection. Staff have an induction book and it is clear what areas are to be addressed during the induction programme. The night time staffing arrangements are now better planned. The staffing rota details what night staff are to do and the staff sleeping in room has been decorated and has new flooring. It is now a much more attractive room in which to spend time. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: The staff supervision arrangements have also been changed. The manager is now supervising all the senior staff who in turn provide supervision to care staff. This is an improvement to the situation that existed at the last key inspection. The supervision arrangements at that time were unclear. We saw from the staff files that the outstanding medication and safeguarding adults training had been provided to staff and that a range of training opportunities were available. However, the new staff will need to be provided with the full range of mandatory training over the coming months. Care Homes for Adults (18-65 years) Page 25 of 32 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is now more in day-to-day control of the home. Further development work is needed in areas such as quality assurance and residents finances to make sure that improvements are passed on to residents. Evidence: At this inspection we noted that there had been an improvement to the management of the home. The manager has altered some of the management arrangements and has a much better grasp of day-to-day events at the home. For example, staff supervision is now under the managers control, the quality assurance work is more detailed, the financial arrangements for residents is becoming much more clearer and time has been spent re-looking at the homes statement of purpose and aims and objectives. Work has also taken place preparing to meet with the local authority to agree a new contract for the home. Over the course of 2008, the manager has been able to address the serious shortfalls found in the service at key inspections. These matters included the failure to recruit Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: staff properly and safely as well as a failure to manage residents money properly. Now that these matters have been addressed the manager and staff can turn their attention to other matters including the need to improve the quality of life residents experience at the home. Work can also take place to provide residents with the skills and confidence to lead more independent lives. The manager has made progress with developing the quality assurance system. Surveys have been received and the data analysed. These is much useful information about residents views of the service. The next stage of the process will be for the manager to set out ways in which the matters arising will be responded to. For example, residents have mixed views about food provision and there will need to be a way to meet these varying expectations. A sample of health and safety records were inspected as we had looked in more detail at these records at the last two key inspections. We identified that the outstanding requirement about water safety had been complied with. Over the course of key inspections in 2008 we have seen evidence that health and safety matters are properly addressed. Care Homes for Adults (18-65 years) Page 27 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 28 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 12 Plans must be drawn up for promoting harmony at the home, in particular between residents and with staff. Residents had expressed dissatisfaction with the running of the home and there had been a recent incident where residents were fighting. There were also other incidents of some residents being in disagreement with one another. 02/02/2009 2 6 12 Specific, timetabled care plan objectives must be set for the promotion of independence skills among residents. Care plans must reflect that work is taking place to meet the aim of the service to maximise residents independence skills. 02/02/2009 3 18 12 The manager to develop with key workers daily 02/02/2009 Care Homes for Adults (18-65 years) Page 29 of 32 programmes to assist residents with personal care and hygiene, the purchasing of clothes and leading healthy lifestyles. Further work is needed to develop personal care and healthy lifestyles for residents. 4 23 20 Have a clear system for residents when they are expected to pay fees. The system must be open to external auditing. Further work is needed to ensure that the homes money handling arrangements are clear and transparent. 5 24 23 The home redecoration 02/02/2009 programme must be completed attending to the parts of the home where the finish is poor. A previous requirement was given in this area and minor works needed to complete. 6 24 23 Repair all broken furniture, replace shower hoses and free sticking fire doors. Action needed to make sure home is safe and that equipment is operating properly. 02/02/2009 02/02/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. Care Homes for Adults (18-65 years) Page 30 of 32 No. Refer to Standard Good Practice Recommendations 1 7 The external advocate should be asked to return to the service so that more residents have the opportunity to take up advocacy services. The home should be better resourced in order to provide activities for residents and encourage them to follow their interests and build skills. A computer with internet access should be provided for residents. The arrangements for food provision should be reviewed so that residents are more involved in the choosing, buying, preparing food. Healthy eating options should be considered and a range of fresh fruit and vegetables provided. Programmes should be developed to assist residents to reduce or stop smoking. Links should be made with relevant health care professionals or organisations to assist with the programmes. Review the key holding arrangements for residents bedrooms and safety deposit boxes. Provide keys for residents who wish them. Provide tables for residents bedrooms and work with residents to make them rooms comfortable places to relax. Assist residents to personalise their bedrooms. 2 11 3 17 4 19 5 26 6 26 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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