Inspection on 15/05/06 for Gascoigne Road, 80

This inspection was carried out on 15th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

CARE HOME ADULTS 18-65 Gascoigne Road, 80 80 Gascoigne Road Barking Essex IG11 7LQ Lead Inspector Mr Roger Farrell Key Announced Inspection 16th May 2006 11:00 Gascoigne Road, 80 DS0000067244.V295179.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 Gascoigne Road, 80 DS0000067244.V295179.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. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gascoigne Road, 80 Address 80 Gascoigne Road Barking Essex IG11 7LQ TBC TBC 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) London Borough of Barking & Dagenham Linda Neaves Care Home 12 Category(ies) of Learning disability (0), Learning disability over registration, with number 65 years of age (0) of places Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection First Inspection. Brief Description of the Service: 80 Gascoigne Road is a new purpose-built care home run by Barking and Dagenham Council. It provides accommodation and support for up to twelve people who have a learning disability, some of whom also have a physical disability. Two residents are over 65. Opened in December 2005, it was the modern replacement for the old-style York House, where eight of the nine current residents had lived for many years. The new building is a spacious bungalow, with lots of design features to help those who use wheelchairs - such as wide corridors and doorways, large bedrooms with en-suites, and specially equipped bathrooms. It is set well back from the busy Gascoigne Road in Barking, and shares the site with a similar style new resource centre called The Maples. Most of the staff, including the manager had worked at York House and therefore know all the eight residents who transferred well. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was registered in March 2006. This first inspection took place three months later, six months after it opened. The registered manager, Linda Neaves was away for three months. Sue Hindley, an experienced care home manager who now works at the resource centre next door, had stepped in as acting manager at the end of March. Most inspections are now unannounced. As this was the first inspection, and because there was a stand-in manager, they were given a couple of weeks notice ahead of this service assessment. Sue Hindley took the lead in dealing with the inspector’s checks. The lead senior support worker also played a major role, including taking notes in order to brief the registered manager on her return. The inspector was very pleased with how Sue Hindley and the senior support worker dealt with the assessment. He gave an overview of the recent changes in how care services are monitored, which are explained in ‘Inspecting For Better Live’, and the home has a letter explaining these changes. From next year this will include giving homes a ‘star rating’. The inspector spent two days at the home. He carried out the full range of core checks covered under the main headings in the ‘National Minimum Standards’ (NMS). As well as the time spent with the managers, he met with a group of eleven staff and spoke with other staff and managers; checked a range of records including care plans; and looked at all parts of the building including bedrooms. He is particularly grateful to the two residents who met him with their families; and to those relatives and professionals who visit the home who made comments. Their views have helped the inspector reach the conclusions and ratings in this report. A questionnaire has been sent out to a wide sample of relatives and professionals, and their comments will be considered in the next report. What the service does well: The headline finding is that all the residents who transferred from York House have dealt with the move remarkably well. The person who had joined the group six weeks before this visit was also settling in very well. During the early period staff have had to cope with some teething problems, notably a delay getting the phone lines to work. But overall the building has many design merits, with excellent attention paid to equipping the house to a high standard to help residents with a physical disability. One health care professional said – “It is certainly an improvement. York House was terrible. My client has improved, both in his behaviour and medically. It was a good move for him. He is more interested in things around him, such as looking at magazines. The staff are quite consistent, and that includes the agency staff being regular.” Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Gascoigne Road, 80 DS0000067244.V295179.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 Gascoigne Road, 80 DS0000067244.V295179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The quality rating in this area is ‘good’. This included seeing the most recent resident in his bedroom, speaking to his family, and looking at the care plan files. The inspector also spoke to key people who were part of the York House transfer planning – such as offering independent advocacy and coordination with the community learning disabilities team. EVIDENCE: All but one of these five standards have been scored as ‘met’. The shortfall is not keeping the main care-plans files up-to-date, with most sections remaining unchanged since well before the move-in. Most of the permanent staff had worked with the eight original residents at York House over many years. Therefore they were familiar with each person’s support needs, their means of communication, and how they would express distress. There was unanimous agreement that all residents had dealt with the move and adjusted to their new setting very well. This included the one resident that could give a view; family; staff; and outside professionals. The advocate said good steps had been taken to involve and familiarise the residents with the big change. For instance, he had used building models and photos, and there had been a number of site visits as the new building was going up. He said that some choices had not filtered through, such as having different coloured carpets in bedrooms, but overall it had been a success. He had shown particular attention to ensuring those with the least levels of obvious communication were included. He said - ”That staff were so familiar Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 9 with the service users was a real benefit. Some of the staff are quite exceptional. They know the behaviours and trigger points……I have a positive view of the process. There have not been any significant issues for any of the individuals.” A staff member said – “We all agree that {the residents} have coped really well. I think they are more comfortable, and some have shown improvements. There was lots of consultation, such as with physios and ot’s.” Another added – “Although we still need to strengthen the team, I think we have worked well together. Yes, I would agree that the residents are more comfortable here. It has been important that {the residents} were familiar with us, and that goes for the agency workers as well.” One visiting relative said – “We think it is wonderful, just fantastic. {Our relative} has settled in fine. I cannot think of any problems that we would need to mention.” The inspector looked at a sample of care plan files. This included the records of the most recent resident. The next section includes the main comments on these important records. The new resident’s file had a good range of referral and assessment material. This included the standard five-page ‘community care plan assessment’; a basic referral form; support plans from his previous setting; a recent report from his resource centre; a log of his initial visits; and some specialist assessments such as an ot report on use of his new matrix wheelchair. Together these show sufficient information gathering and planning – though the manager is reminded to check Standard 2.3 as this lists all the areas that must be covered with prospective residents. This needs to guide the assessment of those being referred to the remaining three vacant places. Steps are being taken to make some key documents more understandable. Examples are the recently revised ‘statement of purpose’ and ‘service users guide’ that uses lots of photos and pictures. The next step was to speak to the advocate to make sure that these were successful in making information more useful to the residents. The files seen had copies of the standard contract of residency. Gascoigne Road, 80 DS0000067244.V295179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. The quality outcome score for this section is ‘adequate’. The findings under these important headings were generally good, including comments received from relatives and others. However, the care plan files need to be brought upto-date to show that support is being reviewed, including taking into account individual’s choices – and changes such as living in the new building. EVIDENCE: The inspector was told that the care plan files were overdue for an update. This indeed was found to be the case. Many of the key sections - such as the central ‘Care Plan’ schedules; ‘My Personal Programme’; and individual profiles – had not been revised for a couple of years. Nevertheless, the existing formats, the ordered layout of files, and the quality of content are really quite good. The ‘statement of purpose’ says that they use the ‘person centred planning’ approach. The files do not show the main element of this style, which emphasises the involvement of service users in expressing choices. The inspector was told that a specialist advisor in this modern approach was due to start, and would be available to help this team. However, the inspector said that the manager and team need to recognise that the system they have been Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 11 using for the past three years has a number of merits, and that it is updating that is needed rather than a complete overhaul. Strengths included some recent guidelines and specialist assessments; periodic summaries; day-to-day notes and personal care checklists; and transfer action plans. Yet the main failing is not having updated key elements such as risk assessment and care instructions in vital areas such as using the new hoisting equipment. Most residents use few or no words. There is good evidence that the relatively good level of staff retention and overall continuity in the team means that modes of expression are understood, including signing and gestures. The regular advocate plays an important role, and it is very positive that he has confidence in staff’s ability in this vital matter. Although overdue for an update, the profiles give good guidance on individual’s communication pathways, and a speech and language therapist is used. Steps are being taken to have communication aids, such as using visual styles for some information. It is said that there is little benefit in arranging more formal means of seeking views and reaching decisions such as holding resident meetings. Nevertheless, staff are sensitive to preferences within the group, such as who wants to sit near whom at mealtimes. There are plans to change the office arrangements. The inspector did note that there is good attention to keeping personal information safe, such as routinely locking the offices when they are not being used. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. The quality rating in this section is ‘adequate’. This judgement reflects the need to have up-to-date records – and to start to demonstrate that lifestyle opportunities have been reviewed in line with the modernisation of this service. EVIDENCE: The acting manager and lead senior gave an overview of residents’ main activities and the level of contact they have with their families. The parents of two residents visit a number of times each week, and one person stays with his family over weekends. Good attention was paid to including families in the phases of the relocation, including the important role played by the independent advocate. One relative had complained about not being consulted. This was being looked into, but is likely to be due to having an old address. As stated above, the ratings in this section suffer as a result records being outof-date. The section in the main files - ‘my weekly plans’ – had not been changed since before the move. Nevertheless, three residents continue to go to Heathlands five days a week, and another attends part-time. The new neighbouring resource centre is geared to supporting people with greater living Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 13 skills. However, options to use the new facilities are being looked at, such accessing the sensory room, and some residents have visited for lunch. Where residents have particular interest - such as aeroplanes, buses and football – these are followed through. The home has a minibus with a tail-lift. Most residents contribute to the costs. One person said that they like the new home as it is easier to get to the wider range of shops in Barking. All residents are helped to go to shops, including most helping with the main weekly shopping. There are a couple of resident who are not keen to go out in groups. The lead senior said that she will be updating the weekly activity sheets, and revive better use of the ‘activity book. However, the inspector said that this will be an area looked at again as the opportunities for residents to access a greater range of social and leisure activities needs to be a consideration in the overall service improvement. However, the lead senior did do a helpful tick-list showing activity over the last four months, including regular local trips to shops, bowling, cinema, lunches out, and two residents who attend church. All comments made about the standard of catering were favourable. Staff said they have a clear understanding of individual’s likes and dislikes. One parent said that she was pleased with how staff had asked for her guidance on this matter as her relative needs pureed food. The cooks and those who help with the catering said they had adapted to the more domestically proportioned new kitchen. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. The overall quality rating under this section is ‘good’. This judgement is based on the evidence seen at the visit – such as looking at the medication arrangements - and talking to families and visitors. Residents need a high level of support with personal care, and this is provided in a sensitive and caring manner. One relative told the inspector – “I can go away without a worry in the world knowing {my relative} is so well cared for. The staff are wonderful, they have always been wonderful. I know I can speak to {my relative’s key worker} anytime.” EVIDENCE: He acting manager and lead senior gave an overview of each resident’s dependency needs, how they spend their time, and the level of contact they have with their families. There has been very good support from colleagues in the community learning disabilities team, and others such as physios and ot’s. There is a main link nurse, and monthly liaison meetings. A bonus has been the helpful way the local health centre has welcomed the residents, and the approach of the practices’ GPs. The surgery is wheelchair accessible. One staff member said – “The doctors are really good, including when we have had to ask for home visits. There are also too really helpful practice nurses.” The care plan files have individual practitioner tracking sheets – that is a contact page for the GP, dentist, optician; chiropodist and so on. However, it Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 15 was admitted that these may not be up-to- date. As with the health related sections of the main care plans, the problem remains that these are not being updated. Files have a general health care profile done by the community nurses a while back, but some of this information may now be old. Part of the day-to-day record is a personal care checklist, and other monitoring sheets to do with intimate support. Two seniors demonstrated the arrangements for handling medication. Boots supplies this in their monitored dose bubble packs, with printed recording sheets. Drugs are stored in a purpose built trolley, that is kept in the locked medicine storeroom. Two staff are involved in giving the medication, normally one of whom is the senior on that shift. There is a double signing system. There are good audits, including checking repeat prescriptions and incoming supplies. This has picked up on a couple of errors in slotting the packs into the right frame at the pharmacy. A discrepancy over medication was part of a complaint made by a parent about respite stays. Not being able to find the ‘mar sheets’ covering those stays was a significant problem identified in the subsequent investigation. Other than that matter, the seniors reported that the only other problems have been a couple of lapses in signing the administration sheets. They have a ‘community pharmacy contract’ with Boots. This involves giving training, and doing occasional checks, but no such visit has taken place since the move-in. They were advised to follow this up, and to keep a record of any mistakes found with the incoming supplies. However, overall the existing systems were found to be satisfactory. The Commission’s pharmacy inspector had checked the arrangements at York House, and staff confirmed that they are still following the advice given at that time, such as having a supply of a sterilising agent. The team have tackled the sensitive area of the service users and their families’ wishes in the event of serious illness and death. Instructions covering these agreements are on peoples’ files. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The overall rating for these areas is ‘good’. This judgement is based on how they have responded to the first major complaint, and having all the necessary guidance available. They are also keeping the complaints log up-to-date. EVIDENCE: The complaints file has all the main guidance, including the main complaints and protection procedures. The day before this visit twelve staff had attended a course on adult protection. A further day was being arranged, and this would include ancillary staff. Staff are therefore aware of the ‘whistle blowing’ expectation. The acting manager and seniors are aware of who to contact if there was a suspicion or allegation of abuse. All staff have been given a copy of the General Social Care Council’s code of practice. Also available is a complaints guide using widget symbols. On the same day as the transfer from York House two brothers were admitted for three weeks emergency respite care. The timing was not favourable, particularly as one of the persons in particular became quite distressed over his stay. The temporary residents’ family had complained about a number of problems. The council had followed their set complaints procedure in looking into, and replying to the issues raised. This included having an independent person look at the matters to do with medication, the report setting a number of recommendations. Another relative had complained about not being kept informed about the move. This matter had been followed through, as there appeared to be confusion over having the right address. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The quality rating in this section is ‘good’. This is based on looking at all areas, discussing the merits and problems of the facilities with the acting manager and staff, and asking the opinion of others such as visiting professionals and relatives. One nurse who visits said – “I think it would have been better if they had been able to go for the original idea of having two {six place} houses. I’m not too sure about the long corridors and having a new place for twelve clients, but it has got plenty of space. The bedrooms are nice and large.” Initial teething problems are being sorted out, and there are intentions to make the interior appearance more homely. EVIDENCE: The inspector was told that there were a number of design proposals. A couple of people said that they were disappointed that the result was not the option of having two distinct six-place ‘ordinary houses’, adding that the final spread bungalow design looked ‘institutional’ – particularly as the architectural style is identical to the new resource centre built next door. Nevertheless, the outstanding feature of the new building is the space and facilities it provides for those with physical disabilities. The bedrooms are 15.5 sqm, each having a spacious private toilet. These large bedrooms have ceiling tracking hoists. All four bathrooms have ‘aquanova’ platform baths. There are specialist shower Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 18 chairs. There is an assistance call system. One resident uses this quite regularly, and staff have relied on it when they need a hand. The ‘statement of purpose’ says that it will be operated as two separate sixplace units. The layout lends itself to this to some extent, but this is not the case yet. With nine of the twelve places taken, resident preferences are still determining how the ‘big’ and small‘ lounge/ diners are being used. This will be reviewed as they reach full occupancy. There have been some running-in problems. The problem with the phones has been sorted out. The main remaining defect is with the showers. The floor of the walk-in shower room has to be replaced, there is a need for a splashscreen, and new hand-shower attachments are needed on the four baths. There are also some problems with the hot water distribution – but the inspector said that the staff need to have a better understanding of how the equipment worked - such a the tracking hoists and controlling water and room temperatures. Thought is also being given to swapping rooms used by staff, including combining the two offices and creating a bigger staff restroom. The main office will still be located in the front entrance lobby. Also, a request is to be made for more magnetic fire latches, including for one resident who likes to spend time alone in his bedroom, but likes the door open. On the second day of this visit a buildings’ manager and the main health and safety officer were on-site doing checks ahead of the ‘six month snagging’ aimed at putting right the defects. The home’s staff had been told not to carry out any major changes until after this had been done. Some steps have been taken to ‘soften’ the appearance, such as hanging pictures. Nevertheless, more can be done to make the interior more homely, such as greater personalisation of bedrooms. In particular, the four bathrooms and en-suites look stark and impersonal. There has been good attention to security, including gated entry to the entry forecourt, an internal and external cctv system, and window restrictors. All parts of the building were found to be clean and fresh. This included safely arranged kitchen and the well-equipped laundry-room. One relative commented – “I think the building is lovely. I can tell by {my relative’s} attitude that he is happy. He understands and nods when I ask him if he likes it… he nods for yes. He likes his bedroom, and staff understand that he likes to spend time there on his own watching television.” Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. The outcome under this section is ‘good’. This judgement is based on discussions with the acting manager and lead senior; meeting with a group of eleven staff; checking staff files; and looking at training records. Some areas have slipped a bit during the setting up period, and requirements have been set to ensure that these areas are now strengthened. EVIDENCE: Most of the staff transferred from York House. Details of the staff complement are available. This includes a sliding scale of care hours depending on occupancy levels (613 care hours for nine residents; rising to 824 at full occupancy), but full cover is being maintained during the early months. In addition to the manager, there are four ‘seniors’ (two full-time and two parttime). Normal cover is six staff on each of the early and late shifts (0700 to 1500; 1400 to 2200); with two waking and one sleep-in staff at night. Normally there is a senior on each of the day shifts. In addition there are two cooks (0800 to 1300 over seven days); three part-time domestic assistants three part-time domestics (including covering weekends); and a full-time handyperson shared with The Maples next-door. At present, there were four support worker vacancies. The inspector estimated that agency staff were providing about 30 of cover, but these were all well established familiar staff. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 20 There was a consensus view that staff had worked well to support the transfers and to support the new resident. However, there are some issues within the team that need to be addressed. All transferring staff had ‘assimilation interviews’. There has been an increase in the proportion of weekend working, and the relocation from Dagenham to Barking means a longer journey for a number of staff. Despite the overwhelming benefits to service users of moving to such a modern, well-equipped home – a few staff have had difficulty accepting change. There are regular staff meetings, and individual supervision is occurring for some staff. The manager needs to aim to achieve the recommended rate of supervision, which is six sessions a year. The inspector checked a random selection of staff files. The paperwork for those who had started over recent months had not yet been copied to the home from the human resources section. Assurances were received that new staff do not commence until all the required checks have been completed, including receiving a CRB certificate. Other files did have the necessary documents. Each file has a contents list. It is recommended that the home’s administrator use this as a check-list, noting the date when each key element is received. A strong headline under this section is that all permanent staff are qualified – having gained NVQ at Level 2 or 3 – far exceeding the target of 50 . Some have undertaking this award on their own initiative. It was said that training in some core areas had decreased over the setting up period, as had sticking to induction programmes. The council does run a rolling programme of core courses. The inspector saw the recent ‘training needs analysis’ and future plan. The files of established staff have a section for training certificates. The individual training profiles were now due to be updated. Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43. Quality in this outcome area is ‘good’. This judgement has been made using the evidence available at the visit, and the comments received. An undertaking was received to make sure all safety records will be available at unannounced visits. EVIDENCE: The registered manager has over sixteen years experience of care experience, including three years managing a care home. She has an NVQ at Level 4, and is due to commence the registered managers award. She was away during the period of this first inspection. The lead senior helpfully took detailed notes, and along with the acting manager would brief Linda Neaves on her return regarding this service assessment and the changes in regulation. Over the course of the visit there were a number positive remarks about the manager from staff and relatives. This was also true of the manager who had stepped in during Linda Neaves’ absence. One comment was – “Linda is a brilliant manager. Sue has been equally good…..she listens and responds. They listen and respond; come to hand-overs; and are here early.” Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 22 The inspector asked to see a range of health and safety records. This included the weekly tests of the alarm system; the fire risk assessment and practice drills. There is a list of staff training on fire safety and response. The inspector said that it would be better to schedule practice drills three monthly, and to include night staff. This was also the advice given by the fire safety inspector at his last visit on 19 April. His report had not yet been received, but notes had been taken at the time and were in the fire log. Fire equipment, as with other electrical and mechanical installations, were still covered by the initial guarantees. The building ‘hand-over file’ had just been sent to the Civic Centre ahead of the six-month snagging check. The buildings manager who visited said they would ensure that copies of all the relevant ‘commissioning certificates’ would be returned to the home. The inspector said that the manager needed to forward plan when these would expire, and make sure the usual periodic maintenance contracts were in place. There had already been one instance of confusion over who should be contacted out-of-hours. Certificates available included the gas safety; hoist maintenance; and public liability insurance. Water safety tests had been carried out two weeks earlier, and the report was due. There is a record of in-house water temperature checks. These are important during the running in period. The inspector said that it was better to keep these in a file rather than have them posted at each outlet. Assurances were given that the handyperson completes other routine safety checks, but he was away and these records were locked away in his office in the next-door building. The manager needs to contact the environmental health section to make sure the premises is registered under food hygiene regulations as there has not been an initial assessment visit yet. Quality control measures include departmental managers doing ’monthly monitoring visit’ reports. Copies of these need to be sent to the inspector. Also, a relatives’ consultation survey had been carried out, with four completed forms returned. These were all favourable, one comment being – “I am pleased with the way the home is being run and the welcome I always receive.” Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X X 2 2 Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? This was the home’s first 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 YA2 Regulation 14 Requirement Make sure that the initial assessment of prospective residents covers all areas set out in Standard 2.3. Have available for each resident an up-to-date service user file. This must include personal details and a photograph; an assessment of needs; a current care plan setting out the support needed by that individual; monitoring records, including contact with all health care workers; and periodic reviews of the service and facilities. All relevant care needs must be identified in the care plan, including those resulting from a physical disability. Maintain an up-to-date record of each resident’s social, leisure and recreational opportunities. Complete all items identified on the building defects schedule, including providing safe shower facilities and adequate supply of hot water. Promote homely conditions in line with residents’ choices. This should include en-suite and DS0000067244.V295179.R01.S.doc Timescale for action 10/07/06 2 YA6 15 10/07/06 3 4 YA12 ; YA13 ; YA14 YA24 15(2)(b); 23 10/07/06 10/07/06 5 YA24 ; YA27 23 11/09/06 Gascoigne Road, 80 Version 5.2 Page 25 bathrooms. 6 YA34 19/ Sched 2 Maintain staff files that demonstrate that all the necessary vetting procedures have been completed, including two verified references; proof of identity; and a CRB certificate. Provide staff with individual supervision. This should include promotion of the practice principles set out in the ‘statement of purpose’. The target is to achieve six secessions each year. Have available copies of all the required safety certificates, including those covering fire equipment; electrical supply; and water safety. Follow all advice given by the fire safety inspector (LFEPA), including increasing the rate of practice drills/instruction for night staff. Confirm that the service has been registered as a food premises, and follow all guidance given by environmental health inspectors. Provide the Commission with copies of the ‘monthly reports.’ 10/07/06 7 YA36 18(2) 10/07/06 8 YA42 13(4) 10/07/06 9 YA42 16(2)(n) 10/07/06 10 YA42 16(2)(j) 10/07/06 11 YA42 26 10/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gascoigne Road, 80 DS0000067244.V295179.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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