Inspection on 14/07/08 for Granville Road 75-77

This inspection was carried out on 14th July 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granville Road 75-77 31/07/07

Granville Road 75-77 18/04/06

Granville Road 75-77 03/10/05

Granville Road 75-77 27/04/05

Granville Road 75-77 25/09/04

Granville Road 75-77 29/04/04

Granville Road 75-77 17/11/03

Granville Road 75-77 13/08/03

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Granville Road 75-77 Wood Green London N22 5LP Lead Inspector Susan Shamash Key Unannounced Inspection 14th July 2008 1:00 Granville Road 75-77 DS0000010723.V367745.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 Granville Road 75-77 DS0000010723.V367745.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. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granville Road 75-77 Address Wood Green London N22 5LP Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8888 4189 F/P 020 8888 4189 HAIL (Haringey Association for Independent Living Limited) Anthony Gaynor Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2007 Brief Description of the Service: 75 - 77 Granville Road is a registered care home providing personal care for six younger adults with learning disabilities. Circle 33 Housing Association owns the property and the care and support are provided by Haringey Association for Independent Living (HAIL), an independent sector provider offering a range of accommodation for people with a learning disability in the London Borough of Haringey. The home is a large converted domestic building with three floors. The ground floor comprises the main communal areas and one resident bedroom. The second and third floors contain the remaining resident bedrooms with an additional activity/therapy room recently created on the second floor. There are adequate bath and toilet facilities in close proximity to the residents’ bedrooms. The home is situated in a quiet residential road within easy reach of Wood Green shopping centre and a range of multicultural resources in the vicinity. The stated aim of the home is to provide twenty-four hour support and care for six people with a learning disability to live as independently as possible within the community of Wood Green. Weekly fees as at July 2008 are £1053.44 inclusive although on rare occasions additional charges are made for specialist care negotiated with social services. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection took place over approximately seven hours. I was assisted by an ‘expert by experience’, accompanied by their support worker, for part of the inspection. An expert by experience is a person who, because of their shared experience of using services, and/or ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in or use the service. One resident was present when I arrived at the home, and the others returned home from their day activities during the inspection. Three staff members were available on the early and late shifts, although one staff member went out with a resident to the cinema, on the late shift. Three residents’ files and training records for all staff were inspected. I spoke with one resident and spent time with the others, and spoke to four staff members during the inspection. The expert by experience also spent time with all residents and spoke to two residents and two staff members. A tour of the building was conducted and safety certificates, other health and safety documentation and records relating to the running of the home, were also inspected. What the service does well: The home continues to be well run, with a committed staff team and there are trusting and supportive relationships between staff and people living at the home. The staff team undertake effective work with people living at the home and relatives with support from the senior staff and the home continues to provide a wide range of activities for residents both inside and outside of the home. There is a high level of satisfaction with the food served in the home, and people are encouraged to be as independent as possible taking part in household chores with support from staff as appropriate. Residents are also supported to make their own choices, and their preferences are respected. All people living at the home have person centred care plans (although some are still being developed) and they are reviewed regularly and are consulted about these as far as possible. The staff team are generally well trained and experienced, and offer consistent support to people living at the home. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 6 A massage therapist attends people living at the home according to their choices and staff are creative in arranging a wide range of activities for people living at the home according to their wishes. Residents usually have an annual holiday away from the home. The home is decorated with photographs of residents’ holidays and parties, and the use of pictorial formats to communicate menus and staff members on duty, are very successful. What has improved since the last inspection? What they could do better: People living at the home must have sufficient activities outside of the home at weekends to ensure that their activity preferences are addressed. Clearer records of medicines in stock and the removal of those no longer needed from medication administration records, is needed to ensure that people’s medication needs are met safely. The home’s record of complaints must include action and timescales taken to address each issue raised, to ensure that people’s concerns are taken seriously. The home’s oven and grill, the cabinet door in the dining room area and the television in the lounge must be repaired/replaced for the comfort of people living and working at the home. The sensory room must be kept free from dust, the broken furniture in this room must be renewed, and the hazards of overhanging wires and an overloaded plug socket must be addressed, to ensure the comfort and safety of people living at the home. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 7 An adequate supply of hot water must be available in the home at all times for the comfort of people living and working at the home. Any further failures of the home’s boilers must be notified to the CSCI without delay. Staffing numbers within the home must be reviewed to ensure that sufficient support is available for residents, particularly at weekends. Failure to comply with this requirement may result in enforcement action being taken by the CSCI. Staff communication about staff cover provided for the home must also be improved, to ensure that residents’ activities are not compromised by insufficient staffing. All staff must have current training in food hygiene, first aid and fire safety for the safety of people living at the home, and must be supported appropriately with effective use made of staff meetings, and regular individual supervision sessions at least six times annually, to ensure that they support people living at the home in line with best practice. Higher standards of health and safety and financial record keeping are needed to ensure that people are safeguarded appropriately. Any occurrence affecting the wellbeing of residents (such as problems with the home’s boilers) must be reported to the CSCI without delay. It is recommended that people should be given the choice of having music played for them in the lounge/dining area, particularly when none of them are actively watching the television, to ensure that their preferences are taken into account. It is recommended that additional pictorial symbols should be made available for people living at the home e.g. of seasonal fruits such as strawberries, to aid better communication with people living at the home. It is recommended that the toilets and bathrooms in the home have a clear symbol available to indicate whether they are in use or not, to ensure that people’s privacy is respected as far as possible. It is recommended that staff be encouraged to open windows in the home on hot days to ensure that the home is well ventilated, and that the possibility and practicalities of having a water feature in the garden be considered with the preferences of an identified resident in mind. Please contact the provider for advice of actions taken in response to this inspection. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 9 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 Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. New people are only admitted following detailed assessments, so that the home is able to meet the needs of people living at the home effectively. EVIDENCE: The same six people remain living in the home, and records on the three people’s files inspected showed that their needs had been assessed comprehensively prior to admission. There was also evidence that their needs were being reassessed and reviewed on a regular basis. Inspection of care plans and observation of support provided to people living at the home indicated that their disparate needs continue to be met effectively. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs, choices and aspirations are assessed and monitored to ensure that they can be met effectively. They are supported to take informed risks in order to increase their independence skills. Mechanisms are in place to ensure that people are involved in most aspects of home life and they are encouraged to make choices about the way in which they are supported at the home. EVIDENCE: Inspection of three people’s care plans showed that they included comprehensive information about each person. The monthly summaries for each person are particularly helpful. Information included cultural and linguistic needs and lifestyle choices. A ‘life story’ book has also been commenced or completed for each person alongside person-centred plans and reviews. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 12 Care plans and risk assessments inspected had been reviewed and updated within the last six months. Observation of staff/resident interactions such as encouraging resident involvement in food preparation, setting the table and clearing up, indicated that they are encouraged to be involved in household routines, thus practicing independent living skills. Observation alongside speaking to people living at the home, indicated that they were not forced to engage in activities in which they did not wish to participate, thus ensuring that their choices were respected. A number of written risk assessments were available in each care file, for activities carried both within and outside of the home, and these had been reviewed as appropriate. Minutes of resident meetings indicated that they were encouraged to participate in making decisions about the home, including holiday destinations and food to be available on the menu. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have a wide range of opportunities to take part in age, peer and culturally appropriate activities within and outside of the home, however these are compromised by lack of staffing provided, particularly at weekends. Support is provided in maintaining family contacts and developing independence skills. The home is innovative in supporting people with cultural, religious, educational, vocational and leisure activities and ensuring that their rights and responsibilities are respected. People living at the home are involved in, and satisfied with the provision of food at the home, which consists of a varied and nutritious diet that takes account of cultural preferences. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 14 EVIDENCE: People’s activity charts, care plans and daily notes indicated that a wide range of activities are available to them within and outside of the home. The majority of people living at the home were attending day activities during the early part of the inspection, at various day centres within the local area. One person attends an access to further education course for people with profound and complex learning difficulties at a local college. Each resident had a weekly rota of chosen activities within their care plan, including one day off from the day centre, during which they engaged in activities within the local community with a staff member from the home. A massage therapist also visits the home regularly for people who choose to have individual massages at a reasonable cost. Staff and residents spoken with advised that trips were arranged within the local community to visit restaurants, the pub and local shopping facilities. One person is supported to visit Turkish shops and cafes in accordance with their cultural preferences. Another person is supported to see an Indian film regularly, in accordance with their wishes. Staff and records confirmed that people are also supported to contact and visit their family members regularly. Last year residents had been on holiday to Norfolk over the summer, and photos were available indicating that this had been enjoyed. Staff advised that one resident was to be supported to visit Ireland this year in accordance with their wishes, and individual holidays were also being planned for other people living at the home. Records also indicated frequent opportunities to go out to the pub, cinema, cafés, for meals out, on train rides, swimming and horse riding, and to be involved in cooking, having manicures, and doing puzzles with staff support. One person was observed doing a puzzle with staff support before dinner on the day of the inspection, another went out to the cinema and for a meal out with a staff member on the evening of the inspection. However discussion with staff members and observation of daily records indicated that few activities were undertaken with residents at weekends. Staff felt that this was frequently due to short staffing at weekends, and that this was also a problem during some weekdays. A requirement is made accordingly, alongside a related requirement made under Standard 33. A new Turkish-speaking staff member had been appointed to work at the home, particularly with the Turkish-speaking resident, to ensure that their needs are met effectively. Staff have also supported one person in attending a Hare Krishna or Hindu temple periodically, and arrange for another person to attend church on a weekly basis, in accordance with their wishes. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 15 There was evidence within care plans, and through observation of the evening routines in the home, that people living at the home are encouraged to be involved in the day-to-day tasks of shared home living, including setting the table and clearing up afterwards. The expert by experience noted that staff appeared have good interactions with the residents. They noted, however that staff seemed to be under pressure when one staff member went out to the cinema with a resident, and one was cooking in the kitchen, particularly as one resident in particular required a lot of supervision. One member of staff did try to involve a resident in helping with food preparation. Also, on a food photo card there were the instructions ‘You are supporting a service user to prepare a meal. How will you make sure that you are giving them the choice of what they want, not just what is convenient for you? ‘ This staff member came out and interacted with the other residents, once they had finished with dinner time, and they seemed to understand her well. It is recommended that the possibility of a resident answering the door, with staff help, be considered, to encourage independence and their being involved. The T.V. in the lounge was constantly on during the whole of the inspection. The residents did not appear to be watching it really, and it is recommended that playing music might be more suitable at such times. The sensory room didn’t look as if it was being used. It was not clean, and had broken furniture, lights that did not work, overloaded plug sockets and wires that were not well organised. It did not seem to be a safe place for people to use, with or without staff support. It was noted that one resident was stopped from being near water most of the time, although she clearly enjoyed playing with water, and a recommendation is made accordingly under Standard 24. Menus seen were appropriate and indicated a range of balanced meals. However it is required that records of food served in the home must be maintained up to date. Food was appropriately stored and in date, and the kitchen was clean and tidy. People spoken to and observed during the mealtime, indicated that they enjoyed the food served within the home. A pictorial menu board is used to help people make choices for their evening meal. The home was well stocked with fresh fruit and vegetables and staff were well acquainted with the cultural and dietary preferences of each resident. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 16 It is recommended that additional pictorial symbols should be made available for people living at the home e.g. of seasonal fruits such as strawberries, to aid better communication with people living at the home. The expert by experience was invited to join in the evening meal. They noted that the food was nice, and that at least two of the residents asked indicated that they were happy with the food. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People receive appropriate physical and emotional support in line with their preferences, and are adequately protected by systems in place for administering medicines. EVIDENCE: Care files that I inspected showed regular input from a variety of health professionals. These included psychiatry, psychology, speech and language therapists as well as appointments with GPs, opticians and dentists. I spoke to several staff members and observed the interactions of staff and people living at the home before and after the evening meal in the home. Staff were seen to interact appropriately and sensitively with people, treating them with dignity and encouraging them to be independent where possible, whilst providing support when needed. The expert by experience also noted that staff interacted well with residents. In conversation, staff spoke enthusiastically about their work, and although the two staff remaining in the home that evening were a newly appointed staff member, and a member of the bank staff team, they generally appeared well Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 18 informed about working with people with profound learning disabilities. Staff were also seen to knock and wait for an answer prior to entering people’s rooms, toilets and bathrooms as appropriate. Current medication and MAR charts for people living at the home were inspected and were complete and up to date as appropriate. There were records of medicines received for people living at the home, but these still did not include medicines carried forward (i.e. still in stock within the home from previous months). There were also a large number of medicines that were no longer prescribed for residents, but remained printed on the medication administration records. At a previous inspection the manager had advised that this was due to communication issues with the local pharmacy. It is required that these be removed in consultation with people’s GPs and the pharmacist to avoid potential confusion, which might impact on people’s medication needs being met safely. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s views are acted upon, but inadequate records mean that people cannot be sure that their complaints will be addressed appropriately within set timescales. People are protected from abuse and self-harm, as appropriate, with staff very aware of the need to monitor changes in the behaviour of people who are nonverbal, and thus particularly vulnerable. EVIDENCE: The home has a satisfactory complaints policy and an appropriate format is available for recording complaints. However a complaint by a relative recorded in March 2008 did not include details of actions taken to address the issues raised, or timescales by which the complaint was investigated and feedback provided to the complainant. A requirement is made accordingly. Care plans and resident meeting minutes indicated that residents’ views are listened to. Discussion with staff members and observation of procedures within the home, indicated that staff are familiar with the adult protection policy for the home and that records are maintained as required. Staff files confirmed that they had undertaken training in the Protection of Vulnerable Adults. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment in which people live is generally adequately decorated, safe and clean. Bedrooms reflect residents’ individuality and choices as appropriate. However a number of issues need to be addressed to ensure the comfort of people living and working at the home. EVIDENCE: All residents’ rooms were inspected and found to be personalised as appropriate. The Annual Quality Assurance Assessment for the home indicated that a new fitted kitchen, new bath, carpeting, flooring and decoration of the communal and external areas had been undertaken within the last year. Three service users beds had also been replaced in addition to the sofa in the dining room, and the identified residents’ rooms had been repainted. Staff indicated that there had been repeated problems with regard to the availability of hot water in the home, but that this had recently been addressed. I was concerned to learn that the home had been without hot Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 21 water in several areas for several days, and that this had not been notified to the CSCI although it clearly impacted on the wellbeing of people living at the home. Requirements are made accordingly. The rear garden was in a reasonable condition. Staff advised that people with learning difficulties who work for an employment development group set up by the provider organisation continue to tend to the garden. Staff told me that one side of the home’s oven, and the grill, are not working and that the television ‘on’ button is also not working (requiring some difficulty and use of a pen to switch it on at present). These must be repaired/replaced and the broken cabinet door in the dining room area must be replaced. The sensory room was dusty and the majority of furniture inside was broken or appeared to be unsafe. The expert by experience also noted the hazards of overhanging wires and an overloaded plug socket, which must be addressed, to ensure the comfort and safety of people living at the home. They also noted that the home felt quite hot and stuffy on the day of the inspection, with no windows open. It is therefore recommended that staff be encouraged to open windows in the home on hot days to ensure that the home is well ventilated. It is recommended that the toilets and bathrooms in the home have a clear symbol available to indicate whether they are in use or not, to ensure that people’s privacy is respected as far as possible. It was also suggested that the possibility and practicalities of having a water feature in the garden be considered with the preferences of an identified resident in mind. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are protected by a robust recruitment procedure, and are supported by staff who are experienced and receive appropriate training to meet their needs. However insufficient staffing numbers and the need for more regular support and supervision places people at risk of not receiving care and support in line with best practice at all times. EVIDENCE: As noted in the Annual Quality Assurance Assessment for the home, three new support workers had been appointed for the home. One new member of staff is Turkish speaking so that they are able to support one resident who is from a Turkish background, and speaks very little English. It was not possible to inspect staff files on this occasion as no members of the management team were present. However at previous inspection staff files were found to include all information specified under the care homes regulations such as satisfactory enhanced CRB disclosures, two written references, application forms, proof of identity etc. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 23 Observation of the staff rota and feedback from four staff members in the home indicated that there have been some recent problems with staffing, particularly on weekends. Staff experienced this as a particular problem on early shifts, as two residents required one to one supervision, and felt that there were safety concerns at such times. The staff rota showed that a large number of bank staff members continue to work at the home on a regular basis. On the day of this inspection, only two staff members were recorded on the rota to work the evening shift. Staff therefore phoned to try and arrange for bank cover, unsuccessfully, only to find out later (after a considerable amount of time and effort) that another bank staff member was already booked to work on this shift. It was my overall impression that the home benefits from a committed staff team, however poor channels of communication, and insufficient staff on the rota, are impacting on the quality of lives of people living at the home. Thus weekend shifts noted on the rota with only two staff members on the early or late shifts are related to the lack of activities outside of the home arranged for people living at the home on weekends. A letter regarding this issue of serious concern about the home will also be sent to the service. Failure to comply with this requirement may result in enforcement action being taken by the CSCI. Staff communication about staff cover provided for the home must also be improved, to ensure that residents’ activities are not compromised by insufficient staffing. There were trusting and supportive relationships evident between staff and people living at the home. However staff fed back that they did not always receive as much support as they would like from management. Staff advised that although one to one supervision sessions were arranged, there had been gaps in this area since the manager had been suspended from working in the home for several weeks. At one point during the evening a service user was sitting on a staff member’s lap, whilst being given a massage. Guidelines should be put in place for addressing this issue when working with this person, for their protection and the protection of staff members working at the home. The expert by experience noted that staff seemed to have a good interaction with the residents, however they seemed under pressure, as one resident in particular required a lot of supervision and the other staff member was busy making the dinner. Another staff member was out with a resident at the cinema, at this time. A staff member was able to explain how they communicated with a particular non-verbal resident. This member of staff was new and had not yet had the Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 24 chance to do any Person Centred Planning training. Although they advised that they were looking forward to doing this course. Training certificates available within each staff member’s file indicated that staff had undertaken a wide range of relevant training courses including mandatory food hygiene, first aid, manual handling, adult protection, health and safety, and fire safety training. They has also undertaken training in other relevant areas such as autism awareness, communication, medication administration, risk assessment and abuse prevention for people with learning difficulties. However for the majority of staff members, training in food hygiene, first aid and fire safety was out of date and needed to be updated for the safety of people living at the home. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to be well organised, and the service is generally run in the best interests of residents. Monitoring systems are in place to safeguard people living at the home and their views are taken into account. However residents are not sufficiently protected from financial abuse. The health and safety of people living and working at the home is generally promoted and protected effectively, however there are some hazards that place residents at risk of harm. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 26 EVIDENCE: The homes’ registered manager was not working in the home at the time of the inspection following their suspension without prejudice, several weeks prior to the inspection. Following the inspection, the CSCI was notified that the manager was due to return to work. Feedback from staff members indicated that there were some issues of contention within the staff team. Several staff felt that they did not receive enough support from the management. Records indicated that there are regular staff meetings and resident meetings held at the home, however staff members did not feel that their opinions were always taken into account. Staff advised that the responsible individual for the provider organisation (the area manager) was visiting the home regularly and carrying out some unannounced inspections of the home, although insufficient records were available for these visits to meet the national minimum standard of monthly visits. A completed Annual Quality Assurance Assessment was provided for the home as appropriate. Monies maintained for safekeeping on behalf of residents within the office, were stored appropriately. Records for three residents were inspected and found to match the amounts stored for them in each case. However I was concerned to find the financial records for monies kept on behalf of one resident indicated that £50 was unaccounted for. This was confirmed by staff members spoken to. Discussion with the area manager indicated that this was being investigated by the deputy manager. The results of this investigation must be sent to the CSCI and this must be followed up as a Safeguarding Adults referral if necessary. Satisfactory records of incidents and accidents occurring at the home are maintained. However I was concerned that not all significant events affecting the wellbeing of residents were being notified to the CSCI e.g. the incidences of lack of hot water, and the failure of the heating system in parts of the home. Significant gaps were found in the records of food served in the home and fridge/freezer temperatures. Maintenance records and safety certificates were inspected and generally found to be appropriate. A current electrical installation certificate was available for the home. Current and satisfactory gas safety, portable appliances, legionella and fire equipment servicing certificates were in place. Weekly fire alarm testing was carried out as appropriate, however records of fire drills did not specify the time at which these were held (which should ideally be varied). Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 27 Records of the hot water temperature in the home’s bathrooms indicated that an unsafely high water temperature of up to 47°C was being provided in baths and showers. Action must be taken to address this without delay, and staff must be trained to take appropriate action whenever the temperature of hot water from outlets other than the kitchen sink exceeds 43°C. Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 2 2 X Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA14 Regulation 16(2mn) Requirement Timescale for action 22/08/08 2. YA20 13(2) 3. YA22 22 4. YA24 23(2c) The registered persons must ensure that people living at the home have sufficient activities outside of the home at weekends to ensure that their activity preferences are addressed. 22/08/08 The registered persons must ensure that clear records are maintained of medicines carried forward from the last month and that medicines no longer needed are discontinued on medication administration records following consultation with people’s GPs, to ensure that people’s medication needs are met safely. The registered persons must 29/08/08 ensure that the home’s record of complaints includes action and timescales taken to address each issue raised, to ensure that people’s concerns are taken seriously. The registered persons must 26/09/08 ensure that: the home’s oven and grill is repaired, Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 30 The cabinet door in the dining room area is repaired, and The television in the lounge is repaired, for the comfort of people living and working at the home. The registered persons must 05/09/08 ensure that the sensory room is kept free from dust, that the broken furniture in this room is renewed, and that the hazards of overhanging wires and an overloaded plug socket are addressed, to ensure the comfort and safety of people living at the home. The registered persons must 23/08/08 ensure that there is an adequate supply of hot water in the home at all times for the comfort of people living and working at the home. Any further failures of the home’s boilers must be notified to the CSCI without delay. The registered persons must 16/08/08 ensure that staffing numbers within the home are reviewed to ensure that sufficient support is available for residents at all times, particularly at weekends. (Previous timescale of 22/02/08 not met). Failure to comply with this requirement may result in enforcement action being taken by the CSCI. Staff communication about staff cover provided for the home must also be improved, to ensure that residents’ activities are not compromised by insufficient staffing. The registered persons must 10/10/08 DS0000010723.V367745.R01.S.doc Version 5.2 Page 31 5. YA24 13(4) 23(2cd) 6. YA30 23(2j) 7. YA33 18(1a) 8. YA35 18(1ci) Granville Road 75-77 13(4) 23(4d5) 9. YA36 18(2) ensure that all staff have current training in food hygiene, first aid and fire safety for the safety of people living at the home. The registered persons must 12/09/08 ensure that staff working at the home are supported appropriately with effective use made of staff meetings, and regular individual supervision sessions at least six times annually. (Previous timescales of 21/09/07 and 22/03/08 partly met), and Appropriate guidelines should also be in place regarding how staff should react in the event of a service user sitting on their lap to ensure that they support people living at the home in line with best practice. The registered persons must ensure that there are no gaps in records of food served and fridge/freezer temperatures, The time at which fire drills are undertaken must be recorded, and 10. YA41 16(2j) 23(4e) 29/08/08 11. YA41 Any occurrence affecting the wellbeing of residents (such as problems with the home’s boilers) are reported to the CSCI without delay, to ensure that people’s needs are met safely and that they are protected as far as possible in all events. 17(2) Sched The registered persons must 4(9) ensure that effective systems are in place to ensure that there are no discrepancies in the records of monies kept on behalf of people living at the home. The CSCI must be DS0000010723.V367745.R01.S.doc 29/08/08 Granville Road 75-77 Version 5.2 Page 32 12. YA42 13(4) notified of actions taken to address the shortfall in an identified person’s monies, noted at the time of the inspection. The registered persons must ensure that appropriate action is taken to ensure that hot water temperature in the home’s bathrooms does not exceed 43°C. 22/08/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA12 Good Practice Recommendations It is recommended that people should be given the choice of having music played for them in the lounge/dining area, particularly when none of them are actively watching the television, to ensure that their preferences are taken into account. It is recommended that the possibility of a resident answering the door with support from staff be considered to encourage independence and being involved in daily routines. It is recommended that additional pictorial symbols should be made available for people living at the home e.g. of seasonal fruits such as strawberries, to aid better communication with people living at the home. It is recommended that the toilets and bathrooms in the home have a clear symbol available to indicate whether they are in use or not, to ensure that people’s privacy is respected as far as possible. It is recommended that staff be encouraged to open windows in the home on hot days to ensure that the home is well ventilated. It is recommended that the possibility and practicalities of having a water feature in the garden be considered with the preferences of an identified resident in mind. 2. YA16 3. YA17 4. YA24 5. 6. YA24 YA24 Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Granville Road 75-77 DS0000010723.V367745.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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