Inspection on 31/07/07 for Granville Road 75-77

This inspection was carried out on 31st July 2007.

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 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 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granville Road 75-77 14/07/08

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 08/07/2008.

CARE HOME ADULTS 18-65 Granville Road 75-77 Wood Green London N22 5LP Lead Inspector Susan Shamash Key Unannounced Inspection 31st July 2007 12:30 Granville Road 75-77 DS0000010723.V341766.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.V341766.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.V341766.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) ** Post Vacant *** Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2006 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 2007 are £1053.44 inclusive although on rare occasions additional charges are made for specialist care negotiated with social services. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately six and a half hours. I was assisted throughout by the manager and deputy manager for the home, and received assistance from other staff members working in the home. I had the opportunity to speak with three other staff members and one person living at the home. I spent some individual time with five other (less verbal) people living at the home and observed their interactions with members of the staff team before and after the evening meal. A tour of the premises took place and care records, staff records and other records relating to the running of the home were inspected. What the service does well: The home continues to be well run, with a committed staff team and good channels of communication. 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 well trained and experienced, and offer consistent support to people living at the home. A therapy room is available in a spare room on the top floor of the building, including vivid murals painted by staff and a wide range of multi-sensory equipment. The room is warm and inviting, and is used and enjoyed by residents frequently. 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. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Limitations on people’s freedom (that are deemed necessary) such as the right to have running water in their bedroom, must be recorded, with agreement from the person (if possible) and other advocates on their behalf to ensure that their rights are protected. Records of food served in the home must be maintained up to date. Clearer records should be maintained of all healthcare appointments attended and of medicines received for people living at the home to ensure that they are protected from harm. A number of identified repairs and maintenance issues must be undertaken for the home to ensure the comfort and safety of people living there. Certificates must be available in each staff member’s file to evidence training undertaken and the frequency of individual supervision sessions provided to staff members must be increased to ensure that they are adequately trained and supervised to meet people’s needs effectively. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 7 A quality assurance audit must be undertaken at least annually and the responsible individual must carry out monthly, unannounced inspections of the home. More frequent fire drills must be held at the home and water temperature checks mut be recorded for people’s rooms to ensure their safety. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 8 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.V341766.R01.S.doc Version 5.2 Page 9 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, and thus the home is able to meet the needs of people living at the home effectively. EVIDENCE: There had been no changes to the people living in the home since the previous inspection. Records maintained within people’s files showed that their needs had been assessed comprehensively prior to admission. There was also evidence that their needs were being reassessed 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.V341766.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 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 sufficiently 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 all aspects of home life and they are encouraged to make choices about the way in which they are supported at the home. EVIDENCE: Satisfactory individual care plans are in place for people. A ‘life story’ book is being completed for each person alongside person-centred plans and reviews. As required all care plans had been reviewed and updated within the last six months. Inspection of three people’s care plans showed that they included comprehensive information about each person. The monthly summaries for Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 11 each person are particularly helpful. Information included cultural and linguistic needs and lifestyle choices. It is recommended that all records residential domestic skills assessments be dated to ensure that information recorded is current. A number of written risk assessments were available for all people living at the home and these had been reviewed within the last six months as appropriate. However agreements were not available for all people for whom preventative action was being taken to minimise risks (e.g. when water has been turned off in individual people’s rooms due to repeated flooding incidents). A requirement is restated accordingly under Standard 16. 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. Observation of staff/resident interactions such as encouraging resident involvement in setting the table for a meal, also indicated that they are encouraged to be involved in household routines, thus practicing independent living skills. People spoken to 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. Granville Road 75-77 DS0000010723.V341766.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience excellent 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, and support is provided in maintaining family contacts and developing independence skills. The home is creative and 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 appear to be 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.V341766.R01.S.doc Version 5.2 Page 13 EVIDENCE: People’s activity charts, care plans and daily notes indicated that a wide range of activities are available to them both within and outside of the home. Various games and jigsaw puzzles are available in the home, in addition to a therapy room, equipped with a wide selection of multi-sensory equipment. Five of the six people living at the home were attending day activities during the early part of the inspection, at various day centres within the local area. Activities at these centres included music, drama, arts and crafts and swimming. One person attended 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. The manager advised that one person now attends a sewing group which was set up by the provider organisation’s employment coordinator, and two others have been supported to go horse riding regularly, although one is still growing accustomed to being around horses. One staff member had previously arranged for and supported a person living at the home, who expressed an interest in becoming a nurse, to have a day’s work experience in a residential care home for older people, which had been a huge success. Previously there had been at least one Turkish-speaking staff member working at the home and key-working the Turkish-speaking resident, to ensure that their needs are met, however they had since left employment at the home. The manager advised that staff have learned rudimentary words in Turkish and this was confirmed by staff spoken to, there was also a list of useful Turkish words within this person’s care file. Staff have also supported one person in attending a Hare Krishna temple and a Hindu temple periodically, and arrange for another person to attend church on a weekly basis, according to their wishes. The home is commended for its commitment to meeting people’s cultural needs. On the day of the inspection one person had spent a day with their key worker (away from the day centre) shopping and going out for lunch. Another went for a walk with a staff member after dinner. A massage therapist also visits the home regularly and attends people who wish at a reasonable cost. 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. Although people living at the home had not been able to go on holiday in 2006, they usually enjoy an annual holiday away from the home. This year they had Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 14 been to Norfolk for a week in July and photos were available indicating that a good time was had by all. Staff and people 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. Discussion with them and the manager as well as examination of activities and daily records within the home indicated that the manager had been proactive in increasing the number of activities available to people living at the home, making extra staff available on duty in the home, when necessary. Records also indicated that residents had frequent opportunities to go out to the pub, cinema, a disco club, cafés, for meals out, on train rides, and to be involved in cooking, have manicures, do puzzles etc. with staff support. Two people were observed doing puzzles with staff support after dinner on the day of the inspection. One person is supported to see an Indian film regularly, in accordance with their wishes. Records indicated that people were also supported to contact and visit their family members. Records of residents’ meetings indicated that people living at the home are consulted about activities and food provision as appropriate. However activities records for two identified people living at the home did not reflect as wide a range of activities offered or engaged in as their counterparts. Discussion with staff and observation of routines, indicates that this may partly be due to activities not always being recorded. It is recommended that staff ensure that all activities offered or undertaken by identified people living at the home should be recorded. It was required at the previous inspection that limitations on people’s freedom, where deemed necessary (e.g. their right to have running water in their bedroom) must be recorded including agreement of the person (if possible or next of kin), their social worker and the home manager and should be reviewed periodically. However this had not yet been undertaken and this remains required. 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. Staff spoken to were very aware of residents’ individual preferences and cultural requirements regarding diet. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 15 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.V341766.R01.S.doc Version 5.2 Page 16 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: People’s files 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. However it is recommended that clearer records be maintained of all healthcare appointments attended by people living at the home, as these were hard to trace, to ensure that people see healthcare professionals regularly. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 17 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. In conversation, staff spoke enthusiastically about their work, and were well informed and skilled in 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. As noted at the previous inspection, all staff administering medication within the home had undertaken appropriate training in August 2004. However records of medicines received for people living at the home were not up to date, and this is required. Medicines no longer needed should also be discontinued on medication administration records following consultation with people’s GPs to avoid confusion. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 18 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, and appropriate complaint recording procedures ensure that complaints are 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 including actions taken, those involved, timescales by which the complaint was investigated and feedback provided to the complainant. 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.V341766.R01.S.doc Version 5.2 Page 19 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 maximise the comfort of people living and working at the home. A therapy room including multisensory equipment is available to meet people’s needs and the home is commended for this provision. EVIDENCE: People live in an environment that appears to meet their needs with personalised rooms and sufficient toilets and bathrooms. All residents’ rooms were inspected and found to be personalised and decorated appropriately. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 20 As required at the previous inspection, a larger table had been provided in an identified person’s bedroom, for their use in accordance with actions agreed at their previous review meeting. The décor of the bathrooms on the first and ground floor following refurbishment, including stencilled designs on the walls, remains pleasant and bright. The damage sustained to this wall of the ground floor bathroom, had been repaired as appropriate and the wall had been reinforced as recommended. Staff indicated that there had been intermittent problems with regard to the availability of hot water in the home, but that this had been addressed. Inspection of hot water temperature and temperature records indicated that there was no longer a problem with the home’s supply of hot water. The rear garden was in a reasonable condition, however a requirement is made that the lawn must be mowed regularly. The manager advised that people with learning difficulties who work for an employment development group set up by the provider organisation now tend to the garden. Staff advised that people living at the home continue to make use of the therapy room on the top floor of the building, including vivid murals painted by staff and a range of multi-sensory equipment. The room is warm and inviting, and included more soft furnishings, making it more comfortable for use. As required the banisters on the stairwells in the home had been repainted and accumulated rubbish in the rear garden had been disposed of. The rear garden fence and lock on the gate had also been repaired, further protecting people’s security within the home. An identified person’s bedroom needs to be repainted, a number of chairs in people’s rooms should be cleaned thoroughly and the wardrobes in two identified people’s rooms must be repaired. Mew lino flooring must be provided in the toilet by the staff room and the lino flooring next to the ground floor bathroom must be repaired for the comfort and safety of people living at the home. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 21 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 staff need more regular supervision to ensure that people receive care and support in line with best practice at all times. EVIDENCE: Four staff files were inspected and included information specified under the care homes regulations such as satisfactory enhanced CRB disclosures, two written references, application forms, proof of identity etc. Inspection of staff files and discussion with three staff members indicated that people are supported by an effective and competent staff team, who have attended a wide range of training courses. Observation of the staff rota and discussion with staff also indicated that there is sufficient flexibility in staffing numbers to enable people living at the service to engage in a range of activities both inside and outside of the home. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 22 The staff rota showed that a number of bank and agency staff members work at the home on a regular basis. The manager advised, and staff confirmed that all new staff receive induction training prior to working at the home. Induction records were available for inspection. The names of staff covering shifts were indicated by initials, with the full names recorded at the base of the rota. However not all of the initials included were accompanied by the name of relevant staff members in full. It is therefore recommended that the staff rota be updated to include the names of all bank/agency staff used at the home. At the previous inspection it was required that the number of staff members scheduled to work in the home be reviewed, with particular consideration given to people’ needs for attending community activities. Feedback to the inspector in the action plan from this inspection indicated that at least three staff members are provided in the mornings and two in the afternoons and evenings. It was my overall impression that the home benefits from a committed staff team and good channels of communication. There were trusting and supportive relationships evident between staff and people living at the home. Although there had been a certain level of disruption caused by changes in the home’s management, prior to the new manager commencing work at the home, staff expressed confidence in the new management team’s ability to run the home effectively. Records of one to one supervision indicated that whilst staff are receiving some supervision, it is not scheduled with sufficient frequency to meet the national minimum standard of six times annually. Training certificates available within each staff member’s file indicated that staff had undertaken a large number 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 training certificates were not available in the files of two staff members working at the home, and were sent to the CSCI from the organisation’s head office following the inspection. It is required that up to date certificates must be maintained on each staff file to evidence training undertaken. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 23 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 good 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 people living at the home. Monitoring systems are in place to safeguard people living at the home and their views are taken into account. However this is compromised by insufficient quality assurance systems. The health and safety of people living and working at the home is generally promoted and protected effectively. EVIDENCE: The new manager who had commenced work at the home prior to the previous inspection, remains in place at the home. He has submitted an application for Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 24 a CRB disclosure through the CSCI in order to apply to be the registered manager for the home. Feedback from a number of different staff members spoken to individually, indicated that they felt well supported and confident about the leadership of the new manager and deputy manager. Records indicated that there are regular staff meetings and resident meetings held at the home. This was confirmed by staff and residents spoken to. The responsible individual for the provider organisation (the area manager) was carrying out some unannounced inspections of the home, however these were insufficiently frequent to meet the national minimum standard of monthly visits. This is required and reports of these visits must be sent to the home and the local CSCI area office. I also had the opportunity to meet with the area manager for the home, who advised that a quality assurance audit was due to be undertaken for the home in September, and saw the format that was to be used for this exercise. This is long overdue, as no quality assurance audit was undertaken for the home last year, although this was required at the previous inspection. The manager agreed to send the main findings of the audit to the CSCI once complete, alongside an action plan as to how remaining issues would be addressed. 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. Discussion with the manager and area manager indicated that the organisation has gone to some trouble to ensure that staff members do not act as appointees for people living at the home. This has resulted in several people living at the home being unable to access their finances whilst the situation is being sorted out with their social workers. Instead the provider organisation has been loaning money so that people’s daily activities and holidays are not disrupted. Satisfactory records of incidents and accidents occurring at the home are maintained, with significant events notified to the CSCI including an outbreak of bedbugs since the previous inspection. Maintenance records and safety certificates were inspected and generally found to be appropriate. As required 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 there need to be more frequent fire drills held at the home. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 25 As required emergency lighting in the home was being tested at least monthly and self-closing doors were being tested weekly (during the weekly fire alarm tests). All hazardous chemicals were locked away when not in use, hot water temperatures from various outlets in the home and fridge and freezer temperatures were being recorded and monitored as appropriate. It is required that people’s rooms be recorded on the water temperature charts recorded for the home to ensure water is delivered at a safe temperature, and that action being taken on a regular basis to prevent Legionellosis within the home should be recorded. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 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 4 13 4 14 4 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 3 2 X Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 27 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 YA16 Regulation 14(1a2a) Requirement The registered person must ensure that where limitations on a people’s freedom are deemed necessary (e.g. their right to have running water in their bedroom), the recorded agreement of the person (if possible), next of kin, social worker and the home manager, should be obtained. (Previous timescales of 24/06/05, 25/11/05,16/06/06 and 09/02/07 partially met). The registered person must ensure that records of food served in the home are maintained up to date. The registered person must ensure that a record is maintained of all medicines received for people living at the home. Medicines no longer needed should be discontinued on medication administration records following consultation with people’s GPs to avoid confusion. The registered person must DS0000010723.V341766.R01.S.doc Timescale for action 21/09/07 2. YA17 17(2) Sched 4(13) 13(2) 31/08/07 3. YA20 24/08/07 4. YA24 23(2bd) 21/09/07 Page 28 Granville Road 75-77 Version 5.2 ensure that: - the identified person’s bedroom is repainted, - new lino flooring is provided in the toilet by the staff room, - the lino flooring next to the ground floor bathroom is repaired, - the wardrobes in two identified people’s rooms are repaired - a number of identified chairs in people’s rooms are cleaned thoroughly, - and the lawn in the back garden is cut regularly. The registered person must ensure that certificates are available within each staff member’s file to evidence training undertaken by each staff member. (Previous timescale of 23/02/07 not met). The registered person must ensure that the frequency of individual supervision sessions provided to staff members is increased to at least six times annually. The registered person must ensure that a quality assurance audit is undertaken at least annually. A summary of the findings of this audit must be sent to the local CSCI area office. (Previous timescales of 30/06/06 and 09/03/07 not met). The registered person must ensure that the responsible individual carries out monthly, unannounced inspections of the home, with reports of these DS0000010723.V341766.R01.S.doc 5. YA35 19 Schd 2(4) 07/09/07 6. YA36 18(2) 21/09/07 7. YA39 24 01/10/07 8. YA39 26 07/09/07 Granville Road 75-77 Version 5.2 Page 29 9. YA42 13(4) 23(4e) visits sent to the home and the local CSCI area office. (Previous timescale of 09/02/07 not met). The registered person must ensure that fire drills are held at the home with greater frequency, include people’s rooms on the water temperature charts recorded for the home to ensure water is delivered at a safe temperature, and record action taken on a regular basis to prevent Legionellosis within the home. 31/08/07 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. 2. 3. 4. 5. Refer to Standard YA7 YA14 YA19 YA24 YA33 Good Practice Recommendations It is recommended that all records of residential domestic skills assessments be dated to ensure that information recorded in current. It is recommended that staff ensure that all activities offered or undertaken by identified people living at the home should be recorded. It is recommended that a clearer system be put in place for recording healthcare appointments attended by people living at the home. It is recommended that a new piece of furniture be provided in the home to replace the swinging double seat, which is no longer operational. It is recommended that the staff rota be updated to include the names of all bank/agency staff. Granville Road 75-77 DS0000010723.V341766.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH 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.V341766.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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