Inspection on 24/04/06 for Greenfield Road 9

This inspection was carried out on 24th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 20 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenfield Road 9 05/06/08

Greenfield Road 9 11/05/07

Greenfield Road 9 31/10/05

Greenfield Road 9 25/04/05

Greenfield Road 9 25/10/04

Greenfield Road 9 14/07/04

Greenfield Road 9 04/03/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Greenfield Road 9 London N15 5EP Lead Inspector Karen Malcolm Unannounced Inspection 24th April 2006 09:35 Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greenfield Road 9 Address London N15 5EP 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 8809 7044 020 8809 7044 Companion in Care Limited Mr John Ajumobi Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 3 people of either gender who have a mental disorder (MD) or who have a learning disability (LD) Date of last inspection 31st October 2005 Brief Description of the Service: Greenfield Road is registered as a care home for a maximum of three adults between the ages of 18 and 65 who may have mental health problems or learning difficulties. The home’s registered provider has been changed in October 2003 to Companion in Care Ltd. The company owns two other homes in Brent and Newham. The home consists of a large three-storey town house situated in South Tottenham in the borough of Haringey. There are good public transport links to the area and a good variety of shops and other amenities are close by. On the ground floor, there is a kitchen/ lounge/diner, a toilet and bathroom, with access through the lounge to the garden and a laundry area. Two bedrooms and an office are situated on the first floor. A toilet and bathroom and two more bedrooms are located on the second floor. None of the bedrooms are en-suite. There is a small garden at the front of the property and a large paved garden at the rear. The home is not suitable for people with mobility problems. The stated aims of the home are to provide care, support and attention to service users to enable them to lead as normal a life as possible. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges are from: - £500 to £550 per week. There are no other additional charges. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven hours. On duty was one support worker that assisted the inspector through a part of the inspection process. The assistant manager of the organisation arrived later and assisted the inspector through the later part of the inspection. Both parts of the inspection were very positive and open. The registered manager/provider was unavailable at the time of this inspection due to a family crisis. Presently the home is fully occupied. The service users who live at the home are three men with mental health problems and have lived at the home for a number of years. One of the service users recently turned 65 years of age and stated to the inspector that he celebrated this in style. The inspector spoke to two of the three service users individually and the feedback given was positive and informative. The inspection process involved the inspector speaking to two service users and two members of staff, a tour of the building, sampling three service users care plans, observing staff with service users in day to day running of the home and examining policies and procedures. The inspector would like to thank the assistant manager, support worker and service users for their time, patience and co-operation during the inspection process, which was positive and open. What the service does well: What has improved since the last inspection? At the previous inspection fourteen areas of improvement were made. It was evident at this inspection that eight areas of improvement had been addressed. These are: • Complaints on file are now appropriately recorded and actioned by the manager • The specific service user’s care needs has been addressed appropriately by the home • The rota indicates clearly that care staff now have appropriate breaks between shifts Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 6 • • • • • Records of hot water temperatures are maintained Records of completed service users questionnaires are on file A copy of the home’s environmental and fire risk assessments were in place The specific service user who constantly refused to take their medication now takes their medication regularly and this is reviewed with the GP On each shift there is a qualified first aider What they could do better: This inspection has identified twenty areas of improvement and seven recommendations. Three of which have been restated from the previous inspection report. While it’s evident that the staff are experienced and competent, the home has failed to ensure that service users needs are consistently reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The summary of findings is that the registered person is to ensure that the shower unit in the bathroom is replaced or repaired. The Statement of Purpose is to be amended to include all the communal room sizes. It is noted that this requirement has been restated in four inspections and therefore it is concerning to note the continued non-compliance. An application is to be submitted to the Commission with regards to varying the home’s Conditions of Registration to support the specific service user who has recently turned 65. Care plans and risk assessments are to be reviewed and reflect individuals’ goals and aspirations. Healthcare guidance notes for one specific service user is to be in place around the user’s support needs, and the medication policy is to be amended to add a section on ‘Control Drugs procedures’. The current staffing levels is to be reviewed and the action taken is to be documented and submitted to the Commission and the feedback from the Quality Assurance questionnaires received is to be completed along with the home’s annual or business report. Fire doors are to be kept shut at all times as this is a serious concern and the Department of Environmental Health is to be contacted with regards to cockroach in the kitchen and to seek advice their regarding the home not having in place separate hand washing facilities in the kitchen. Care staff are to undertake training in mental health, fire and manual handling. The manager is to ensure that current Health and Safety certificates are to be renewed within the specified timescale indicated on each certificate. The manager is also to ensure that his working week covers a full time role. Regulation 26 visits are to be undertaken at least once a month and the bathroom and communal areas are in need of redecorating. The recommendations addressed in the table at the back of this report are deemed good practice. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 7 Any unmet requirements impact upon the welfare and safety of service users. Failure to comply by the revised timescale will lead to the Commission for Social Care Inspection considering enforcement action to secure compliance. 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. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. The home has a statement of purpose however, prospective service users are not able to access the correct information needed to make a clear judgement on the types of rooms provided by the home. Therefore service users are not able to make an appropriate judgment on the suitability of the home for their individual needs. The manager has not ensured that service user needs are being fully met when any changes occur, therefore placing them at risk. Individual service users’ signed contracts do not reflect the correct services offered by the home. Therefore service users cannot be sure that they are receiving the appropriate care that was offered to them at the start of their placement. EVIDENCE: At the past four inspections, it was required that the registered person amends the home’s Statement of Purpose to reflect all the room sizes in the home. The document did contain a list the bedrooms in home, however the communal areas such as the lounge, kitchen, laundry area, bathroom and the downstairs toilet are not included. It was advised that the Statement of Purpose is amended to include these areas as stated in Regulation 4(1)(c) Schedule 1.16. The assistant manager for the organisation stated that the registered Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 10 provider/manager was not clear on what was being requested since the bedroom sizes were listed. It was advised by the inspector that if the registered provider/manager was unclear on what was being requested, have contact should be made with the Commission to seek clarification on the matter. Also this requirement has been restated at least four times in previous reports. No action plan regarding the requirements made in the last inspection report was submitted to the Commission to address this matter of clarity. One of the service users who have lived at the home for a number of years has recently turned 65 years of age. At previous inspections it was recommended by the inspector that the registered person submit an application for variation to the Commission with regards to continuing the care and support, of this specific service user. However, no application was received. Therefore, the registered provider/manager is now in breach of their Conditions of Registration. It is therefore, required that an application to vary the home’s Condition of Registration is submitted to Commission. This is to include a letter from the placing authority, a copy of the specific service user’s care plan with risk assessments and a copy of the home’s Statement of Purpose reflecting the current changes. It was also recommended by the inspector that the assistant manager should ensure that the Statement of Purpose and Service User’s guide are both user friendly and are produced as a selling tool for the home. Areas such as service users care and what the home provides on a short term and long-term basis should be reflected in both documents. A number of contracts relating to an individual’s care were on file. However, one contract, which was discussed with the assistant manager, relates to the home not providing personal care under the Domiciliary Care Agencies Regulation 2001 is to be either removed or amended. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. While care plans are in place these are not consistently monitored or reviewed. Therefore the information recorded is likely to be inadequate and may not reflect the current care or support needs of the individual living at the home. Therefore service users may not be receiving appropriate care. Service users can be confident that information about them is handled appropriately. EVIDENCE: All service users have a care plan in place. Two care plans were examined. At this inspection a thorough inspection of care plans were undertaken. The findings were that the information recorded were either old, or did not reflect individual service users’ current day-to-day goals or aspirations. The goals addressed in individual care plans, had been the same since the beginning of the placement. They had been constantly kept under review, in line with the Regulation 15(2)(b). However the goals set to improve the individual’s way of life had not changed or evolved since the Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 12 start of their placement. It is the view of the inspector that service users have not developed. In discussion with the one of the support workers and the assistant manager, it was evident that some goals, had clearly been met and other goals were never going to be met due to the specific service users lack of interest. For example, ‘ managing money effectively’, which is has remained for one individual as a long-term goal. But it was clearly evident that the individual had achieved this goal, as there were clear guidelines in place. It was also evident that service users sign and date their care plan. However, it wasn’t clear as to whether the individuals’ understood and were consulted with regards to making proper informed choice around their care and support needs. It was discussed that all service users care plans must be reviewed with the specific service user. It was suggested that ‘Person-Centred planning’ for preparing and setting up care plans with individuals is another way forward with regards to an individuals’ care. Ensuring that individuals’ obtain and make proper informed choices around what they want and how they are to obtain this. At the last inspection it was required that the registered person ensures that a specific service user who smokes in their bedroom is consulted, with regards to their risk assessment in place. At this inspection it was evident that the risk assessment had been updated, as a new date was recorded 17/02/06. But as stated above, it was not clear whether the specific service user had been consulted properly with regards to the overall dangers of smoking in their bedroom, with regards to the risk and the impact on other service users, staff and the home. The section relating to ‘action to be taken to achieve change’ was not completed, to indicate whether the risk is/are low, medium or high. It was also evident during the tour of the building that all service users smoke in their bedrooms as ashtrays were found. The support worker and the assistant manager stated that this is a constant battle with service users. It was advised by the inspector that the registered person must try different approaches with regards to highlighting the dangers of smoking in their bedrooms. It is advised that service users could undertake fire awareness training with care staff to reinforce the dangers. One of the three service users manages their own finance. One service user’s money is managed by the home and the placing authority manages the other service user’s money. Although it was evident that each service users receive a weekly allowance, there was no clear documentation with regards to who manages whose personal monies. Service users are offered opportunities to participate in the day-to-day running of the home, through questionnaires. These are completed yearly. The inspector read feedback forms. A number of comments made by the service users were recorded, however, there was no evidence of how these comments were addressed by the registered person. It was advised that as part of the organisation’s assessment of quality of care, comments must be featured in Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 13 the organisation annual report or business plan. Comments from service users must be addressed. Risk assessments regarding individual’s personal care were in place. However, along with the care plan these are to be updated. A copy of an application to register the organisation with the Data Protection body was on file. It was advised that this must be completed and submitted to the appropriate body. Service users files are kept secure in the office, which is kept locked when not in use. The home has in place a confidential policy. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. Service users’ know that their rights are respected and their independence is supported. Therefore service users were found to be independent and supported appropriately. Service users maintain their family contact. The meals in this home are good offering both choice and variety. Therefore service users cultural needs are being appropriately met by the home in terms of dietary needs. EVIDENCE: The assistant manager stated that one service user has a voluntary job with Outreach Tower View, packing gifts into boxes. Another service user goes out to the local café or shops and one user spends most of his time at Holloway Road market and the local betting shop. The inspector observed care staff interaction with the users and this was deemed appropriate. The home ensures that individual rights are respected and their independence is Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 15 supported appropriately and monitored accordingly. During the course of the inspection the service users’ entered in and out of the home independently. All service users’ have a key to the door. Timetables of each service users daily activity programmes were displayed in the office. Upon examining each one, each service user had a full day planned. However, upon discussing each activity with the support worker it became apparent that a number of planned activities were daily chores. It was rare that joint group activity happened, especially Monday lunchtime. One service user spoken to stated that they like doing their own thing. If they did not participate in a planned activity, they had to sign a sheet to state this. The specific service user was not particularly happy about this. The support worker stated that on Mondays and Tuesdays one service user is supported by care staff to go to the local gym. The rota indicated that one member of staff was on shift during this period indicating that the home is unsupported during this time. The support worker stated that the manager comes in early during this time to ensure the home is covered. This was not evident from the rota seen. The resident’s notice board was discussed. It was recommended that it was good practice to have a notice board in the lounge. The home provides one hot meal during the day and this is at dinner. Breakfast and lunch is also provided. The inspector observed service users making cups of tea at their own leisure. The support worker stated that one service user whose eating habit is sparse during the morning, has a sandwich at lunchtime, which the support worker had prepared. However on the specific service user’s activity plan it was clearly recorded that the service user is supported to make a sandwich. This was discussed at length with the support worker and assistant manager during the feedback session. There is a visitors’ policy, which states that visitors are welcome at the home at any reasonable time and with the consent of the service users. It was evident on individuals’ files that family contact is maintained. Most of the service users’ families live close by. One user’s family lives abroad and he keeps in contact by phone or letter. The menu plan shown indicated that hot meals are provided daily. Service users are able to access the kitchen to make beverages at anytime. This was evident during the inspection. During the inspection of the kitchen a cockroach was seen. It was advised that the registered manager contact the Environmental Health department regarding this. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20, Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to the service. The home has improved on their procedures recording and promoting good health and wellbeing. Service users know that they are safeguarded by the policies and procedures for dealing with medicines. Therefore medication procedures are wellmanaged promoting good health. EVIDENCE: Service users are supported by the home in the way they prefer. All service users are independent with regards to personal care, but the support worker stated that at times service users might need the occasional prompting from time to time to ensure personal care is maintained. Since the last inspection there were no accidents/incidents recorded. However, on file there were three recorded accidents/incidents, which happened prior to this inspection. The section relating to ‘action taken by the manager’ was not completed. This was concerning, as one of the accidents recorded was pertinent to a requirement made in the previous inspection report requiring the manager to ensure that all support workers undertake sexual awareness training. The course was required to equip and provide the Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 17 staff with support and guidance they need to support service users appropriately. The assistant manager did state that the registered provider has written to MIND with regards to this specialist training, and they are waiting for a reply. No information with regards to this was evident on file. Healthcare records have improved since the previous inspection. Each service user has a named GP who is local to the home. One service user has a weight problem, which has affected their cholesterol. Staff to the gym supports twice a week the service user. On the specific service user’s care plan there was no guidance on how this individual is supported, and if the gym is giving support. Medication was checked and all were in good order. The medication policy was also examined. All sections relating to good practices were in place and being followed. However, one section relating to control drugs was not in place. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using evidence including a visit to this service. Service users know that their views are listened to. Staff have a good practical knowledge and understanding of adult protection issues which protects service users from abuse. EVIDENCE: The home has in place complaints and abuse policies and procedures. It was evident at this inspection that no complaints were recorded. Records of staff training around the Protection of Vulnerable Adult with the local authority were on file. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. The home is adequately decorated, however, the communal area and the bathroom are in need of redecoration, to ensure the home is safe and an inviting place for service users to live. The home is clean and hygienic. EVIDENCE: Service users stated that they are happy in the home, and their bedrooms are comfortable to meet their individual needs. Over the years the manager has improved a number of areas of maintenance within the home. This is evident by the installation of a new kitchen and stairs and hallway flooring has been laid. However, during the tour of the building it was evident that communal areas are in need of redecoration, which was agreed by the assistant manager. The bathroom and toilet on the top floor need a major revamp and the separate toilet was locked, as it was out of action. It was advised that this must be repaired and reopened. The outside windows especially the top ones are in need of professional cleaning. In one of Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 20 the service user’s bedroom there is a number of dangerous and unsuitable electrical plugs in place near especially the wash hand basin. In the kitchen area there is a double sink. However, there is no separate hand washing facilities and in one of the cupboards a live cockroach was found. It was advised that that the manager consults with the local Environmental Department for their advice on hand washing arrangements for staff preparing food and act upon the advice must be sought given in addition advice from the pest controller. The laundry facilities can be accessed by the garden. All facilities in place were found to be in good working order. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. A competent and effective staff team supports service users. The registered person however, has failed to review the staffing levels in the home. Therefore service users care needs might be potentially put at risk due to care staff not being able to support individuals appropriately. EVIDENCE: The rota was displayed on the staff notice board. It was evident that apart from the manager on the rota there are two full-time and one part-time support workers employed. From past and present rota’s it was evident that the part-time support worker, works on average approximately four shifts in a two-week period. The two full time workers cover all the sleeping-in duties, have the same days off each week, which is either a Tuesday or Wednesday, and both work each weekend. In discussion with the support workers the rota was discussed. Their response was that if they wish they could request a weekend off at anytime. Annual leave was also discussed, as it was evident that no annual leave had been taken, staff rights were discussed also. This was addressed with the assistant manager. At the previous two inspections the staffing levels have been discussed. It is concerning that although this has been discussed at great length with the registered manager/provider it still remains the fact the staffing levels have Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 22 not been reviewed. It is also concerning that the two members of staff, who have worked full-time in the home for over a year, have not had any annual leave since being employed. The manager is therefore in breach of the ‘Working Time Directive’s. In the previous report it was quoted from the action plan submitted by the registered provider/manager that ‘the home is providing care to three people with low to medium needs. The staff levels in the home are reviewed regularly and the management that staffing level in the home reflect the need of the service user. There are records of this in the home. The manager is able to use the service of bank staff whenever there is any need for it’. However, this was not reflected on the rota seen. Four care staff personnel records were examined. All documents required for employment were in good order. Training has been paramount in the organisation yearly planned achievement. The assistant manager states that they are now planning the yearly programme for this year. The service training deficiencies identified were fire safety, mental health and manual handling. Supervision was discussed with support workers. They both stated that they have supervision with their line manager once every two months. They both listed to the inspector the courses they have undertaken relating to first aid, food hygiene, POVA, infection control. Both support workers are currently undertaking NVQ level 2 in care. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to the service. Service users benefit from a home that is run well Service users are confident that their views are being asked, however the comments made have not been reviewed or monitored. Therefore service users are not confident that they are being listened to. Service users health, safety, welfare and future plans are not being regularly reviewed and monitored. Therefore, service users are not fully protected with regards to health and safety procedures. EVIDENCE: Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 24 The manager is qualified and experienced to run the home and meet the Statement of Purpose’s, aims and objectives. The manager has a Diploma in Social Work and has extensive experience of working with people who have mental health problems. However, there is no evidence that the manager has undertaken a qualification in NVQ level 4 in management and care or equivalent. The manager was not available at the time of this inspection. However, the assistant manager of the organisation assisted the support worker on duty with the inspection. The inspector was of the opinion from the findings that although it was evident that the manager is rota’d on shift not in the home as regularly as indicated. One service user made the comment that they hadn’t seen the manager for weeks. The assistant manager stated that this is because the service user goes out daily and would not see the manager as often as they would have liked. But from further discussion, it was evident that the service user does go out daily but comes back to the home at least a number of times for their allowance. It was also evident that the manager is rota’d on each day working 12-6pm Monday to Friday. The hours indicate that the manager works 30 hours a week, which is classified as part time. It is therefore recommended that the registered manager is rota’d to work full time hours. At the previous inspection it was required that the registered person completes an environmental risk assessment that includes a fire risk assessment, which is to be reviewed annually. It was evident at this inspection that this has been completed. It was evident that the three permanent support workers have undertaken a qualified first aider course. It was also required at the previous inspection that the registered person ensures that the results of the service users questionnaires surveys are published and made available to service users and their representatives and other interested parties. Copies of the questionnaires were completed and on file. However, no annual report was in place. This was discussed with the assistant manager in the feedback session. Health & Safety certificates were checked and are in place. However, there were no legionnella, Electrical Installation, Portable Appliance Testing certificates in place. There was no indication that the fire blanket in the kitchen had been tested. It was also evident from the findings that the registered person does not submit to the Commission Regulation 26 visits as part of the ongoing quality assessment of the home. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 25 The environmental and fire risk assessment was in place and the last fire drill was completed on 8/04/06. It was advised that a zone map on the fire panel should be put in place. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 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 2 2 3 3 2 4 X 5 2 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 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The registered person must repair or replace the shower unit in the top floor bathroom. (Previous timescale of 30/12/05 not met.) Timescale for action 30/06/06 2. YA1 4(1)(c) Sch The registered person must 1.16 & 6 amend the homes Statement of Purpose to include the number and size of all rooms in the care home as set out in Regulation 4(1)(c) Schedule 1.16 of the Care Homes Regulation 2001. (Previous timescale of 30/12/05 not met.) The registered person must amended the home’s Statement of Purpose with regards to accommodating one specific service user who has recently turned 65. The registered person must obtain and submit an application for varying the home’s Conditions of Registration to accommodate the specific service user who has recently turned 65 years of age. DS0000010810.V288176.R01.S.doc 30/06/06 3. YA3 4 30/06/06 Greenfield Road 9 Version 5.1 Page 28 4. YA5 5(1)(c) The registered person must either amend or review the service users contracts that are in place that refer to personal care and Domiciliary Care Agencies Regulation 2001. 30/05/06 5. YA6 15 30/06/06 The registered person must update and review all service users care plans and programme of activities, to ensure that each service users has the opportunity to maintain and develop social, emotional, communication and independent living skills that are real to the individuals. Each service user must be consulted appropriately and if support is needed this is to be sought by the social worker or their representative on their behalf. This is to be recorded on each care plan and reviewed regularly. The registered person must ensure that service users risk assessments are fully completed. The registered person must ensure that all service users who smoke in their bedrooms are consulted with regards to risks. 30/06/06 6. YA9 13(4) & 15 7. YA7 17(2) Sch 4.9 The registered person must ensure that information regards to individual finance is recorded clearly on their care plan. The registered person must ensure that the specific service user with healthcare needs has in place clear and precise guidance for staff on how the service user is supported in the community. The registered person must DS0000010810.V288176.R01.S.doc 30/05/06 8. YA19 17(1)(a) Sch 3.3(m) 30/05/06 9. YA20 13(2) 30/05/06 Version 5.1 Page 29 Greenfield Road 9 amend the medication policy to included a section on Controlled drugs. 10. YA19 The registered person must ensure all care staff undertake an appropriate sexual awareness course. 18(1) The registered person must review the current staffing levels in the home. An action plan of the proposal must be submitted to the Commission. 34 The registered person must ensure that the quality assurance and quality monitoring feedback forms are addressed appropriately. The questionnaire must be open to other stakeholders such as relative and friends and social workers. 13(4)(a)(b) The registered person must 23(4) & ensure that all fire doors are 13(4) able to effectively self -close at all times and are not wedged open. Magnetic door hold or release mechanisms must be fitted to any fire doors in the home that service users/staff members routinely prefer to leave open for extended periods of time during the day or night. Alternatively, the registered person must consult with the London Fire Emergency Planning Authority (LFEPA) fire officer with regards to risk assessment with regards to the safety aspect of fire doors and provide evidence that LFEPA are satisfied with fire doors being propped open. (Previous timescale of 28/02/06 not met) Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 30 18(1)(c)(i) 30/06/06 11. YA33 30/06/06 12. YA39 30/06/06 13. YA42 30/05/06 14. YA17 15(2)(j) The registered person must ensure that the Department of Environmental Health office is contacted with regards to the cockroach found in the kitchen. The registered person must consult with the Department of Environmental Health with regards to the home having in place appropriate separate hand washing facilities for care staff when preparing food. The registered person must ensure all care staff undertake fire awareness, mental health and manual handling training. The registered person must update the home’s registration with the Data Protection body and obtain a data protection number. The registered person must ensure the water supply (water Fittings) Regulation 1999 with regards to Legionella is in place. The registered person must ensure that the Electrical Installation and Portable Appliance Testing certificates are updated. The fire blanket in the kitchen must be tested yearly and indicated clearly on the equipment in place. The registered person must ensure, that where the registered provider is an organisation or partnership, the care home shall be visited in accordance with Regulation 26. While undertaking monthly visits to the home the registered provider must record findings, which are in line with the NMS 39 Quality Assurance DS0000010810.V288176.R01.S.doc 30/06/06 15. YA35 18(1)(c)(i) 30/07/06 16. YA10 Data Protection Act 1998 13(4) 30/06/06 17. YA42 30/06/06 18. YA37 26 30/05/06 Greenfield Road 9 Version 5.1 Page 31 and Regulation 26 CHR 2001. 19. YA24 23(2)(b)(d) The registered person must redecorate all the communal areas and refurnish the bathroom and toilet on the top floor. The registered person must ensure that the electrical leads in one service users bedroom is made safe. The registered person must ensure that all the outside windows are cleaned regularly. The registered person must ensure that the manager has undertaken NVQ level 4 care and management. 30/07/06 20. YA37 18(1)(c)(i) 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations It is recommended that the registered manager should seek professional advice with regards to ensuring that service users’ rights to make decisions are upheld in the home. It is recommended that the registered person should consider organising training for all care staff in ‘person centred planning’ with regards to meeting service users needs within the home. It is recommended by the inspector that the registered person should ensure that the Statement of Purpose and service user guide are user friendly and a selling tool for the home and the organisation. Areas such as service user care and what the home provides on a short term and long-term basis should is reflected in the document. The registered person should involve all the service users in the fire awareness training planned for care staff working in the home. To help manage and reinforce the DS0000010810.V288176.R01.S.doc Version 5.1 Page 32 2. YA7 3. YA1 4. YA9 Greenfield Road 9 5. YA12 6. 7. YA42 YA37 dangers of service users smoking in their bedroom. It is recommended that the registered person has in place a ‘resident notice board’, which is easily accessible to service users and displays relevant information pertaining to individuals needs. The registered person should have in place on the fire alarm panel a zone map that indicates clearly what each zone represents. The registered manager/person should ensure that he completes full time hours per week. This is to be clearly indicated on the rota. If there are any changes this is to be clearly indicated also. Greenfield Road 9 DS0000010810.V288176.R01.S.doc Version 5.1 Page 33 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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