Inspection on 05/06/08 for Greenfield Road 9

This inspection was carried out on 5th June 2008.

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

Other inspections for this house

Greenfield Road 9 11/05/07

Greenfield Road 9 24/04/06

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

Wadham Avenue

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 27/09/2008.

CARE HOME ADULTS 18-65 Greenfield Road 9 London N15 5EP Lead Inspector Susan Shamash Unannounced Inspection 5th June 2008 10:30 Greenfield Road 9 DS0000010810.V363842.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 Greenfield Road 9 DS0000010810.V363842.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. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 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 companionincare@hotmail.com Companion in Care Ltd. 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.V363842.R01.S.doc Version 5.2 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 29th October 2007 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 people living at the home 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.V363842.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection visit lasted approximately three hours, and followed two random unannounced inspection visits on 4th and 11th April 2008. On arrival at the home, I was greeted by a staff member, who advised me that two residents were at home, and that the manager was due in shortly. The home remains fully occupied by people who have lived there for a number of years. I spoke to one person during this visit, and all three residents at the previous random visits to the home. Positive feedback was provided about the service by residents and staff. I also conducted a brief tour of the building, and examined residents’ care plans, staff records, health and safety records, and other records relevant to the running of the home. I also checked on compliance with the Immediate Requirement made at the previous random inspection visit. What the service does well: What has improved since the last inspection? As required previously, residents’ contracts had been reviewed and amended to ensure that their interests are fully protected. There was evidence that people are prompted to attend routine health care appointments in the interests of promoted good health. The medication policy had been updated to ensure that safe systems are in place for meeting people’s medication needs. A large amount of work had been undertaken within the home to improve the environment for residents, including redecorating, repairs, external window Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 6 cleaning and some new furnishings, and people living at the home told me that they were pleased with the results. Soap and hand drying facilities were being provided in the laundry, and the leak and broken tiles had been addressed in the interests of infection control. Staff members had undertaken training in fire awareness and mental health training and a diversity training course addressing sexuality, had also been sourced. The manager provided evidence that he had commenced undertaking the Registered Managers Award at NVQ (National Vocational Qualification) level 4 in care and management. Reports of monthly unannounced visits to the home undertaken on behalf of the registered provider are now being sent to the local CSCI area office each month. The local fire officer had visited that home and requirements made had been addressed, for the safety of people living and working at the home. As recommended staff members had undertaken ‘person centred planning’ training, and more varieties of fresh fruit and vegetables were available in the home. What they could do better: A greater selection of activities should be offered to people living at the home to ensure that they are supported to live stimulating lives. Evidence must be provided to the CSCI that an identified staff member has a satisfactory Protection Of Vulnerable Adults check from the Criminal Records Bureau, to ensure that people living at the home are protected from abuse. Failure to comply with this requirement may result in enforcement action being taken by the CSCI. All staff must have up to date first aid training updates, to ensure the safety of people living at the home. There must be no gaps in regular individual staff supervision sessions or staff meetings, to ensure that staff receive adequate support and information to meet the needs of people living at the home. A quality assurance audit must be undertaken for the home at least annually including feedback from all stakeholders such as residents, staff, relatives, health care professionals and social workers. The current Annual Quality Assurance Assessment must also be completed for the home and returned to the CSCI without delay to evidence that the quality of the home is managed in the interests of people living at the home. The hot water temperature for the kitchen sink must be adjusted to ensure effective food hygiene procedures within the home. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 7 It remains recommended that the statement of purpose and brochure for the home be made more user friendly, that training in ‘person centred planning’ be taken forward and used to inform care plans for people living at the home encouraging greater participation by residents and a more holistic approach. It is also recommended that residents be supported to have an annual holiday away from the home, and that the implications of the Mental Capacity Act 2005 be discussed in staff and residents to ensure that people’s rights are supported appropriately. 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. Greenfield Road 9 DS0000010810.V363842.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 Greenfield Road 9 DS0000010810.V363842.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): 1, 2 and 5. 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 provides people considering living at the home with sufficient information to make an informed choice, although this information could be provided in a more accessible format. Prospective residents’ needs are assessed prior to their admission to ensure that these can be addressed appropriately. EVIDENCE: As required at previous inspections, the home’s Statement of Purpose had been updated to reflect all the room sizes in the home. This was verified at the previous random inspection conducted at the home. It remains recommended that the Statement of Purpose and Service User’s guide be available in a user friendly format and can be used as a selling tool for the home. Detailed assessments were available in the files of the three people living at the home, indicating that appropriate information was obtained prior to their being admitted. This was confirmed by staff and residents spoken to. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 10 Contracts relating to each individual’s care were on file. As required at previous inspection, the contract format had been updated so that it no longer refers to the Domiciliary Care Agencies Regulation 2001, and includes the room to be occupied by each resident. New contracts had been signed by people living at the home and the home manager as appropriate. Compliance with this requirement was verified at the previous random inspection carried out at the home. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans are monitored and reviewed regularly to ensure that the changing needs of people living at the home are met appropriately. People living at the home are supported to make decisions about their lives and to take informed risks to develop their independence skills. EVIDENCE: Care plans and risk assessments continue to be in place for people living at the home taking account of people’s cultural needs and lifestyle choices. All people living at the home have a care plan in place and all three care plans were examined. Each care plan had been updated within the last six months as appropriate and discussion with staff and people living at the home confirmed that they reflected individuals’ current day-to-day goals and aspirations. These included mental health needs, budgeting, activities, personal hygiene and daily activities. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 12 Care plans were signed and dated by people living at the home and residents spoken to advised that they were consulted about their care and support needs. As recommended previously two staff members had undertaken training in Person-Centred planning. It is recommended that this training be taken forward and used to inform care plans for people living at the home encouraging greater participation by residents and a more holistic approach. As required at the previous random inspection, risk assessments were updated regarding all three people, indicating that they may not be left alone in the care home, prior to obtaining the written agreement of their placing authorities and relevant medical professionals. Residents spoken to told me that they are no longer being left alone at the home for short periods of time, and this was confirmed by the staff member on duty. The minutes of the most recent staff meeting also confirmed that this practice had ceased. It was therefore deemed that the Immediate Requirement made at the previous random inspection is now met. The manager confirmed that the practice of leaving any resident alone in the home has ceased and will not resume prior to the written agreement of placing authorities and relevant medical professionals. Risk assessments were available regarding smoking for all people living at the home indicating that they had been consulted and agreed to the safeguards recorded. One of the people living at the home manages their own finances. One person’s money is managed by the home and the placing authority manages the other person’s money. Monies stored on behalf of this person, were clearly recorded, as were details of monies withdrawn from bank accounts and how these had been spent. Residents confirmed that their monies were available to them whenever needed, as appropriate, and I was able to witness one resident requesting and being given their money as appropriate. People living at the home are offered opportunities to participate in the day-today running of the home, through monthly resident meetings and annual questionnaires. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home know that their rights are respected and their independence is supported. They are encouraged to maintain contact with family and friends and their cultural needs are met. They are encouraged to utilise facilities in the local community but would benefit from more encouragement to engage in activities of their choice. People living at the home are satisfied with the choice and variety of meals served to them, and these meet their nutritional needs. EVIDENCE: People living at the home told me that they continued to go out independently, visiting local shops, markets, the gym, family members and friends. The staff member on duty confirmed that one person living at the home continues to undertake voluntary work, packing gifts into boxes. The others Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 14 go out to support group drop-in sessions, local cafés or shops and Holloway Road market. I observed staff interaction with people living at the home and this was appropriate. During the course of the inspection, residents came in and out of the home independently, all having their own key to the door. Timetables of each person’s daily activity programmes were displayed in the office, and these indicated that each person had a full days’ activities planned. Activities recorded in daily records included shopping, household chores, cooking, bus rides, a support group drop-in, visiting friends, resident meetings, going to the market, post office, betting shop and gym. However there were few activities planned for the evenings or at weekends and there was not a great variety of activities, a requirement is made accordingly. It was only possible to speak to one resident at length during the current visit. At the previous random inspection, two residents spoken to stated that they preferred to do their own thing, the other advised that they generally enjoyed the activities planned for them, but would prefer to have more options available to them. A day trip to the coast was last arranged in November 2007. The staff member and the manager advised that days out to the coast and a barbeque were being planned for the summer. This was mentioned in the minutes of the most recent residents meeting. Discussion with person living at the home indicated that they would like to have a holiday away from the home. However the manager advised that residents had previously changed their mind when trips were arranged. It remains recommended that residents be supported to have an annual holiday away from the home as indicated by their expressed wishes. There is a visitors’ policy, which states that visitors are welcome at the home at any reasonable time and with the consent of the people living at the home. It was evident on individuals’ files that family contact is maintained. Most of the residents’ families live close by. One person’s family lives abroad and they keep in contact by phone and letter. Records of food served indicated that the home continues to provide at least one hot meal during the day, in the evening, with breakfast and a light lunch also provided. I observed residents making cups of tea at their leisure during the inspection. The kitchen was well stocked with fresh fruit, dried, tinned and frozen produce, and a selection of fresh, canned and frozen vegetables as required at the previous inspection. People living at the home advised that they continue to enjoy the food provided. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 15 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 living at the home are supported by the home in the way they prefer. People’s health and social care needs are met appropriately. People living at the home know that they are safeguarded by the policies and procedures for dealing with medicines, promoting good health. EVIDENCE: All people living at the home are independent with regards to personal care, but the staff advised that at times they might need prompting to ensure good personal hygiene is maintained. At a previous inspection it was required that staff undertake training to provide them with the support and guidance they need to support residents’ sexuality needs appropriately. Staff advised that a training course in diversity had been located, which addressed this area, and one staff member had now undertaken this training. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 16 Healthcare records were detailed indicating appointments attended by people living at the home, including those refused by residents. One person living at the home is working to control their weight, with support from staff to attend the gym twice a week. Medication was checked and was in good order with no gaps in the medication administration records and appropriate storage arrangements in place. Prescribed medicines received at the home and those returned to the pharmacy were recorded as appropriate. I observed staff administering medication to one resident and people living at the home confirmed that they are given their medication regularly by staff. No residents are currently self medicating. At the previous random inspection the medication policy was inspected and had been updated to include a section relating to control drugs as required. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 17 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 living at the home feel that their concerns are listened to and addressed. Staff have a good knowledge and understanding of adult protection issues which protects people living at the home from abuse. EVIDENCE: People spoken to during the random inspection visit, advised that they would feel able to speak up about issues of concern to them within the home. The home has in place complaints and abuse policies and procedures including the local authority’s Adult Protection Policy and Procedure. Two complaints had been recorded since the previous key inspection, but these were both from staff regarding their concerns about people living at the home. Two compliments from residents were also recorded, both of which were about the food served at the home. Staff records showed that all had undertaken training in the Protection of Vulnerable Adults as appropriate. The staff member spoken to was aware of action to be taken in the event of an allegation or disclosure of abuse against a service user. Residents spoken to during the random visit, and the current visit, were aware of their rights, and had been given the opportunity to vote at the most recent local election. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 18 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 good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was recently decorated and was clean and hygienic, ensuring that it is a safe and comfortable place for people to live in. EVIDENCE: At this inspection and the previous random visits, people living at the home stated that they are generally 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 has included the installation of a new kitchen and new stairway and hallway flooring. As required previously, the communal areas of the home had been redecorated and the bathroom and toilet on the top floor had been refurbished. The leak in the shower room on the first floor had also been repaired as appropriate. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 19 Hazardous electrical plugs in a resident’s room had also been made safe as appropriate and the outside windows had been professionally cleaned. Residents’ bedrooms had recently been redecorated and were generally in a good state of repair. The manager and a staff member confirmed that a new lampshade had been purchased for the identified person and the window restrictor had been refitted in this room, as had been requested at the previous inspection. It was not possible to verify this myself as the person in question was out at the time of the current inspection visit. The laundry facilities can be accessed by the garden and included soap and towels for hand washing. Overall significant improvements had been made to the home’s environment. The staff member advised that the shower room on the first floor was now in use again, following repair of the leak. People living at the home told me that they had chosen the colours for their bedroom walls, and were happy with the outcome. Some new doors were provided in the home and new curtains were fitted in the lounge. New sinks had been provided in the kitchen and monthly door closure checks were also in place as appropriate. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 20 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, 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. A competent and effective staff team supports people living at the home, however it is unclear if sufficiently rigorous recruitment procedures are in place for the home to protect residents from potential abuse. Staff are generally well trained but need further first aid training to ensure the safety of people living at the home. Gaps in the supervision of staff places residents at risk of not receiving the best possible support at all times. EVIDENCE: The rota was displayed on the staff notice board. It was evident that apart from the manager on the rota there are now only two other staff members employed at the home on a regular basis, following one staff member leaving in the last few months. They cover almost all the sleeping-in duties, with the same days off each week, and work the majority of weekends. In discussion with one support workers the rota was discussed, they advised that they were happy with the rota and could request time off at anytime if needed. They also advised that support was available from other staff working for Companion in Care – the registered provider for the home. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 21 All residents continue to speak highly of the support provided to them by the staff team. Following the last key inspection visit, the manager provided a staffing level review for the home to the local CSCI area office. The issue of staff leaving residents alone within the home for short periods of time was also addressed, and this is no longer happening following an immediate requirement made at the most recent random inspection visit. This area is further addressed under Standard 9 in this report. The manager’s review of staffing levels at the home indicated that current staffing levels are sufficient. Staff and residents spoken to felt that there was enough support at the home, however I remained concerned that staffing levels may impact on the number of activities offered to people living at the home particularly in the evenings and at weekends. The rota showed no evidence that as-and-when staff workers were being used to provide occasional one-to-one support for residents outside of the home, however the manager advised that when he is on shift alongside staff members, they have the opportunity to go out in the community with service users. I examined two staff files during the inspection. One was for a long standing member of staff which contained the relevant recruitment information. The other was for a relatively new staff member, and I was concerned that there was no evidence of a satisfactory enhanced Criminal Records Bureau (CRB) disclosure for this staff member or a Protection of Vulnerable Adults (POVA) check. The manager assured me that a POVA check had been received for this staff member and that this would be forwarded to the CSCI shortly after the inspection. However no such evidence was received by the CSCI. A requirement is made accordingly to ensure that people living at the home are protected from abuse as appropriate. Failure to comply with this requirement may result in enforcement action being taken by the CSCI. At the previous inspection the service’s training deficiencies identified were fire safety, mental health, manual handling and sexuality awareness training. I was also able to inspect training records and the staff member spoken to advised that she was booked to attend training courses shortly updating her knowledge in Safeguarding Adults and regarding Personal Safety for Lone Workers. I saw evidence of these bookings as well as certificates confirming her training undertaken in fire safety, manual handling, mood disorders, food hygiene, health and safety, self harm, care planning, infection control, person centred care and diversity. She advised that the issue of sexuality was addressed as part of the diversity training. She had gained an National Vocational Qualification at level 2 in care and was about to start working towards level 3. I also evidence that the newer staff member had undertaken training in all mandatory areas including medication administration. This represents considerable progress since the previous key inspection. However the manager and one staff member did not have up to date training in first aid, and this is required, as both spend extended periods of time working alone in the home. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 22 The support worker spoken to advised that they receive regular supervision and support from the manager. Records showed that regular supervision was being carried out at the moment however there had been a gap of approximately six months between August 2007 and February 2008 during which no supervision sessions or staff meetings were recorded. A requirement is made accordingly. One staff member and the manager had undertaken training in the implications of the Mental Capacity Act 2005 as recommended at the previous inspection. It is recommended that the implications also be discussed in staff meetings, and also briefly in residents’ meetings to ensure that people’s rights are supported appropriately. Greenfield Road 9 DS0000010810.V363842.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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from a well organised home but cannot be confident that their views are always sought or taken into account. Residents are generally well protected from harm by the home’s health and safety procedures. EVIDENCE: The manager is qualified and sufficiently 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. As required at previous inspections, the manager provided evidence that he has commenced working towards the registered manager’s award at NVQ level 4. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 24 It was also required that the registered person ensures that the results of residents’ questionnaires surveys are published and made available to people living at the home and their representatives and other interested parties. Copies of the questionnaires completed a year ago were on file. However, no annual quality assurance audit had been undertaken for the home as required at previous inspections, including feedback from all stakeholders such as residents, staff, relatives, health care professionals and social workers. A quality assurance audit must be undertaken at least annually and the result of these audits must be provided to the local CSCI area office. Failure to comply with this requirement may result in enforcement action being taken against the home. Regular residents meetings were being held as appropriate, although there had been some gaps in the staff meetings arranged for the home. As required previously the Regulation 26 reports of unannounced visit undertaken to the home on behalf of the provider organisation are now being provided to the CSCI monthly as appropriate. However the most recent Annual Quality Assurance Assessment must be completed without delay, to avoid enforcement action being taken by the CSCI, to evidence that the home is managed in the interests of people living at the home. Inspection of the management of residents’ finances indicated that appropriate procedures are generally in place, with signed records available of all transactions made. Residents confirmed that they could access their monies whenever needed. A record is now maintained of any properties kept on behalf of residents including cashbooks, passports etc. However although safeguards appear to be in place including checking of bank statements on a regular basis etc. it is recommended that a log be maintained of when the bank card kept for an identified service user is taken and returned by the service user, for the protection of staff and residents at the home. Clear records were maintained of incidents and accidents occurring at the home and the general standard of record keeping was found to be high. Current gas and electrical installation certificates, portable appliances testing and fire equipment records were available as appropriate. The manager advised that the home had recently been visited by a local London Fire Emergency Planning Authority (LFEPA) fire officer and consulted with regards to fire doors being propped open. A report of this visit was available and I was able to verify that requirements appeared to have been addressed by the provider, although the LFEPA had not visited again to confirm this. The environmental and fire risk assessment was in place and regular alarm tests and fire drills were being organised. Records were available of hot water temperature from various outlets in the home, evidencing that these are maintained at 43°C or below, to avoid the risk of scalding. Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 25 I noted that the records included the hot water temperature for the kitchen sink which was also below 43°C, which is not sufficient to ensure effective food hygiene procedures within the home. The temperature of this water outlet must therefore be reviewed to ensure that this is addressed. Greenfield Road 9 DS0000010810.V363842.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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 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 2 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X 3 2 X Greenfield Road 9 DS0000010810.V363842.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 YA12 Regulation 16(2mn) Requirement Timescale for action 25/07/08 2. YA34 19 Sched 2(7) The registered persons must ensure that a greater selection of activities are offered to people living at the home on a regular basis, particularly in the evenings and at weekends, to ensure that they are supported to live stimulating lives. 11/07/08 The registered persons must provide the CSCI with evidence that an identified staff member has a satisfactory Protection Of Vulnerable Adults check from the Criminal Records Bureau, to ensure that people living at the home are protected from abuse. Failure to comply with this requirement may result in enforcement action being taken by the CSCI. The registered persons must ensure that all staff have up to date first aid training updates, to ensure the safety of people living at the home. 3. YA35 13(4) 18(1ci) 22/08/08 Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 28 4. YA36 18(2) 5. YA39 24 6. YA39 24 7. YA42 13(4ab) The registered persons must ensure that there are no gaps in regular individual staff supervision sessions or staff meetings, to ensure that staff receive adequate support and information to meet the needs of people living at the home. The registered persons must ensure that a quality assurance audit is undertaken for the home at least annually including feedback from all stakeholders such as residents, staff, relatives, health care professionals and social workers. Results of these audits must be provided to the local CSCI area office to ensure that high quality support is provided to people living at the home. (Previous timescales of 31/08/07 and 09/05/08 not met). The registered persons must ensure that the current Annual Quality Assurance Assessment is completed for the home and returned to the CSCI without delay, to evidence that the quality of the home is managed in the interests of people living at the home. The registered persons must ensure that the hot water temperature for the kitchen sink is sufficient to ensure effective food hygiene procedures within the home for the protection of staff and people living at the home. 18/07/08 08/08/08 25/07/08 11/07/08 Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 29 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 YA1 Good Practice Recommendations It is recommended 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. Copies of amended documents should be sent to the CSCI. It is recommended that training in ‘person centred planning’ be taken forward and used to inform care plans for people living at the home encouraging greater participation by residents and a more holistic approach. It is recommended that residents be supported to have an annual holiday away from the home as indicated by the expressed wishes of two residents spoken to. It is recommended that the implications of the Mental Capacity Act 2005 be discussed in staff meetings, and also briefly in residents’ meetings to ensure that people’s rights are supported appropriately. It is recommended that a log be maintained of when the bank card kept for safekeeping on behalf of a service user is, taken and returned by the service user. 2. YA7 3. 4. YA14 YA35 5. YA41 Greenfield Road 9 DS0000010810.V363842.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenfield Road 9 DS0000010810.V363842.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. Re-publishing this information is in breach of the terms of use of that website. 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