Inspection on 09/03/06 for Hillgreen Care (Ruskin Road)

This inspection was carried out on 9th March 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 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

Hillgreen Care (Ruskin Road) 22/05/06

Hillgreen Care (Ruskin Road) 20/07/05

Hillgreen Care (Ruskin Road) 22/11/04

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 09/07/2008.

CARE HOME ADULTS 18-65 Hillgreen Care (Ruskin Road) 13 Ruskin Road Tottenham London N17 8ND Lead Inspector Tola Akinde-Hummel Unannounced Inspection 9 March 2006 09:05 Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 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 Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 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. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hillgreen Care (Ruskin Road) Address 13 Ruskin Road Tottenham London N17 8ND 020 8880 9494 020 7226 3939 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) Hillgreen Care Ltd Mr Dennis Obemeata-Yamah Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users living above the first floor should not require assistance in the event of an emergency. Date of last inspection 20th July 2005 Brief Description of the Service: The home is one of two operated by Hillgreen Care. 13 Ruskin Road is a sixbedroom house on a residential street in Tottenham. The home is registered to care for six adults between the ages of eighteen and sixty-five years who have a learning disability. The people in the home have challenging behaviour and/ or autistic spectrum disorders. The home is well equipped with six single bedrooms each with en suite toilet and sink. One bedroom has its own bathroom. Two bathrooms are provided for the other five residents. There is a spacious lounge and separate dining room. The dining room is also used for music, activities and smoking. There is a garden. The home is within a short walk of Tottenham High Road ands within easy access of busses, Seven Sisters Underground stations and Bruce Grove White Hart Lane and Northumberland Park rail stations. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately six hours to complete. At the time of inspection five service users were in the home and undertook various activities outside of the home during the day. Over the course of the day four staff were on duty excluding the manager. The inspector interviewed two members of staff and three service users in confidence. The manager Mr Dennis Obemeata- Yamah assisted the inspector throughout the day. The inspector looked at the requirements from the previous inspection, completed a tour of the building, looked at the storage and recording of medication, examined care plans, staff records and some of the homes policies and procedures. One service user is currently in hospital and will not be returning to the home, as the building is not suitable to meet their increased need. The home will therefore have a vacancy shortly. Since the previous inspection one new service user who has limited verbal communication has moved into the home and seems to be settling well. What the service does well: What has improved since the last inspection? At the previous inspection, ten requirements were made. Of these nine requirements were met. One recommendation also made has been met. The home has updated its complaints procedure and completed an adult protection procedure for the home. Staff have completed vulnerable adults training and the home has produced a written policy on managing service users finances, which reflects actual practice. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 6 The home has tightened its recruitment practice in relation to references and criminal records checks. An outstanding risk assessment in relation to a particular individual was also completed however the service user has since moved on. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Hillgreen Care carries out assessments on all prospective service users in detail prior to admission. EVIDENCE: Since the last inspection a new service user has been admitted to the home. The service user file contained detail of the assessment carried out by the local authority. The home also carried out assessments of the service user prior to the service user moving in. The assessments were extremely detailed and informative highlighting what service users are able to do independently and where support is needed. Two other files sampled also contained detailed information. These assessments have been amended where necessary when needs change. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 9 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 Hillgreen Care demonstrate that they are able to assess the needs of service users thoroughly taking into consideration risk and implementing strategies to minimise risk and increase independence. Attention must be paid to putting the date on records. EVIDENCE: Three files were sampled in the home. Whilst the plans are very thorough, staff are not dating them thereby not demonstrating when they were written and how current they are. This applies to some monthly reviews and goal setting. The plans highlight areas where potential conflict can arise with service users. These plans have strategies in place to enable staff to deal with challenging behaviour. All plans recognise potential risks to service users and the risks that they may pose to others. The plans outline how these risks can be minimised for example ensuring adequate staffing at particular times of the day. The plans also highlight any particular triggers for service users and how these can be avoided or managed. During the inspection it became clear how risk was managed with a particular service user. This was done professionally and sensitively. It is evident that the plans are reviewed on a monthly basis and amended as needed. These are regularly signed by service users that have the Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 10 capacity to do so. Service users preferred activities are pursued where possible and service users are introduced to other leisure activities they may enjoy. The previous inspection required an updated risk assessment for a service user known to fire raise. This assessment was completed however the service user has no longer lives in the home. One service user advised how his finances are managed and how he can access money should he wish to purchase new items. The process explained is now reflected in the procedure concerning service users finances. This policy was updated following a requirement from the previous inspection. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 11 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): 12,15,16 Service users are encouraged to increase independent living skills, pursue leisure activities and maintain positive relationships with service users in the home their relatives and people in the community. EVIDENCE: On the day of inspection service users were observed preparing breakfast and snacks during the morning. When asked, one service user stated, “ I can cook spaghetti, I make my own snacks and I made a cup of tea for the manager this morning.” Another service user advised that he is assisted to complete his laundry and keep his room tidy. Over the course of the day, service users were preparing to participate in various activities. Service users make the decision themselves about what they wish to do outside of any structured programmes. All service users have an activities programme and are encouraged to develop interests. One service user was preparing to go to the cinema with a member of staff, another service user was supported to attend a GP appointment and another service Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 12 user was going sightseeing. One service user stated, “ I like living here, I go to the café, I see my dad every weekend and the staff here are lovely”. Other services users confirmed that their relatives were welcomed into the home. The home is now planning summer holidays for service users. Key workers with service users have agreed the length of the holidays and which service users are compatible and may enjoy a holiday together. The activities organiser will be making contact with various hotels in Brighton and Bournemouth to assess their suitability for the service users. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 13 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 Service users are supported to maintain optimum physical and emotional health. The home manages the storage, administration and recording of medication well. EVIDENCE: The inspector noted that all five service users in the home were appropriately dressed. Their clothes were clean and age appropriate. A number of service users require assistance or prompting with personal care. Same sex staff members undertake this in private. The files inspected found evidence that service users are registered with GP’s and have access to primary health care services from the local health centre. Service users also have access to a psychologist who operates as part of Hillgreen Care to support service users and staff. All service users have recently had their medication reviewed. Service users are also advised of any changes to medication. The inspector examined the medication storage, recording and administration. These were satisfactory. One service user is able to self- administer creams and powders. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 14 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 The home has now improved its policies and procedures relating to complaints and adult protection. This will ensure that service users are properly listened to and are better protected by robust procedures that staff fully understands and implement. EVIDENCE: The previous inspection highlighted the inadequate complaints procedure in the home. The home has since improved the procedure ensuring that it is accessible to service users and their relatives. The inspector asked two service users about making complaints. Both service users stated that they had no reason to complain at present and if they did they would make the manager and any member of staff aware of any issue. Service users are also clear that they can share any concerns with their relatives. The new complaints procedure is prominently displayed in the home and all relatives and service users received a personal copy of the complaints procedure. There has been ? complaint since the previous inspection. This was resolved adequately and within timescale. The previous inspection also highlighted the lack of an adult protection procedure in the home. The home has now completed a procedure, which gives staff a step-by-step guide to reporting any abuse. The quick reference guide is placed on the notice board at the entrance of the home and the more detailed version in the policies and procedures manual. All staff received adult protection training in October and November 2005 with refresher training scheduled for October and November 2006. Two staff members confirmed to the inspector that they had received this training and were able to detail what action would be required of them in the event of an allegation of abuse. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 15 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): 24,27 Hillgren provide a warm, homely environment for service users. Minor repairs must be made to ensure service users remain comfortable in their environment. EVIDENCE: The home is ideally located to access transport and shops and amenities are close by. During the inspection a tour of the building was completed. The home is clean and comfortable. The requirement to provide hand-drying facilities in all toilets and bathrooms has been met. The inspector noted that with the exception of bedrooms all service users had access to all parts of the building without restriction. The ground floor laundry room ceiling is damaged and requires repair. The manager is aware of this. The bathrooms in the home are well decorated and clean. However the shower- head in the first floor bathroom is broken and requires repair. As advised, the manager completed a risk assessment on bathroom locks and has replaced the locks on a bathroom to allow access from the outside should there be an emergency. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 16 Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 17 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): 34, 35 Hillgreen Care supports staff to undertake training and increase their skills in supporting service users. There has been improvement in the recruitment practices of the home. EVIDENCE: The inspector was able to speak to two staff members. Both stated that they found the manager supportive and were clear about their roles and responsibilities within the home. One staff member stated that rotas are carefully planned according to the needs of service users and where activities are organised more staff are required to work to ensure adequate cover. On the day of inspection four staff were on duty including the manager. The previous requirement regarding a lack of written references and an up to date criminal records bureau check has not been met. The individual staff member concerned has now left the organisation. However, the inspector was able to examine the files of two recently recruited members of staff and found that they both had the required documentation for the purposes of recruitment. The inspector saw evidence that staff are periodically receiving training to further enhance the care and support offered to service users. Staff have completed epilepsy training, understanding autism, Physical intervention Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 18 training, adult abuse training and NVQ training. The programme is ongoing with topics identified for the coming year. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 19 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): 39,42 The home must complete quality assurance and monitoring to ensure a high standard of care and support is maintained. The home must ensure that their health and safety responsibilities are carried out consistently. EVIDENCE: The home has weekly service users meetings where their views are shared and listened to by staff. The inspector saw evidence in minutes that these meetings take place and staff and residents agree a written agenda. The items include food, activities, service users well being and staffing issues. The inspector suggested incorporating aspects of fire safety to ensure that service users are reminded of how to respond in the event of a fire. It was also suggested that complaints could be incorporated also. The home has yet to complete quality assurance and monitoring in the home, which incorporates the views of service users and all relevant stakeholders. This must be completed once a year to ensure continuous improvement. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 20 The records of weekly fire alarm testing showed that this was not up to date. The home must ensure that this is undertaken in the absence of the individual delegated to take this responsibility. Three service users spoken to were able to advise the inspector what they should do if a fire broke out in various parts of the building. An inspection of the contents of the freezer revealed that food is not being adequately stored once opened. This increases the risk of food related illness and must be rectified. The previous requirement to ensure that risk assessments are undertaken regarding dismantled window restrictors has not been completed. A further assessment must be undertaken of the ground floor lounge windows to ensure the safety of service users from outsiders accessing the home. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 21 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 3CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 4 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 2 X X X LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hillgreen Care (Ruskin Road) Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000060578.V259467.R01.S.doc Version 5.0 Page 22 Yes 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 YA6 Regulation 17 (3) (a) Requirement The registered person must ensure that staff date and sign all care plans, monthly reviews and other relevant documentation. The registered person must ensure that the ceiling in the laundry room is repaired. The registered person must ensure that the shower fixture in the first floor bathroom is replaced. The registered person must complete their annual quality assurance with an improvement plan. This should be made available to service users stakeholders and a copy must be sent to the commission. The registered person must ensure that fire tests are completed weekly and in the absence of the responsible member of staff this is delegated to another member of staff to complete. The registered person must ensure that food is properly stored in the freezer. The registered person must DS0000060578.V259467.R01.S.doc Timescale for action 10/04/06 2 3 YA24 YA27 23 (2) (b) 23 (2) (c) 02/05/06 10/04/06 4 YA39 24 (1) (2) 01/06/06 5 YA42 23 (4) (c) (V) 13/03/06 6 7 YA42 YA42 23 (16) (2) (g) 13 (4) (a) 13/03/06 02/05/06 Page 23 Hillgreen Care (Ruskin Road) Version 5.0 undertake a risk assessment regarding the dismantled window restrictors in bedrooms. If any risk is identified for any resident regarding falling from a window the restrictors must be repaired/replaced as a matter of priority. A risk assessment must also be carried out on the lounge window to assess the risk of outsiders entering the home. Previous timescale 31/08/05 not met 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 39 Good Practice Recommendations The registered person should consider periodically including complaints and fire safety on the agenda of residents meetings to ensure service users are familiar with their rights and how to respond in the event of a fire. Hillgreen Care (Ruskin Road) DS0000060578.V259467.R01.S.doc Version 5.0 Page 24 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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