CARE HOME ADULTS 18-65
Homer Road (22A/B) 22a/b Homer Road Hackney London E9 Lead Inspector
Robert Sobotka Unannounced Inspection 18th January 2006 10:00 Homer Road (22A/B) DS0000035305.V278436.R02.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 Homer Road (22A/B) DS0000035305.V278436.R02.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. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Homer Road (22A/B) Address 22a/b Homer Road Hackney London E9 020 8525 3933 020 8502 3543 philipa.jones@heritagecare.co.uk www.heritagecare.co.uk Heritage Care 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) Ms Phillipa Jones Care Home 7 Category(ies) of Learning disability (7), Physical disability (7), registration, with number Sensory impairment (7) of places Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 10th September 2005 Brief Description of the Service: 22 Homer Road is a registered care home that provides 24-hour residential care for adults with learning disabilities and/or physical disabilities. Homer Road opened as a care home on 31st of March 2003. The premises are owned and managed by Peabody Trust and Heritage Care provide care. The home is situated in a residential area of Hackney within walking distance from local amenities and public transport links. All bedrooms in the home are single. The home has a garden at the rear of the building. The downstairs part of the house is wheelchair accessible. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place over 1 day (morning and early afternoon) and included speaking to some of the staff working in the home and spending time with the service users. The inspector also conducted a tour of the premises and viewed various records. The aim of this announced inspection was to check the home’s progress towards full compliance with the legislation. What the service does well: What has improved since the last inspection?
There has been some improvement in ensuring that service users’ care plans are up-to-date and reviewed. All risk assessments have been updated since the last inspection visit. There was also evidence that accidents and incidents were being monitored by the registered manager, as recommended. Food was appropriately labelled to prevent food poisoning, as required during the last three inspection visits. The premises were now appropriately ventilated. Carpets in the service users’ bedrooms have been cleaned.
Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 6 Staff personnel files have been updated to include all information required by law. There appeared to be an improvement in the frequency of supervisions offered to staff working in the home. Fire drill were being carried out of regular basis. What they could do better:
The home had 16 requirement and 4 good practice recommendations made during the last inspection, some of which were requirements not met from the previous inspection visit. This inspection visit showed that there were still 10 statutory requirements as well as 2 good practice recommendations, which remain unmet. These included: - Stains on ceilings in toilet/wet room and bathroom must be repainted. - Cracks in the wall around the doorframe by staff sleepover room must be refilled and replastered. - It is required that care plans are regularly updated/reviewed to reflect changing needs of the service users. - The registered manager must ensure that service user’s weight is monitored and recorded as indicated within care plans. - It is required that the person in control visits are undertaken on a monthly basis and are unannounced and that report from each visit is forwarded to the home without delay. - It is required that the responsible person ensures that individual service user contracts are signed by all relevant parties. - The registered manager must ensure that the wall tiles in the kitchen on the first floor are replaced. - Kitchen drawer next to the cooker/stove in the upstairs kitchen must be replaced. - The worktop in the upstairs kitchen must be made stable. - It is required that an application is submitted to the Commission for the responsible individual to become registered. In addition 3 new requirements were issued during this visit: - It is required that fridge/freezer temperatures are monitored and recorded on daily basis. - The responsible person must ensure that the service users financial affairs are resolved and that they have access to their own finances. - It is required that the visitors book is maintained at all times, as required by the legislation. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 7 Unmet requirements affect the quality of care and wellbeing of the service users. Non-compliance with the legislation may result in enforcement action being taken against the registered individual. 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. Homer Road (22A/B) DS0000035305.V278436.R02.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 Homer Road (22A/B) DS0000035305.V278436.R02.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): 3, 5. The home appeared to meet the needs of the service users, however further improvements were required to ensure that all service users needs are included in their care plans. Service user’s contracts required to be signed by the service users’ representatives/relatives. EVIDENCE: There have been no new admissions to the home since the home since the last inspection. The standard relating to admission process could not therefore be assessed. The home appeared to meet the needs of the service users, however in case of one of the service user, staff on duty were unable to evidence that his care plan has been reviewed. In order to meet this standard fully, the registered manager must demonstrate that all care plans are kept up-to-date and reviewed on regular basis and that staff enable and support service users to achieve goals identified in each care plan. The requirement that the responsible person ensures that individual service user contracts are signed by all relevant parties remains unmet. Out of 4 contacts viewed, none have been signed by the service users’ representatives/relatives. The requirement has therefore been repeated and must be met without any further delay. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 8, 9. Some progress has been made to ensure that service users’ care plans have been brought up-to-date and reviewed on regular basis, however further work was required to ensure that the standard relating to care planning process is fully met. EVIDENCE: As part of this visit, the inspector viewed four randomly chosen care plans. Three out of four care plans were found up to date and have recently been reviewed. Care plan of one service user has not been reviewed for considerable length of time. The inspector was informed by the person in charge that the service user’s review had taken place and the home was in the process of updating the care plan, however it was not available for inspection. The requirement in relation to this standard has therefore been repeated. The inspector was also informed that the home has restarted residents meetings, however minutes from those could not be found during this inspection visit. The recommendation that the service users meetings are introduced has therefore been repeated. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 11 All care plans viewed contained appropriate risk assessments, which have been reviewed/updated since the last inspection visit. Those who were living in the home were unable to comment on the quality of care provided and whether their needs were being met (due to their disability), however the inspector was satisfied that they appeared to be settled and happy in the home. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17. Appropriate food arrangements were in place, however staff must ensure that fridge/freezer temperatures and monitored and recoded on daily basis. EVIDENCE: Standards relating to activities offered to service users were not assessed during this visit, however they were fully met during the last inspection visit. The inspector saw service users going out on outings supported by staff during this inspection visit. There were appropriate food supplies in the home and products were labelled when opened, as required during the last inspection visit. Record of food offered to service users was maintained. The recommendation for the home’s menus to be produced in pictorial form remains unmet. Records of fridge/freezer temperatures were found incomplete. It is therefore required that fridge/freezer temperatures are monitored and recorded on daily basis. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 13 Food was mainly prepared by staff, but the service users also had an opportunity to assist in food preparation in accordance with their wishes, assessed abilities and risk involved. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 14 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): 19. The service users’ emotional health needs were being met. Limited progress has been made to ensure that service users weight is monitored and this required improvement. EVIDENCE: The inspector viewed records relating to the healthcare needs of service users accommodated in the home. These were generally well maintained, however it was noted that weight of the service users was still not being monitored and recorded on regular basis, as required during last inspection visit. The registered manager must ensure that service user’s weight is monitored and recorded as indicated within care plans. This is a repeated requirement and must be met without delay. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 15 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 had appropriate complaints system in place. Service users were protected from abuse, however the situation of service users not being able to access their own finances remains unresolved and must be addressed as a matter of urgency. EVIDENCE: There have been no complaints about the home since the last inspection. The Inspector viewed the complaints policy, which was available in a format accessible to the current service user group. The home had appropriate adult protection procedure in place. Staff working in the home have attended adult protection training. The situation of service users not being able to access their own finances remains unresolved and must be addressed as a matter of urgency. The responsible person must ensure that the service users financial affairs are resolved and that they have access to their own finances. The Inspector viewed accident and incident records, which showed appropriate action taken by the home and that accidents/incidents were being monitored by the manager, as previously recommended. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 16 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, 30. The premises were meeting the needs of the people using the service, however little progress has been made to ensure that the condition of the building is improved. EVIDENCE: The home provided adequate living space for service users. None of the service users living in the home were on respite/emergency/short-term placement. The home had one wheelchair user at the time of the Inspection, who occupied the room on a ground floor. There are two kitchens (one on each floor in the building). The kitchens were generally clean and well maintained with the exception of few tiles coming off the wall in the kitchen on the first floor, which have not been replaced since the last inspection visit. The registered manager must ensure that the wall tiles in the kitchen on the first floor are replaced. This is a repeated requirement. The home has a sufficient number of toilets, bathrooms and shower facilities. Several door could not be fully closed and required attention. The carpets in one of service user’s room (on the first floor) have been cleaned since the last inspection.
Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 17 Kitchen drawer next to the cooker/stove in the upstairs kitchen remains missing. The worktop in the same kitchen must be made stable, as previously required. Homer Road is a purpose built building; those service users who needed specialist equipment (i.e. hoist) have been assessed by occupational therapists. Satisfactory equipment was in place and available throughout the house. The home met the needs of the current service user group in terms of moving and handling. The home had satisfactory arrangements for repairing and maintenance of specialist equipment. The home had appropriate clinical waste disposal arrangements in place. Laundry facilities were kept clean and in good working order and appeared to be appropriately ventilated. The home was found clean and hygienic at the time of this inspection. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 18 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, 36. Staff working in the home were appropriately trained and committed to supporting service users in a friendly and professional manner. The home is continuously staffed and there were appropriate staffing levels in place. Recruitment practices were satisfactory. Staff received regular supervision. EVIDENCE: Duty rosters were displayed in the home. These showed that there were sufficient numbers of staff on each shift to meet the needs of those living in the home. There are 4 staff working in the home during daytime on each shift (2 members of staff on each floor). In addition there were either 1 or 2 care staff working flexible hours during the day. There is one person sleeping in and one waking night staff in place during night time. There was a mix of gender to provide personal care. There was an assessed person on each shift, who would be in charge of the medication. The inspector was informed that at the time of this inspection, there were four staff vacancies, however shifts were covered with regular bank and agency staff, who were aware of the service users’ needs. Staff training records showed that Heritage Care provide a wide range of courses to its staff. The majority of care staff working in the home have obtained their NVQ qualifications. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 19 Staff personnel files have been updated to include all information required by law. As part of visit, the inspector checked staff supervision file for one member of staff, who was being supervised by the person in charge on the day of this inspection. File viewed showed that regular supervision sessions were now taking place, as recommended. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 20 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, 41, 42. Little progress has been made to ensure that the service user’s needs were being met. These shortfalls have a potential to place residents at risk. EVIDENCE: The standard relating to the registered manager could not be assessed, as at the time of this inspection, the registered manager was on secondment until the end of January 2006. This standard will be inspected during next inspection visit. The inspector checked reports from the “responsible person visits”. The report from November visit was not available. The visitor’s booked was check to establish whether the responsible person visited the home that month, however no record to such effect was found. Additionally, the was no record in the visitor’s book that the responsible person signed himself in during the month December on the day when his “responsible person visit” took place. The requirement in relation to the “responsible person visits” has therefore
Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 21 been repeated. Additionally, it is required that the visitors book is maintained at all times, as required by the legislation. The home’s registration certificate shows the name of the previous responsible person has moved to another region. The organisation appointed a new person, who has been overlooking the running of the home for over 6 months, however at the time of this inspection visit, no formal notice has been given to the Commission about the change in the responsible person. It is required that an application is submitted to the Commission for the responsible individual to become registered. This is a repeated requirement and must be met without any further delay. As described in previous parts of this report, some of the documentation required in the home required improvement. This included care plans, fridge/freezer temperatures record, service users’ weight records, reports from the visits of the responsible person and visitors book. The requirement for the fire drills to be carried out on a regular basis has now been met. All other fire safety arrangements were also in place. Fridge/freezer temperatures were not being recorded on a daily basis. The registered manager must ensure that fridge/freezers must be recorded on a daily basis. The home had appropriate insurance cover in place. Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 x 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 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 3 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 x 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 x 2 3 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 2 x x x x 2 x 2 2 x Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 23 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 YA24 Regulation 13(4) Requirement Stains on ceilings in toilet/wet room and bathroom must be repainted. (Previous timescales of 01/03/04, 15/11/04, 01/03/05 and 01/12/05 were not met.) Timescale for action 01/04/06 2. YA24 13(4) Cracks in the wall around the 01/04/06 doorframe by staff sleepover room must be refilled and replastered. (Previous timescales of 01/04/04 and 15/11/04, 01/03/05 and 01/12/05 were not met.) It is required that care plans are regularly updated/reviewed to reflect changing needs of the service users. (Previous timescales of 15/03/05 and 15/11/05 were not met.) The registered manager must ensure that service user’s weight is monitored and recorded as indicated within care plans. (Previous timescales of 15/03/05 and 15/11/05 were not met.) 01/03/06 3. YA6 15(2)(b) 4. YA19 12(1)(a) 01/03/06 Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 24 5. YA39 26 It is required that the person in control visits are undertaken on a monthly basis and are unannounced and that report from each visit is forwarded to the home without delay. (Previous timescales of 01/02/05 and 15/11/05 were not met.) It is required that the responsible person ensures that the individual service user contracts are signed by all relevant parties. (Previous timescale of 01/12/05 was not met.) The registered manager must ensure that the wall tiles in the kitchen on the first floor are replaced. (Previous timescale of 01/12/05 was not met.) Kitchen drawer next to the cooker/stove in the upstairs kitchen must be replaced. (Previous timescale of 01/12/05 was not met.) The worktop in the upstairs kitchen must be made stable. (Previous timescale of 15/11/05 was not met.) It is required that an application is submitted to the Commission for the responsible individual to become registered. (Previous timescale of 01/11/05 was not met.) It is required that fridge/freezer temperatures are monitored and recorded on daily basis. The responsible person must ensure that the service users financial affairs are resolved and that they have access to their
DS0000035305.V278436.R02.S.doc 01/03/06 6. YA5 17 01/04/06 7. YA24 23(2)(d) 01/04/06 8. YA24 23(2)(b) 01/04/06 9. YA24 23(2)(b) 01/04/06 10. YA39 7 15/02/06 11. 12. YA42YA17 YA23 17, 16(2)(g) 20 15/02/06 01/04/06 Homer Road (22A/B) Version 5.1 Page 25 own finances. 13. YA41 17(2) Schedule 4.17 It is required that the visitors book is maintained at all times, as required by the legislation. 15/02/05 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 YA17 Good Practice Recommendations It would be a good practice for the home to provide menus in pictorial form for those with limited communication skills. It is recommended that the service user meetings be reintroduced in the home. 2. YA8 Homer Road (22A/B) DS0000035305.V278436.R02.S.doc Version 5.1 Page 26 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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