Inspection on 26/06/07 for May Road (1)

This inspection was carried out on 26th June 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

May Road (1) 26/03/07

May Road (1) 30/06/06

May Road (1) 22/02/06

May Road (1) 08/03/05

May Road (1) 05/10/04

May Road (1) 08/03/04

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 09/07/2008.

CARE HOME ADULTS 18-65 May Road (1) 1 May Road Chingford London E4 8NB Lead Inspector Julie Legg Unannounced Inspection 26 June – 4th July 2007 10:00 th May Road (1) DS0000036520.V343803.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 May Road (1) DS0000036520.V343803.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. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service May Road (1) Address 1 May Road Chingford London E4 8NB 020 8527 5258 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) Annette.Baidoo@walthamforest.gov.uk London Borough of Waltham Forest Vacant Care Home 22 Category(ies) of Learning disability (19), Learning disability over registration, with number 65 years of age (3) of places May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th March 2007 Brief Description of the Service: The home is operated by The London Borough of Waltham Forest and is subject to the policies of the authority. It is a purpose built facility providing accommodation, care and support for 22 residents with learning disabilities. The home is arranged into four units, three of these units are on the first floor and as there is no lift to access the first floor these units would be inappropriate for anyone experiencing mobility difficulties. The home offers permanent and respite care. It is situated in a residential location and is close to the town centre, providing easy access to all local amenities, leisure facilities and transport services. May Road (1) DS0000036520.V343803.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 took place over a day. The acting manager was present for the duration of the inspection and was available for feedback at the end of the inspection. Discussion took place with the acting manager, two deputy managers and care staff. Care staff were asked about the care that residents receive and were also observed carrying out their duties. The inspector spoke to residents who were asked to give their opinions on May Road. Relatives, health professionals and Mencap were also contacted for their views on the service being provided at May Road. A tour of the home was undertaken and all of the rooms were clean and free from any offensive odours. Residents’ files were case tracked; including risk assessments and care plans, together with the examination of staff files and other home records. These included medication records, staff rotas, menus, and accident/incident records and staff recruitment procedures. Additional information relevant to this inspection has been gained from the Annual Quality Assurance Assessment, Regulation 26 reports and Regulation 37 notifications. The inspector had a discussion with the acting manager on the broad spectrum of equality & diversity issues and she was able to demonstrate a good understanding of the varied needs around religion, sexuality, culture, disability and gender. The inspector was concerned at the disabilities of some of the residents and whether May Road was the most appropriate service to meet their needs. The acting manager has recognised this and has taken steps to address this by referring to health and social care professionals. Some of the health professionals that were contacted by the inspector also shared her concerns and one stated, “I think the staff are doing a good job particularly in the circumstances”. The inspector had a discussion with the people living at the home and the acting manager about how they wished to be referred to in this report. The people living at the home said that they didn’t mind or didn’t know, however, the acting manager stated that they are referred to as residents. This is reflected accordingly throughout the report. The Statement of Purpose and the Service User Guide is on the notice board and is also available from the acting manager. Every resident has been issued with the Service User Guide, which is in written and pictorial format. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 6 The inspector would like to thank the residents, the acting manager and staff for their input during the inspection. What the service does well: What has improved since the last inspection? The acting manager and staff have made some significent improvements since the last inspection. The acting manager has devised a pre-admission assessment pack and the home will carry out their own assessment of the prospective resident to ensure the home can meet their needs. Residents’ monitoring charts are now being regularly completed. Risk assessments and health action plans have been undertaken for all the residents and have been reviewed, when required. Two of the residents have been referred to the Community Learning Disability Team for a reassessment of their needs. One resident has been reassessed; the home is awaiting the outcome. The other resident is awaiting the allocation of a social worker. The Commission is now being notified of all significent events that happen within the home. The home’s fire safety checks are undertaken and the fire risk assessment has been drawn up as required by the London Fire and Emergency Planning Authority. The requirements from the previous electrical wiring inspection have been completed. The home has purchased a wheelchair May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 7 weighing scales and new gates have been fitted to the car park to enhance the security of the building. The acting manager has applied to The Commission to become the registered manager of May Road and the Statement of Purpose has been amended to reflect her details and those of the current staffing levels. The responsible individual is now undertaking monthly visits to the home and the Commission has access to these reports. 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. The summary of this inspection report can be made available in other formats on request. May Road (1) DS0000036520.V343803.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 May Road (1) DS0000036520.V343803.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 and 2 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Prospective residents and their relatives have the information they need to be able to make an informed choice about moving into the home. The home’s admission procedure has now improved and prospective residents will have a full assessment of their needs prior to them moving into the home. This will ensure that the home can meet the prospective residents’ needs. There are currently some residents whose needs could be met more appropriately met in a different care setting, and action is being taken to address this. EVIDENCE: The home’s Statement of Purpose has been amended and now has details of the present acting manager and the changes in the home’s staffing levels. Both the Statement of Purpose and the Service User Guide are available to all residents and the Service User Guide is in a pictorial format. There have not been any admissions since the last inspection. At the last inspection it was noted that the home did not have a pre-admission assessment and relied on the assessment that had been undertaken by the local authority. The acting manager has now devised her own pre-admission assessment form and will visit and assess any potential residents prior to their May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 10 admission to the home. She is also clear that if the prospective resident’s primary need is not of a learning disability, then she will not agree to their admission. This will be further tested at the next inspection. There are currently some residents whose needs could be met more appropriately in a different setting e.g. an environment more suited to people with dementia and impaired mobility. The acting manager is working collaboratively with the community learning disability team to ensure that these residents’ needs are met more appropriately. May Road (1) DS0000036520.V343803.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): 6,7,8,9 and 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. All of the care plans and risk assessments that were inspected have been reviewed and updated. Daily recordings need to be more informative on the well being of the residents, as this could have an impact on residents needs not being appropriately met. Residents are enabled to make decisions about their lives and on life in the home. This ensures that the home is being run in their best interest. Staff are mindful of not leaving residents’ files in an open area so that resident’s confidentiality is maintained. EVIDENCE: May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 12 The inspector examined four resident’s files, which contained a care plan and risk assessments. Staff were observed interacting with residents and some elements of the care plans were discussed with the manager. Each resident has a care plan but the process of involving the residents and relatives (if appropriate) in developing and reviewing the care plan is variable. The care plans identify personal care, social care, religious and health care needs of each individual resident and how these needs are to be met. One social care professional quoted (QA survey) ‘more resident involvement needed in care planning’ The care plans need to be more detailed and person centred. This is Requirement 1. The acting manager and staff have spent some considerable time in ensuring that care plans have now been reviewed and updated. One of the care plans had been updated in March 2007 and the other three in May 2007. One of the resident’s care plans was updated due to an action plan from a multidisciplinary meeting. Care plans were examined alongside the daily records and compared with the support being given. The care staff know the residents extremely well and give a verbal and written handover, however the daily records are too brief and need to reflect the well-being of the resident and how residents are involved in the life of the home. The daily records also need to evidence care plan goals. This is Requirement 2. Most of the residents are able to participate in activities within the home, assisting with tasks such as setting the tables, putting the laundry in the washing machine and putting their clean laundry away, assist in putting the shopping in the cupboards, recycling, dusting and hoovering their own rooms. One of the residents is now living in the ‘training flat’ and he is encouraged to take on more tasks, which will improve his independence. Staff were observed interacting with the residents, their relationship was easy going and friendly but in a professional manner. Some aspects of the residents’ care was discussed with the manager, particularly in relation to their personal care, dietary and social care needs. Some of the residents were asked their views about living at the home. Comments were “I’m happy here”, “the staff are blinding”, “I don’t want to live anywhere else”. There is a stable staff team, who know the residents and their needs very well but this should not stop the staff and acting manager engaging with the residents, to look at their aspirations for the future. Risk assessments that were examined showed areas identified such as, tasks and activities within the home, in the community and health risks. They evidenced that residents are being supported to experience ordinary living within a safe environment. Those risk assessments that were examined showed that they had been reviewed and updated. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 13 The inspector saw the minutes of a recent review of the placement and there was evidence that the resident had attended the meeting and was given appropriate support to participate in the process with the support of an advocate from Mencap. Relatives, key worker and the social worker also attended the review. Residents are consulted on the day-to-day running of the home, through residents’ meetings, advocates, satisfaction surveys, feedback from relatives and informal chats with the staff. Their views are taken on board regarding holidays, social activities, menu planning and the redecoration and refurbishment of the home. It would be good practice if some of the residents could be involved in interviewing process of prospective staff. This is Recommendation 1 At the last inspection it was noted that some of the residents’ files were left in one of the lounges, which could be accessed by anyone visiting the home. The acting manager has spoken to all staff about the need to respect residents’ confidentiality and that all files are kept locked when not in use. During this inspection residents’ files were not seen unattended. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16 and 17 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents have the opportunity for personal development within the home and access to day care facilities but there is only limited access to leisure activities within the community. Residents have appropriate personal and family relationships. Their rights are respected and are supported to take responsibility for their actions. Residents are provided with a diet that is varied and healthy, however staff must be vigilant to ensure that residents’ health is not put at risk. EVIDENCE: The inspector spoke to residents and staff as well as looking at residents’ care plans. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 15 Residents’ care plans identify lifestyle choice, such as leisure activities, activities within the home, day services and family contact. Daily logs record whether these activities have taken place. All of the residents have opportunity for some personal development within the home and in the community, however activities in the community could be more varied taking into their residents’ preferences and interests. Adult education classes and college placements, if appropriate could be sought. This is an area that has been identified by the acting manager, who is currently seeking the views of the residents. Some relatives commented ‘on a lack of activities’ in their survey. This is Requirement 3 Activities within the home include dance & drama, line dancing and music therapy, as well as board games, building blocks and arts & craft. Birthdays are celebrated in a way that residents choose; some have a small lunch on their unit, others have a buffet tea for the whole of the home and some have a house party. St Patrick’s day was celebrated and relatives were invited to a buffet lunch and there was entertainment at Easter. The home has two volunteers who visit on a regular basis and one of the volunteers takes two of the residents out for lunch. Some of the residents attend a local authority day centre and a luncheon club. One resident told the inspector “I like going to the centre, I see my friends”. One of the residents plays football with Mencap, another resident attends an Asian club and another attends an AfroCaribbean club. Earlier this year some of the residents went on holiday to Lanzerote and further holidays are to be arranged for later in the summer. Residents enjoy going to the hairdresser/barber and shopping for their own toiletries and clothes. As stated earlier in the report, most of the residents are able to participate in activities within the home, assisting with tasks such as setting the tables, putting the laundry in the washing machine and putting their clean laundry away, assist in putting the shopping in the cupboards, recycling, dusting and hovering their own rooms. One of the residents is currently living in the ‘training flat’, where it is hoped that with support he will become more independent with daily life skills, which could lead to semi-independent living. He told the inspector “I love it in here, I have bought loads of new stuff, it’s like having my own place”. Another resident is due to move into supported living next week and staff will be part of the transition to ensure that the move goes smoothly. Most of the residents have their own televisions and music centres in their bedrooms and there was evidence of their particular interests and hobbies. One had football poster displayed, another had car models and another a huge collection of fluffy animals. The home also has it’s own resident cat. All of the residents receive visitors, some more regularly than others and some of the residents go home to families. There are no set ‘house rules’ and residents were observed to go about the home freely. At the time of the May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 16 inspection residents were taking part in various activities; playing on their play station, listening to music, building bricks, drawing, reading a magazine, talking to staff and watching television. The inspector examined the menus, which are also in pictorial format. The cook confirmed that residents had been involved with the choosing of the meals, there are always two choices and the cook confirmed that she would cook something different if either of the choices was not to a resident’s liking. Residents’ cultural and medical dietary needs are catered for, such as, fried chicken & yams, lentil curry & rice, sweet potatoes, vegetable curry & rice, plantain, rice & peas. The cook makes apple crumble with eating apples, rice pudding with ‘canderel’ and chocolate cake mix with reduced sugar. One resident stated, “I really like the food”, a relative commented, “The food is very good”. Each unit has their own small kitchen, on green unit there were sauce bottles in the refrigerator that had been opened and the date of opening had not been recorded on them. All perishable food needs to be dated to prevent food poisoning. This is Requirement 4 May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 17 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 and20 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents receive personal care support in the way they prefer and their physical and emotional needs are met. There are policies and procedures that protect residents with the administration of their medication. EVIDENCE: Care plans and daily records were examined and discussed with the manager. The care plans identify health and personal care needs and how these needs should be met. Most of the residents require assistance with their personal care and the other residents require prompting. One relative stated, “ I am very satisfied with the care “ At the last inspection it was reported that because of the increasing levels of physical needs of some of the residents, an occupational therapy assessment should be undertaken to assess the current bathing needs of some of the residents and the home’s environment. These May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 18 assessments have been carried out and all of the residents can now access the bathing facilities. However, because of the mobility of some of the residents, it would be beneficial and give residents a choice, if a shower was fitted downstairs. There are also issues regarding the transferring and turning of residents; the corridors are very narrow and it is extremely difficult to walk beside a resident who is using a walking frame or to push a wheelchair. Some of the bedrooms are quite small, one resident requires to be turned and it needs two care staff one either side of the bed, to safely turn her, this is almost impossible to do. See standard 24. Residents were seen to be dressed in clean and appropriate clothing for the time of the year. One resident told the inspector “I choose my own clothes”; one relative stated, “He always looks clean and tidy”, another relative stated, “She always looks nicely dressed”. Records that were inspected showed that service users have personal health records. All of the residents are supported to access dentist, opticians, chiropody, physiotherapy, community nurse, and any GP or hospital outpatient appointments. The nurse co-ordinator for learning disability offers regular support to the staff to discuss any of the residents’ health issues and the physiotherapist from the community learning disability team has also been working with the staff to ensure they meet the physical needs of the residents. The district matron (community nurses) has also been supporting the home in meeting residents’ medical needs. One health professional stated, “the staff are doing the best that they can, we were alerted as soon as there was a problem”, another health professional stated, “I feel that Annette is making a difference, the staff are very helpful and ensure that residents keep their appointments”. One relative stated, “They are very quick to deal with any medical issues”. Some of the health professionals that visit the home expressed their concerns at the complex needs of some of the residents and the suitability of May Road to meet their needs. There are policies and procedures for the handling, administration and recording of medication within the home. Staff have received medication training. Medication Administration (MAR) charts and the medication cupboard were checked. There were no gaps noted on the MAR charts. Appropriate records in relation to medication received by the home and disposed of were found to be in order. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 19 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 this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Residents’ views are listened to and acted upon and the service responds to complaints within the timescales. Residents are protected by the policies, procedures and monitoring systems within the home. EVIDENCE: The home has a clear complaints procedure, which is also available in pictorial format. A copy of the procedure has been made available to all of the residents and to their relatives and advocate. Since the last inspection there has been one complaint from an agency worker regarding her working arrangements, the acting manager has dealt with this. A compliment letter (thank you note) had been received from a relative The acting manager welcomes complaints and suggestions about the service. In discussion with the residents and information received from relatives, they were aware of the complaints procedure and would have no hesitation in making a complaint if necessary. Some of the residents were asked, “if you were unhappy about something who would you tell?” answers were “I would tell X (a member of staff)”, “I talk to Y (a member of staff)”, “I would tell my brother” or Annette (manager)”. A relative stated “I would go straight to the manager, if I had a problem”, another relative stated “I spend a lot of time there and I can assure you that I would let the May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 20 authorities know if there were any problems. You can give them a big tick from me”. The home has policies and procedures for the safekeeping and expenditure of resident’s’ monies. Residents are given support to make purchases, receipts are kept for all expenditures and records of money held. During this inspection three residents’ accounts were inspected and all were in order. The inspector viewed the records of accidents and incidents and these correlated with the notifications of significent events that are now being submitted to the Commission. The home has the local authority ‘s (London Borough of Waltham Forest) policies and procedures on Safeguarding Adults. The acting manager was clear about what incidents needed to be referred to the Local Authority as part of the safeguarding procedures. A member of staff that was spoken to was very clear on what constituted abuse and their responsibilities to report any potential abuse. Staff files indicated that not all members of staff have attended formal Safeguarding Adults training. This is Requirement 5. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 21 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): 24,25, 27 and 30 People who this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is clean and free from any offensive odours. However most of the home needs to be redecorated and some refurbishment and essential maintenance need to be undertaken to ensure that the residents are safe and comfortable. Residents’ safety could be further compromised by the physical layout of some of the bathrooms and bedrooms. EVIDENCE: The home is a purpose built two-storey building that is situated in a residential area. The home is divided into four units and three of these units are situated on the first floor. The building does not have a lift and therefore people with mobility difficulties cannot access the first floor. Each unit has their own lounge/dining room and kitchen and Green Unit have recently taken delivery of a new dining room suite, which had been chosen by the residents. There is also a ‘training flat’ on the first floor, which consists of a bedroom, lounge/kitchen and bathroom. A tour of the home was undertaken including May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 22 the residents’ bedrooms. The interior of the home is clean, tidy and free from any offensive odour. Residents’ bedrooms were personalised with televisions, CD players, ornaments, posters and photographs and two of the residents’ bedrooms have been redecorated and new carpets laid. However at this inspection it was noted that the home was showing signs of wear and tear, walls and doors needed repainting and some carpets were stained, also some of the furniture needs replacing. This is Requirement 6. Whilst touring the building it was apparent that some of the windows need attention; some cannot be opened and others cannot be closed properly. This situation could put resident’s safety at risk; therefore these windows need to be repaired or replaced. This is Requirement 7. A visit was made to both the laundry room and the main kitchen on yellow unit, the laundry was well maintained, however the kitchen is in a poor state of repair. The kitchen cupboards are old and showing signs of wear (some of the shelving is disintegrating), which makes it extremely difficult to keep clean. Ventilation in the kitchen is also a problem, as the windows do not fully open, on the day of the inspection the weather was not particularly warm but the kitchen was very hot. The kitchen cupboards need to be replaced and the ventilation in the kitchen needs to be adequate. This is Requirement 8 There is very little natural light in most of the corridors and these are quite dark unless the lights are switched on and as stated earlier in the report there is no lift to the first floor, which means residents with mobility problems cannot access the first floor. There are sufficient toilets and bathrooms for the number of residents however the staff do experience difficulty in bathing two of the residents (who require a hoist for transfers) because of the restricted space in the bathrooms. It would be beneficial and give residents a choice, if a shower was fitted downstairs. There are also issues regarding the transferring and turning of residents; the corridors are very narrow and it is extremely difficult to walk beside a resident who is using a walking frame or to push a wheelchair. Some of the bedrooms are quite small, one resident requires to be turned and it needs two care staff one either side of the bed, to safely turn her, this is almost impossible to do. The layout of the building does not lend itself to aging residents with associated problems such as sight deteriation, limited mobility and living with dementia. The registered person must ensure that all of the residents’ physical needs are met appropriately. This is Requirement 9. The garden is of a good size and during the warm weather the residents take advantage of sitting out or playing games. The acting manager has recently had gates installed to the entrance of the home’s car park, as they have experienced youths coming into the grounds of the home (the local community police have also been involved). On the day of the inspection, the area where the dustbins are sited was particularly untidy with large cardboard boxes being just thrown down by the May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 23 bins; also outside one of the side doors there were some boxes and other rubbish. It is essential that the grounds of the home are kept free from rubbish at all times and that all rubbish is disposed of appropriately. This is Requirement 10 May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Qualified and competent staff support the residents. Staffing levels are satisfactory and there are sufficient staff on duty. The staff have the skills and training to ensure that they are able to meet the individual needs of the residents. Staff are being regularly supervised and annual appraisals have taken place. EVIDENCE: The acting manager confirmed that the home is fully staffed and agency staff are only used to cover sickness, annual leave and training. The agency staff are known to the residents and are therefore are able to offer continuity of care. Duty rotas were inspected and they correlated with the staff members on duty and there were sufficient staff on duty to meet the needs of the residents. The home employs a manager, three deputy managers, 12 residential support workers and 2 members of staff who work at night. The home operates a waking night and sleeping in system, where 1 member of staff is awake and 2 May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 25 members of staff are asleep. The staffing levels were reviewed earlier this year and the deputy managers’ posts have been reduced from four to three, so that extra resources could be allocated to a support worker whose primary role will be to look at activities within the community. The acting manager advised the inspector that she is awaiting clearance from her manager to be able to advertise the post. As this decision was made earlier this year and the deputy managers have already been reduced from four to three, it is important that this post is recruited as soon as possible. This is Requirement 11 There is quite good staff retention, though sickness levels are quite high. The acting manager is working closely with Human Resources to reduce the high levels, staff have also been advised of the sickness policy and HR has attended a staff meeting. There is a recruitment policy and procedure and the local authority’s Human Resource department are involved with the selection and recruitment of staff. Staff’s main personnel file is held at the HR department, however the acting manager now has written evidence of all the staff’s Criminal Records Bureau (CRB) checks that have been undertaken by the local authority and POVA first checks were applicable. Staff receive induction training that meets the criteria of the Skills Care Council and further training has also taken place. Recent training has been undertaken in: Moving and Handling, Mental Capacity Act, behaviour that challenges and the Learning Disability Awards Framework. Two members of staff have also undertaken Dementia Awareness training, as one of the residents now has a diagnosis of dementia. One of the deputy managers has his NVQ4, another deputy is working towards his and the other deputy has just completed the Diploma in Social Work. More that 50 of the staff have achieved their NVQ2/3 and two members of staff are working towards their NVQ2. It was identified that some of the staff require training in Food & Hygiene and Moving & Handling and as stated earlier Safeguarding Adults. This is Requirement 12 It would be beneficial for the staff if the acting manager completed a training profile for each member of staff, which identified not only training they have undertaken but also what training they require. This is Recommendation 2 Staff files indicated that staff supervision and staff meetings are taking place on a regular basis and that annual appraisals have also taken place. Staff members that were spoken to confirmed that they attended staff meetings and had received supervision. One member of staff stated, “The manager is very supportive and accessible”. A member of a local voluntary organisation stated, “The staff are dedicated, nothing is too much trouble”, a health professional stated, “The staff are really helpful”. One resident stated “I May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 26 like Y she looks after me, she takes me out”, another resident stated, “They are good, they talk to me”. May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 27 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 and 42 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home is well managed, however the home is in a poor state of repair, which means residents health, safety and welfare are not always promoted and protected. Residents can be confident that their views are now underpinning the selfmonitoring, review and development of the home EVIDENCE: The acting manager has been in post since August 2007 and has recently submitted her application to the Commission to become the registered manager and has commenced her Registered Manager’s Award. The acting manager has previous management experience of working with people with a May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 28 learning disability, as well as holding NVQ4 in management and a nursing qualification. She is currently in the process of obtaining her NVQ4 registered Manager’s Award. A member of a local voluntary group stated, “Annette is doing a brilliant job, she knows the residents well and the staff feel valued”. A health professional stated, “I feel that Annette is making a real difference”. A relative stated, “Annette has improved things, she is trying very hard to get a few extras”. Discussions with the manager showed she was able to describe a sense of direction for the home and areas that require improvement. The manager has carried out spot checks on the home outside of ‘normal hours’ and this is supported by supervision of staff and other quality monitoring systems, such as, residents’ meetings and information gathered from stakeholders and advocacy service. There are some residents whose needs are not being appropriately met at the home and the manager has been working collaboratively with the multi-disciplinary disability team and the advocacy service to look at the most appropriate service for these residents. It is important that when decisions are made regarding these residents, they are acted on as soon as is feasibly possible. This will ensure the safety and wellbeing of these and the other residents in the home. As stated earlier in the report residents’ meetings are taking place and all of the residents are encouraged to have an input. Mencap runs these meetings, with the input of one member of staff. An advocate from Mencap is also a regular visitor to the home and stated, “The home want my involvement. I was involved with the change of the keyworker system and residents’ views were listened to, I think Annette is doing a brilliant job”. There have been yearly Quality Assurance meetings that have been attended by residents, relatives, the acting manager, resource manager and Mencap, however this meeting is not very well attended and the group are looking at ways of involving more relatives and residents, one suggestion is to combine the meeting with one of the relatives meetings, which are well attended. Within the past three months the acting manager has sent out questionnaires to residents, stakeholders and relatives asking for their views on the home and the service being provided. There has been quite a good response in the return of the questionnaires, these are now being evaluated and a summary of the answers and opinions will be produced. The inspector was able to look at some of the questionnaires and overall the response was favourable. ‘The majority felt that the service had improved during the past six months, that the staff were very co-operative and the residents were well looked after’ During the course of the inspection the manager was observed leading from the front, by directly engaging with the residents and the staff. Residents, relatives, staff and other professionals who visit the home were complimentary May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 29 of the acting manager. One resident stated, “I really like Annette, she talks to me”. The inspector checked records from the responsible person, which must be carried out in accordance with the regulation 26 of the Care Home regulations. Although reports from most of the visits were available in the home, there was no evidence that a Regulation 26 visit had taken place in May 2007. A visit had taken place in June but at the time of writing this report, the report was not available. Record keeping within the home has improved and most of the records that were seen were being maintained and kept up to date, these included; care plans, risk assessments, health monitoring records, staff files and health & safety records. Regulation 37 notifications are being sent to the Commission as required. Fire drills are taking place regularly; fire extinguishers received their annual check in June 2007 and the fire risk assessment was completed in March 2007. The home’s emergency lighting system was tested June 2007 and there was evidence that the fire alarms are now being tested regularly. The five- year Electrical safety certificate is dated July 2002 (this is due for renewal next month) and the improvements that had been required from the previous report have been completed. The annual gas certificate was issued in July 2006 and was satisfactory. As a registered provider the London Borough of Waltham Forest, as with all other registered providers in the public, voluntary and private sector must ensure compliance with the Care Standards Act 2000 and the Care Homes Regulations 2001. This includes maintaining the registered establishment in providing a safe environment in areas such as, suitable kitchen equipment, appropriate food hygiene and safe working practices. This is Requirement 13 May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 2 26 X 27 2 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 3 X X 2 X May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 31 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 15(1) Requirement The registered person must ensure all service users have a care plan that are more person centred and reflect their needs and aspirations. Previous timescale of 15/05/07 not met The registered person must ensure that daily records are more detailed and need to evidence care plan goals. The registered person must ensure that residents are offered more varied and person centred activities. It is required that all perishable food is labelled once opened to prevent food poisoning of the residents. Previous timescale of 01/05/07 not met The registered person must ensure that all staff have received training in Safeguarding Adults The registered person must ensure that all parts of the home are kept reasonably decorated and furnished The registered person must DS0000036520.V343803.R01.S.doc Timescale for action 31/10/07 2. YA6 17(1)(a) 31/10/07 3. YA12 16(2)(m) 31/10/07 4. YA17 16(2)(j) 01/08/07 5. YA23 13(6) 31/08/07 6. YA24 23 (2)(d) 31/10/07 7. YA24 23 (2) (b) 31/10/07 Page 32 May Road (1) Version 5.2 8. 9. YA24 YA25 YA27 10. 11. 12. YA30 YA32 YA35 13. YA42 ensure that all of the windows can be opened and shut appropriately and that the kitchen is properly ventilated 16(2)(g)) The registered person must ensure that the kitchen cupboards are replaced. 23(2)(f)(j) The registered person must ensure that the physical layout of residents’ bedrooms and the bathing facilities meet their needs. 23(2)(o) The registered person must ensure that the external grounds are appropriately maintained 18(1)(a) The registered person must ensure that the activities post is recruited to as soon as possible. 18(1)(c) The registered person must ensure that all staff undertake training in food & hygiene and moving & handling. 23 The registered must ensure the health, safety and welfare of the residents. Previous timescale of 01/05/07 not met & 23 (2) (p) 31/10/07 30/11/07 01/08/07 31/10/07 31/10/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA8 YA35 Good Practice Recommendations It would be good practice if some of the residents could be involved in interviewing process of prospective staff The acting manager should complete a training profile for each member of staff, which would identify not only training they have undertaken but also what training they require May Road (1) DS0000036520.V343803.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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. 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