Inspection on 30/06/06 for May Road (1)

This inspection was carried out on 30th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

May Road (1) 26/06/07

May Road (1) 26/03/07

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 Zita McCarry Key Unannounced Inspection 30th June 2006 10:00 May Road (1) DS0000036520.V301446.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.V301446.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.V301446.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) 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.V301446.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 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 20 service users with learning disabilities. The home is arranged for unit living in four groups. The living areas are on two floors however there is no lift to access the first floor and therefore this floor would be inappropriate for anyone experiencing mobility difficulties. The home offers permanent, respite and intermittent 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. All service users occupy single rooms that are appropriately furnished and decorated. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the result of an inspection undertaken at the end of June 2006. During the inspection the inspector met with service users and staff. A tour of the building was undertaken. There is no registered manager in post so the inspector was assisted by the senior staff on duty. The inspector read records and files pertaining to the care of service users and the running of the home. The inspector would like to thank the service users and staff for their assistance in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The service will have to demonstrate adequate pre-admission assessments. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 6 Recommendations made in the recent CAFFT report must be implemented and staff given clear guidelines in the appropriate handling of service users finances. 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. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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 May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home must be able to demonstrate that a current and full assessment of need is undertaken to establish its ability to meet the needs of the service users admitted. EVIDENCE: The files of two service users recently admitted were reviewed. Both service users were previously placed in other services. Senior staff confirmed that the service users had not been assessed by the staff at the home prior to admission. One service user had a community care assessment that was two years old and not reflective of his current needs. The assessment of the other service user’s needs did not commence until over a week after her admission to the home. The inspector noted that one service user’s admission was rushed due to difficulties presented at the previous placement. It is crucial that staff have addressed these in a timely fashion in an attempt to ensure they can meet the prospective service users needs. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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, 8, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home will need to record arrangements for how it will meet all service users needs. EVIDENCE: One service user did not have a care plan in place. However on balance the inspector read another care plan that was presented in a text and pictorial format, it was sufficiently detailed to guide staff in providing the appropriate level of care. The inspector tracked the information in the care plan and was pleased to note that it an accurate reflection of the occupational therapist’s recent assessment of need. The inspector met with the service user who did not have a care plan in place and who said most of his day was spent watching television staff advised that a lot of the service user’s day was spent in bed. Appropriate alternatives need to be put in place for this service user. The inspector read the risk assessment of the service user and was concerned to note the document had been completed by the previous placement so there May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 10 was no evidence that the staff in May Road had evaluated risks in relation to the service user living there. The inspector saw the notes for a recent review of placement and there was evidence that the service user had attended the meeting and was given appropriate support to actively participate in the process with the support of an advocate from Mencap. Family, key worker and senior staff had also attended the review. The service has been testing new ways of consulting with service users and has engaged an external organisation to facilitate and chair service users meetings. The service has experienced difficulty eliciting feedback from the facilitators and minutes were not in evidence. Whilst the service has to be commended for this move it still retains responsibility for ensuring and evidencing appropriate consultation. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support service users involvement in appropriate activities. EVIDENCE: On the day of the inspection staff and service users were busy preparing for a barbeque the following day, service users relatives, visitors and members of the local community involved in the life of the home had been invited. The garden had been decorated with flags in preparation for the England world Cup football match. It was evident at service users were involved and looking forward to the occasion. The inspector noted a line dancing session had just finished in one of the units; service users said they had enjoyed it. A member of staff had assisted a service user visit Camden in central London as outing to celebrate his birthday. There was evidence on some service users care plans that staff were supporting service users develop daily living skills such as making a cup of tea independently, and the level of supervision and prompting needed to make a May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 12 sandwich. There was also evidence that staff supported service users to undertake recycling by visiting a recycling bank regularly. May Road has a long history of welcoming and involving service users relatives in the life of the home. A service user told the inspector that his brother visited regularly and there was evidence in a variety of records that relatives are in contact with the service. The inspector observed some very positive interaction between service users and staff. From discussion with staff it was evident that they had a good knowledge of service users needs and their responsibilities in meeting them. In reading a service users care plan who has identified needs around food the inspector was pleased to note that the staff had recorded the list of limited foods the service user was happy to eat. There was sensitive monitoring of the service users eating habits. Inspection of the home’s menu evidenced a choice at mealtimes and four service users told the inspector that they liked the food provided. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home will need to ensure individual service users health care needs are planned for. EVIDENCE: An adapted bathroom has been recently refurbished, there was however an apparent lack of planning as the bath had been raised the existing hoist and sling could not accommodate the new position of the bath. As a result three service users had to visit another local authority service to have a bath. The Commission had not been advised of this and considers it inadequate that frail service users with cognitive impairment have to visit another service to have an assisted bath. Staff were unable to advise the inspector then the ordered equipment would be delivered to the home. The service uses generic health care plans from the “health for all” initiative. The one seen at the inspection was wholly inadequate and failed to reflect the individual health care needs of the service user. One service user had very specific needs around nutrition and mental health but neither of these needs were addressed in the health care plan. The inspector undertook a random check of service users medications held and managed by the home. There was evidence on several records that although May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 14 medication had been removed from blister packs there was no corresponding initials on the medication administration records, therefore the service was unable to demonstrate that the service users have their medication as prescribed. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service responds to complaints within its own timescales however guidelines on the appropriate handling of service users finances must be implemented. EVIDENCE: There has been one complaint received from a relative since the last inspection. There was evidence that the home responded to the complaint within its own timescales. There have been no recorded adult protection issues since the last inspection. Staff have received training in adult protection and their responsibilities in responding to suspected or actual abuse. The organisation has recently concluded a major investigation into the conduct of the home in particular the management and handling of service users finances. The inspector checked three service users finances. Cash is held securely in two safes. For service user A the cash held matched the recorded balance on the cash record sheet. The inspector noted there was receipts accounting for cash spent. For Service user B the cash record sheet noted a balance held of £54.70 however on checking the cash the inspector and deputy manager counted £34.70, a shortfall of £20.00. The deputy manager was unable to account for the missing £20.00. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 16 Service User C had been out for the afternoon as a birthday treat, staff had supported him on the outing. It was evident that the service user’s personal monies had funded the member of staff’s lunch. The inspector was advised that within the home it was “custom and practice” for service users to fund staff meals on outings. This particular issue was a major aspect of the investigation and the report found that staff benefited at the financial detriment of service users. It is of concern that recommendations made in that report have not been implemented. The procedure for managing service users monies fails to provide staff with sufficient guidance in the protection of service users from financial abuse. There is no guidance regarding service users funding staff meals, travel etc. It was confirmed that if staff have a meal at work this is provided by the service in the promotion of social interaction. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 17 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is comfortable and clean and well situated near local shops and amenities. EVIDENCE: May Road is a comfortable and clean home throughout. The staff team have worked hard at treating the garden furniture and making the area comfortable and inviting for service users to enjoy. Each unit is self-contained with its own lounge and dining room. The home is situated close to local amenities and shops staff regularly support service users to visit the local shops. Service users are offered a key to their bedroom although not all choose to use it. As recorded earlier in the report several service users have been without an accessible bathroom for some time. The home has a laundry with flooring that is easily cleanable and industrial type machines that have sluicing programs if needed. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service’s recruitment processes fail to protect service users. EVIDENCE: Whilst the service is carrying staff vacancies these are filled by long term agency staff so whilst it is not ideal service users have care provided by an established team. From discussions with staff they were able to demonstrate a good knowledge of service users needs and their role in meeting them. The inspector observed service users were evidently comfortable with their respective carers. Examination of staff files was undertaken at the centralised Human Resources Department for the Borough. It was identified that five staff either had no files, or there was no evidence that a CRB disclosure had been obtained. This position greatly compromises the welfare of service users, is contrary to Regulations, and immediate remedial action is now required. Enforcement action will be taken for failure to comply with the stated requirement. Like recruitment training is centralised. Whilst staff have had training in areas such as adult protection and challenging behaviour the service does not have a training and development plan nor has the service undertaken a assessment of May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 19 individual staff training needs. The home does not use a induction and foundation training program that meets the Sector Skills Council specifications. There was evidence that staff supervision had begun but this varied greatly in content and frequency. The inspector noted that of the three files randomly selected all staff had their annual appraisals. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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): 37, 39, 40, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service will have to undertake fire safety checks to ensure the health and safety of service users and staff. EVIDENCE: The service has not had a registered manager in post for over two years now and this causes the Commission considerable concern. Currently a service manager is available to support the staff team but this is in addition to the extensive service management responsibilities of his own job description and therefore unsatisfactory. One of the consequences of the home having no registered manager in post is that it lacks any service development plan or operational leadership. However senior service managers do respond to concerns and complaints. There was evidence that as a result there are strategies evolving for ensuring service users and staff affect the running of the home such as team building days, May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 21 garden projects, external facilitators, involvement of external advocate agencies and detailed care plan reviews. From the examination of staff files referred to earlier in this report it was noted that the Local Authority did not hold appropriate records, or evidence of satisfactory CRB disclosures for two staff with line management responsibility in the home. This constitutes a serious breach of Regulations and causes concern to the Commission. Action is now urgently required to ensure that operational management is not compromised by these omissions. Enforcement action will be taken for failure to comply with the stated requirement. The inspector checked the fire safety records in the home and found that the service had failed to undertake adequate fire safety checks. The fire alarm panel, which should be checked weekly, had not been tested in several months and the explanation given was that the alarm sounding disturbed one of the service users. This is unsatisfactory the health, safety and wellbeing of all the service users is paramount so the service must ensure that fire warning and safety equipment is in working order. May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 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 1 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 3 2 X 1 3 May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 23 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 YA2 Regulation 14 Requirement The registered person must ensure that prospective service users needs are appropriately assessed before admission to the service. The registered person must ensure all service users have a care plan that reflect their needs and aspirations. The registered person must ensure the service undertakes comprehensive risk assessments for service users. The registered person must ensure that service users bathroom is brought operation without delay. The registered person must ensure the Commission is notified of all significant event that may affect the wellbeing of service users. The registered person must ensure service users have a health care plans in place that reflect their individual health needs. The registered person must ensure all service users are administered their medications DS0000036520.V301446.R01.S.doc Timescale for action 25/03/07 2 YA6 15 25/03/07 3 YA9 12 25/03/07 4 YA18 23 25/03/07 5 YA18 37 25/03/07 6 YA19 15 25/03/07 7 YA20 13 25/03/07 May Road (1) Version 5.2 Page 24 as prescribed. 8 YA36 18 The registered person must ensure all supervisory staff receive training in providing professional supervision and that all staff receive supervision as prescribed by the NMS. The registered person to ensure that no person works in the home unless a satisfactory CRB disclosure has been obtained by the Local Authority. The registered person must ensure that a named person is registered with the Commission as manager of the service. The registered person must make arrangement to reimburse all service users living in May Road when their personal monies have been used to pay for staff meals, travel subsistence etc. The registered person must ensure the recommendations of the CAFFT report are implemented. The registered person must ensure there are adequate policies and procedures in place to ensure staff guide staff in the appropriate handling of service users personal monies. The registered person must ensure that staff receive an adequate induction that meets the criteria of the Sector Skills Council. The registered person must ensure that the homes fire safety checks are undertaken as prescribed. 25/03/07 9 YA34 19 25/03/07 10 YA37 9 25/03/07 11 YA23 12&13 25/05/07 12 YA23 12&13 25/03/07 13 YA40 12&13 25/03/07 14 YA35 18 25/03/07 15 YA42 23 25/03/07 May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. Extracts may not be used or reproduced without the express permission of CSCI May Road (1) DS0000036520.V301446.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!