Inspection on 01/06/05 for Milbury 46 Flambard Road

This inspection was carried out on 1st June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milbury 46 Flambard Road 07/07/08

Milbury 46 Flambard Road 15/08/07

Milbury 46 Flambard Road 20/03/07

Milbury 46 Flambard Road 20/04/06

Milbury 46 Flambard Road 25/10/05

Milbury 46 Flambard Road 11/01/05

Milbury 46 Flambard Road 26/10/04

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 46 Flambard Road 46 Flambard Road Harrow Middlesex HA1 2NA Lead Inspector Bernard Burrell Unannounced 1 June 2005 14:00 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 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 Stationary 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. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 46 Flambard Road Address 46 Flambard Road, Harrow, Middlesex, HA1 2NA Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8907 5896 020 8907 5896 Milbury Community Services Nigel McCann Care Home 8 Category(ies) of LD - Learning Disability registration, with number of places 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 January 2005 Brief Description of the Service: 46 Flambard Road is registered to provide care and accommodation to a maximum of 8 adults aged 18-65 who have learning disabilities. There were no vacancies at the time of this unannounced inspection. The registered provider is Milbury Community Services. A new manager started working at the home in May 2005 and was not registered with the Commission for Social Care Inspection (CSCI) at the time of this inspection. The home is on two floors and located on a suburban road near to central Harrow town centre. It is close to a variety of shops, health and social care facilities and services, public transportation routes and other community and leisure services. All the bedrooms are single with washbasins. There are 1 bathroom on the ground level and another on the upper floor. There is a large kitchen/dining area, conservatory/smoking room and a large garden that was overgrown at the time of this inspection. There is also a small laundry room and off street parking for several vehicles. The staff support residents with a range of personal care and there is access to specialist health and social care support services. Residents also have the free use of a vehicle used by the home. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place in one day and was assisted with input from the Operations Manager for Milbury Care Services, the new manager for the home, the deputy manager, staff, residents and the relative of one resident. All the key standards were inspected, including review of the requirements and recommendations from the last inspection report. The findings indicated some progress has been made in promoting the rights of residents, their personal health care and lifestyles and seeking their views. Some progress have been made since the last inspection but these have patchy. The inspection findings identified a number of significant shortfalls that still exist. These included the poor environmental condition and maintenance of the home internally and externally, inadequate measures to maximise the safety and welfare of all residents, inadequate working tools and administrative equipment for staff at the home and lack of uniformity among the staffing team. The findings indicated action is needed to address the changing needs of some residents. The provider will also need to consider providing more space for staff to carry out administrative tasks, private meeting with residents and visitors, plus appropriate sleeping room and bath facilities for staff. What the service does well: The findings indicated the service has made commendable efforts to seek the views and opinions of residents in its 2004 annual report. The staff respect residents and allow them to exercise personal autonomy and independence. Staff offer support and encouragement to residents in some keys areas of their lives for example: seeking medical help, accessing local community services and facilities, involvement in menu planning plus listening to residents’ concerns. The senior managers from Milbury Care Services visit the home and examination of recordings at the home, verified that the person in control inspections have been done. Staff induction programmes have been thorough and their personal records and personnel files were organised and up to date. Each resident has a contract outlining the terms and conditions of their tenancy and services to be offered. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home needs major renovation, repairs and general physical upgrading to all areas of the home-internally and externally. There is need for general reassessment of each resident’s social and mental health care needs. This should help the provider to identify those residents whose needs can no longer be met satisfactorily at the home. The staff need to provide more encouragement and support to residents to help them develop independent living skills so those who are able to, can eventually move to less supported living. The staff will need to ensure all health and safety assessments and tasks are monitored better and action taken to deal with shortfalls, including fire safety tests, medication administration, risk assessments and behaviour management of each resident. The staff will need to ensure all relevant electrical and appliance tests are carried out on time and certificates are available for inspection. The provider will need to ensure that staff and residents are provided with appropriate work tools and equipment at the home such as computers and printer machine and adequate office space to carry out administrative tasks. There is also need for adequate room space where staff, residents and visitors can conduct private meetings. The care plans needed to be written in a style and format with appropriate symbols to ensure residents understand the information recorded about them. There also needs to be better effort made to assist residents with holiday planning plus accessing leisure activities outside the home. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 7 There is need for improvements in the communication among the staff team, plus clearer shift planning and a more unified approach to working as a team. The provider will need to ensure full implementation of the action plans generated from the annual and monthly reviews plus this and previous inspection reports. 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. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 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 standard(s) 1,2,3,5 The home provides a comprehensive guide to residents about the services they will receive, but no information about the environmental and physical shortfalls at the home. The home is currently not able to meet the varied needs of all its residents satisfactorily. There is a shortage of the appropriate skills and competence needed by staff to respond effectively to the challenging behaviour and mental health care needs of some residents. EVIDENCE: The home has a comprehensive guide for prospective residents written in a style and format that caters for the communication needs of people with learning disabilities. There is also an additional ‘Service Users Guide’ with details of staffing, the registered provider, the organisational structure at the home, fees charged, space for residents’ views and the most recent CSCI inspection report. It would be helpful if this additional guide is written in the same style and format as the main guide and incorporated in the Milbury guide for the home. The guides do not make any reference to the current physical and environmental shortfalls at the home or what plans are timescales to renovate and upgrade the facilities. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 10 The inspection findings indicated the home is not adequately meeting the needs of at least 3 residents. For example, the relative of a resident reported to the inspector her dissatisfaction with the quality of care offered and the physical condition of the resident’s bedroom. The relative also reported her concerns about the personal safety of residents based on her observation of aggressive behaviour reportedly exhibited by some residents. The relative also showed the inspector example of dampness in a ground floor bathroom and her relative’s bedroom. The inspector saw water leakage coming from the washbasin and noted that this area was poorly maintained. The inspector’s discussion with some staff indicated they would like to see some residents with certain levels of independent living skills be moved to less supported accommodation. They also indicated those residents whose behaviour has become challenging and difficult to manage safely, should be reassessed and move to more appropriate accommodation where their needs can be met more effectively. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9. Milbury Community Services carried out a consultation exercise with residents in 2004 about life at the home. However, there was insufficient evidence to verify many of the action plans have been carried out or that the changing needs of some residents are adequately served. Some residents are capable of making decisions about their lives and are supported to do so, others are more dependent. In addition, the risks faced and posed by residents were not fully assessed and documented as part of their care planning at the time of this inspection. EVIDENCE: The annual review conducted in 2004 was done with the input from and views of residents. The outcomes identified the views and needs of each resident and some of these have been transferred to resident’s person centred care plans. This effort was a commendable exercise by the home but there needed to be more and clear evidence of how the individual goals, aims and objectives were been implemented plus the residents’ role in the process. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 12 Some residents are capable of exploring and accessing community resources and services, but others could benefit from more support, input and prompting from staff. One relative reported to the inspector that the support received by her relative at the home was inadequate and inconsistent and that she often had to do tasks the carers should be doing, for example personal care and cleaning of the bedroom. She also stated she has made several complaints to the staff and manager but felt her complaints were not taken seriously or acted on. The provider stated this relative has chosen to do such tasks because of her need to be involved as she ahs been doing this for 58 years. The risk assessments seen by the inspector were completed in 2004. The deputy manager confirmed that the task of updating risk assessments has started. The inspector noted several were outstanding at the time of this inspection. One user with very challenging behaviour has been receiving individual support from staff on a rotation system since the arrival of the new manager. The inspector’s observation indicated that at least two staff were offering support to this resident. This meant a shortage of available staff to provide needed support to other residents. There appears to be no noticeable change to this resident’s behaviour according to comments from staff to the inspector. However, the staff are managing to contain the residents’ tendency to infringe on other resident’s space and privacy. The inspector was of the view, serious effort must be made to reassess and review the resident’s current and long-term care needs; this should also focus on whether the resident’s needs can be met effectively at the home or elsewhere. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11.12.13.14.15.17. Some residents have the ability and are proactive in accessing a range of community services and facilities with support from staff. Others could benefit from more mental and social stimulation and support. The range of meals offered are generally reflective of residents choice but more attention should be paid to monitoring the diet, nutrition and physical appearance of all residents. EVIDENCE: Several residents are able to lead proactive lifestyles and are involved in a range of community based social and cultural activities, including attendance at local day care centres. The evidence examined and assessed by the inspector indicated staff are often finding it difficult to stimulate the interests of some residents to engage in activities in or out of the home. It was recognised in the 2004 annual review and in case files that more support is needed to help all residents access leisure services and facilities. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 14 The inspection findings indicated more effort is also needed to create appropriate activities inside the home to meet the needs of those residents who are either not interested in external activities, or need prompting and support. Some residents benefit from staff support to explore the local community in activities such as shopping, banking, visits to pubs, coffee shops and walks. The inspector was satisfied that staff do respect the rights of residents to make decisions, including taking responsibilities for their choices. There was a weekly menu displayed in the kitchen and the inspector observed an evening meal being prepared by staff for the residents. The staff informed the inspector that residents’ wishes about choices and types of food and drink are respected and catered for. Recorded information showed that the issues of weight and nutrition for a few residents have been recognised as needing closer monitoring and remedial action plans. However, this objective should be extended to all residents. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20. There was a personal health profile for each resident plus recorded evidence to verify that staff offered appropriate support to access health care services, including appointments at the local hospital. However, there was insufficient evidence to show how the emotional and mental health care needs of each residents are identified and catered for. EVIDENCE: The personal health care profile for each resident provided important information and background about their health care status plus the roles played by staff to help meet those needs. Information was recorded of visits made by residents to their doctor, including hospital appointments with outcomes and follow-ups. It has been recognised by the staff and the provider that some residents do need additional support to assist with mobility, specialist equipment, behavioural difficulties and challenges, low activity and lack of exercise. However, the inspector’s examination of care plans, plus discussions with staff indicated follow-through and implementation have been lacking or difficult to achieve in some areas. For example, staff reported that it has been difficult to get some residents to be interested in things such as leisure activities. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 16 The wishes of residents regarding the management of their death and dying were noted in the individual care plan sections in the 2004 annual report. This is good practice. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23. The home has appropriate policy and procedural guidelines in place covering adult protection and complaints. However there have been several incidents with potentially serious consequences committed by some residents in the home. EVIDENCE: The home’s policy and procedural guidelines relating to the protection and safeguarding the rights and welfare of residents are in line with standard professional practices in care homes. However, since the last inspection report, the Commission has received reports of incidents at the home that had negative impact on the lives of residents and staff. At the time of this inspection, one staff was suspended pending the outcome of an adult protection (POVA) investigation by the home and the local social services. In addition, the inspector examined recorded evidence plus had discussion with staff about the challenging behaviour of another resident that has posed risks to others. Another resident has a fixation with water that often resulted in the bath being left filling up to overflowing. During the inspection, the inspector noted a bath was left to near overflowing by the resident. The matter was reported to the manager. All staff are aware of the resident’s tendency to engage in this kind of dangerous behaviour but careful and consistent monitoring appeared inconsistent. In another incident, one resident’s medication record was not in the file and staff were unable to sign and verify the medication was given. In addition, two 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 18 staff reported to the CSCI that they had to manage a morning shift where medication had to be given to residents, even though they were not qualified to administer medication. Another recorded incident in the staff communication book involved a worker leaving duty at 3pm but signed the medication charts, even though the medicines were not supposed to be administered until 5pm. The manager confirmed this incident has been investigated. The CSCI pharmacy inspector visited the home in May 2005 and issued a report to the registered provider. An action plan was submitted in June 2005. The findings of this inspection indicated the provider must review all areas of the home’s complaints and protection policy and procedures. The objectives must be to help improve, enhance and promote the safety, protection and welfare of residents, staff and visitors to the home. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 19 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 standard(s) 24,25,26,27,28,29,30. No substantial improvements have been made to the physical and environmental conditions at the home, despite statutory requirements issued in two previous inspection reports.. EVIDENCE: It has been recognised by the provider that the home’s physical environment is below National Minimum Standards (NMS). The 2004 annual report carried out by the provider also highlighted many of the defects at the home. Serious effort must now be made by the registered provider to carry out the necessary repairs, renovation and upgrading that are needed. They included, upgrading and renovation of all the bathrooms, bedrooms, conservatory, kitchen, pantry, laundry, ventilation system, windows, doors, cracked walls and flooring. Several pieces equipment were in poor state, including some in the kitchen, washbasins, bathtubs and shower facilities. There were limited storage spaces in the kitchen areas and inadequate space and rooms where staff, residents and visitors can meet in private. The staff stated the shortfalls contributed to a culture of low morale and feelings of stress and ambivalence 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 20 There is also the need for safety and mobility devices such as bath aids, grab rails, non-slip bath mats and repairs to the door of the main side entrance. On the day of this inspection, the garden was in poor state of upkeep and maintenance and could not been used by the residents. The inspector advised that urgent action should be taken to make this area functional. The manager received a quotation from a gardener and work was scheduled to start Friday 17 June 2005. The backdoor handle to the bedroom of one resident with limited physical mobility was broken and had reportedly been in that condition for several weeks. This was pointed out to the manager who arranged for it to be repaired on the day of this inspection. The steps leading from this resident’s room to the garden was judged to be unsafe. A handwritten note was posted on the door with the wordings: DANGER!!! PLEASE DON’T USE THESE STEPS. OUT OF ORDER. The inspector raised concern about the testing of the home’s water supply and heating system. An engineer visited the home during the inspection and started work to remedy the problem. Another problem identified during this inspection was the absence of any temperature control systems inside the home. This problem will need addressing to help ensure users of the home enjoy comfort and safety during changes in the weather and temperature. There was no fire extinguisher in the conservatory room that is used as the main smoking area and no evidence that a fire safety inspection has been carried out at the home by the London Emergency Fire Prevention Authority (LEFPA) service. The registered provider is now required to submit in writing to the CSCI by the statutory requirement timescale, the action plans and dates for addressing the homes’ environmental defects and health and safety shortfalls. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 21 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The staff team needed to develop the required skills, ability and competences to effectively meet the changing and challenging needs of residents. There were inadequate permanent staffing cover plus a lack of uniformity among the staff team to help achieve effectiveness in their work. EVIDENCE: On the day of this inspection, 3 care staff were on duty, including a trainee nurse on short-term placement. The newly appointed manager and deputy manager were also present. The inspector was informed that there are normally 3 care workers on duty plus either the manager or deputy manager. Some staff informed the manager that more staffing is needed on all shifts. There was also recorded information from staff raising concerns about the staffing level and commitment of one particular staff on some shifts. The provider’s employment and recruitment procedures were satisfactory and in line with statutory requirements and professional guidelines. Required preemployment checks and references were taken up for each staff and appropriate inductions carried out. The service manager informed the inspector that 4 staff are currently registered on the NVQ 2 and 3 training programme. The new manager plans to 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 22 start the Registered Manager Awards training in July 2005. There is also a training manager for Milbury Care Services with responsibility for coordinating training opportunities for staff. The staff who spoke to the inspector reported they have had training in protection of vulnerable adults, fire safety, manual handling, first aid and food & hygiene. The deputy manager reported that staff received individual supervision every 4 to 6 weeks. There was no information about professional development plans for staff except for the few who are registered on the NVQ training. The impression received from staff who spoke with the inspector, plus observation of staff at work, indicated staff are capable and competent to offer basic levels of care and support to residents. However, the particular skills and expertise necessary to work with people presenting challenging behaviour and mental health problems were not fully demonstrated. The staff did not have certain essential equipment at the home necessary to carry out administrative tasks, for example no computer, copy machine, adequate work station or storage space for office documentation and certain records. A small room on the upper floor is being used as an office and sleep-in room by staff, the manager and meetings with visitors. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,41,42,43. The provider has sought the views of residents about their life at the home. These have been recorded in the homes 2004 annual review. However, there was insufficient evidence to demonstrate follow-through and implementation of the action plans in the annual review report. In addition, the safety and welfare of residents have been compromised and inadequately safeguarded on several occasions and remain problematic. EVIDENCE: The evidence examined by the inspector indicated that the provider and staff do seek the views and opinions of residents on a range of issues that impact their lives at the home. This is a commendable effort. However, there was insufficient evidence to verify that the views and opinions received are fully acted on or implemented in full. In addition, the provider has made good effort ensuring that staff employed at the home are fully vetted and suitable to work with the service users. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 24 However, the number of reported incidents that has taken place at the home since the last inspection, plus lapses in personal safety among residents and staff, indicated serious shortfalls exist. The provider will need to review and assess all incidents at the home since the last inspection. There should also be plans put in place and actions undertaken to minimise or eradicate any negative or unsafe patterns identified or likely to occur. The process of completing risk assessments for all residents is an area that needs to be finalised without further delay. This should also involve input from other practitioners, advocates or relatives of residents. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 25 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 2 3 3 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 2 2 2 2 2 2 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 3 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 46 Flambard Road Score 3 1 2 3 Standard No 37 38 39 40 41 42 43 Score 2 2 3 3 3 1 2 G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 26 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 2&3 Regulation 14, Sch 3 (1) (a) Requirement The registered provider must ensure prompt reassessment is carried out of each residents social and mental health care needs. The registered provider must ensure that no prospective resident is addmitted to the home unless their needs can be adequately and satisfactorily met. The registered provider must ensure the changing needs and personal goals of each resident are reflected in their individual care plans and acted on. The registered provider must ensure the emotional and mental health care needs of each resident is adequately assessed and appropriate plans put in place to meet those needs. The registered provider must ensure all staff are appropriately trained in the administration of medication. The registered provider must also ensure a review of medication administraion recording is carried out. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 27 Timescale for action 30 July 2005 2. 6 15, Sch 3 (1) (b) 30 July 2005 3. 19 12, 13 30 July 2005 4. 20 13 30 July 2005 5. 23 13 (6) The registered provider must ensure that a comprehensive review of the homes safety and protection policies and procedures is carried out as a matter of urgency. The registered provider must ensure action is taken as a matter of urgency to deal with the number of incidents impacting on the safety and welfare of residents and staff at the home. 30 July 2005 6. 24 37 The registered provider must ensure the garden is maintained in good condition at all times and adequate furniture and seating is provided for use by residents. The registered provider must 30 July ensure the home is fit for the 2005 purpose for which it was intended and that safety of residents is assured. The registered provider must ensure outstanding rennovation, repairs and upgrading work at the home is carried out without further delay. The provider must provide a plan of action to the CSCI detail the work to be done and the start date. The registered provider must ensure that a fire and emergency inspection is carried out at the home by the London Emergency Fire Prevention Authority (LEFPA) as a matter of urgency. The registered provider must 30 July ensure the residents bedrooms 2005 are equipped to meet their individual needs and maintained in acceptable condition. G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 28 7. 25 & 26 23 46 Flambard Road 8. 27 23 9. 29 23 10. 30 16 11. 34 13& 37 12. 28 23 13. 42 12,13 & 37 The registered provider must ensure there are adequate number of bathrooms and toilets that are appropriately equipped to meet the needs of residents at the home. The registered provider must ensure the home has the appropriate equipment and mobility aids to meet the needs of residents individually and collectively. The registered provider must ensure the home is adequately cleaned, including individual rooms and communal areas The registered provider must ensure that its recruitment procedures and monitoring of staffs interaction with residents, work to protect and promote the welfare of residents. The registered provider must ensure the home is adequately equipped with facilities and adequate space necessary for staff to carry out their tasks in the office and other areas. The registered provider must ensure the health, safety and welfare of residents are better protected and promoted. The registered provider must consider carrying out an urgent review of its safety and protection systems and procedures. The registered provider must ensure that all required tests and inspection of equipment at the home are carried out. Certificates must be available at the home for inspection The registered provider must ensure staff are offered the opportunities to equip themselves with the required 30 July 2005 30 July 2005 30 July 2005 30 July 2005 30 July 2005 30 July 2005 14. 22 23 30 July 2005 15. 32 & 35 19 30 July 2005 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 29 16. 37,38 & 43 9 17. 42 12, 13 & 37 skills and knoweldge to work more competently and effectively with the residents. The registered provider must ensure the home is managed in ways that benefit residents and staff plus create stability and effective management of the service. The registered provider must ensure the health, safety and welfare of residents and staff are adequately protected at all times. There must be urgent reassessment and review of all incidents that have taken place and reoccurred at the home in the last several months. The registered provider must ensure the staff are fully supported and measures put in place to help cultivate a more effective and uniformed team. 30 July 2005 30 July 2005 18. 36 18, 19 30 July 2005 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. 3. 4. 5. 6. Refer to Standard 11 39 Good Practice Recommendations The registered provider should ensure each resident has the opportunities to help enhance and promote their personal development and goals. The registered provider should ensure that the views and wishes of residents are not only sought, but acted on where appropriate and possible. The registered provider should ensure the staff work more cooperatvely so that they can be more effective in trying to achieve the best outcomes for all residents. The registered provider should ensure that staff receive adequate support and well-planned supervison to help G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 30 33 36 46 Flambard Road enhance their commitment and performance of tasks and responsibilities. The registered provider should consider having a staff development day to reassess all areas of work and life at the home. 7. 8. 9. 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 31 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow HA1 1BH 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 46 Flambard Road G62 G11 S17532 46 Flambard Road V231164 010605 Stage 0.doc Version 1.30 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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