CARE HOME ADULTS 18-65
Milbury 46 Flambard Road 46 Flambard Road Harrow Middlesex HA1 2NA Lead Inspector
Mr Robert Bond Key Unannounced Inspection 20th March 2007 11:00 DS0000017532.V325262.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 DS0000017532.V325262.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. DS0000017532.V325262.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Milbury 46 Flambard Road Address 46 Flambard Road Harrow Middlesex HA1 2NA 020 8907 5896 020 8907 5896 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) Milbury Community Services Manager not registered Care Home 8 Category(ies) of Learning disability (8) registration, with number of places DS0000017532.V325262.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. As agreed on the 19th July 2006, four named service users under the age of 65 years and five named service users who have mental health needs, requiring personal care, can be accommodated. The CSCI must be informed when any of these service users no longer reside at the home. 20th April 2006 Date of last inspection 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. The Registered Provider is Milbury Community Services. The care home is located on a suburban road fairly close to central Harrow and Kenton. It is close to a variety of shops, health and social care facilities and services, public transport and other community leisure facilities. The building is on two floors. All bedrooms are single and are located on both floors. The home has a lounge, dining room and conservatory/smoking room. There is a small laundry room and kitchen. There is a large garden to the rear of the property. The home has some parking spaces on the front driveway. Otherwise there are some metered street parking places available. The home usually has its own vehicle that can be used by service users to access the community, providing there is a member of staff on duty who can drive. Fees are approximately £1,100 per week. DS0000017532.V325262.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection that considered mainly the ‘key’ National Minimum Standards (NMS) published by the Department of Health for use in care homes for younger adults. On the day of the inspection, the Manager was on leave, and the Deputy Manager post was found to be vacant pending recruitment, therefore the Inspector interviewed the two Senior Support Workers, and the Inspector is grateful for their assistance. The Inspector also met other staff members, talked to service users, toured the premises, and examined a range of records and files. The home had one service user vacancy. The Inspector assessed the home’s performance in reaching anticipated outcomes for 28 of the 43 NMS. He found that 13 outcomes were fully met, whereas 15 outcomes were only partly met. This led to the Inspector making 22 requirements and 4 recommendations. The previous CSCI inspection led to 30 requirements being made, 10 of which had been restated as they had not been achieved within the timescale set. This inspection showed that substantial improvements had occurred during the intervening year, although 7 requirements still remain from before. The Senior Support Workers reported that the home is better managed and is a happier place to work in than was previously the case. What the service does well:
The premises are sound and are well decorated, furnished and equipped, except for curtains in some bedrooms. The premises are adequately clean and hygienic, except for a lack of soap and towels in one bathroom/toilet. The garden is large, attractive and suitable for service users’ needs. Adequate parking is available at the front of the home. The home has its own vehicle. Some use is made of community activities and services. Care plans are quite well developed, and use is made of person centred planning techniques. Goals are clearly identified. Personal care needs are well recorded. Health Action Plans are in place. Service users are encouraged to be independent, and are given choices. Medication is well administered. Links with relatives are encouraged.
DS0000017532.V325262.R01.S.doc Version 5.2 Page 6 The complaints procedure is displayed in a user-friendly format. The home has only one staff vacancy. Most staff members are either NVQ trained or are undergoing that training. Staff members are trained in Safeguarding Adults procedures. Staff members have been trained in First Aid. The views of service users are obtained. Most health and safety measures are in place. What has improved since the last inspection?
The registration of the home has been varied to reflect the circumstances of the service users actually resident. The building work and refurbishment of the home, that was being carried out at the time of the previous inspection, has been completed. Therefore the premises are more suitable, better decorated, safer, and cleaner than before. The rear garden has been landscaped. Work is being undertaken to improve the care plans. Work is being undertaken to create a complete set of risk assessments on service users, and on the property. Electrical devices have been tested for safety. A new manager has been appointed. Most staff vacancies have been filled. More staff are on duty each day than was previously the case. Consultation with service users has improved in that weekly meetings are held where choices such as what should be on the food menu are discussed. Service user-friendly picture documents have been introduced. Staff members have been trained to use age-appropriate and non-judgemental language when describing service user behaviour. Staff members have been trained in ways of enhancing the privacy and dignity of service users. Medication administration records have improved. Additional staff NVQ training has been provided. Staff members have been trained in first aid. DS0000017532.V325262.R01.S.doc Version 5.2 Page 7 Staff morale has improved. Staff recruitment procedures have improved in relation to the checking of work permits. What they could do better:
A review is required of how best to meet the care needs of one service user who displays continuing challenging behaviour. The home’s Statement of Purpose and Service User’s Guide must be updated. Evidence is required to show that care plans are drawn up and reviewed with the involvement of service users and/or their representatives. Evidence is required to demonstrate that care plans are reviewed with sufficient frequency. More work is required on undertaking risk assessments of the property and on service users with a view to promoting responsible risk taking in order to further promote service users’ independence. Flexible written activity timetables are recommended. A greater emphasis must be placed on outside activities, and activities within the home. The privacy and dignity of service users must be enhanced as it is not acceptable for a service user to regularly enter other service users bedrooms and damage property. There must be an up to date record kept of the signatures (initials) of all members of staff who administer medication. The home must have a written complaints procedure that is readily available for staff to apply and to supply to any one who requests it. The home must maintain a complaints record. It is recommended that the home have a copy of The London Borough of Harrow’s Safeguarding Adults procedure. The garden shed that contains paint and white spirit must be kept locked. All bedroom windows must be provided with curtains that are in a good state of repair, or service users’ privacy and dignity must be maintained by other means. DS0000017532.V325262.R01.S.doc Version 5.2 Page 8 Sufficient numbers of bathrooms and toilets must be provided and be in a usable condition. All wash-hand basins within bathrooms and toilet areas must have soap and towels provided. All staff must receive recorded formal supervision at least six times per year. An application must be made to the CSCI to have a Registered Manager in place at the home. Service users views concerning the quality of care provided must be obtained, and the results used to inform a development plan for the year ahead. An electrical safety certificate is required, as is a water safety certificate. Fridge and freezer temperatures must be taken and recorded daily. It is recommended that hot water temperatures are increased. The placing of fire evacuation route notices must be reviewed, together with evacuation procedures, and staff training in this regard. 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. DS0000017532.V325262.R01.S.doc Version 5.2 Page 9 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 DS0000017532.V325262.R01.S.doc Version 5.2 Page 10 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 & 2. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective and current service users and their representatives are not provided with up to date information concerning the registration of the care home. One service user may be inappropriately placed in the care home at present. As no new service user has moved into the home in recent times, it is not possible to determine how satisfactory the assessment process is. EVIDENCE: The certificate of registration was seen to be displayed in the hallway of the home. The Inspector noted that the registration of the home has been subject to a variation that reflected the care needs of those service users actually resident. However, the previous CSCI inspection report made reference to a service user who had perhaps been inappropriately placed at Flambard Road. The Senior Support Worker confirmed that he was still resident and that his challenging behaviour had an adverse effect upon the privacy and dignity of other service users, and their quality of life. Several of the requirements in this report (Requirements 9, 14 and 15) have been made as a consequence of this service user’s behaviour. Other examples of challenging behaviour, that have not led to requirements being made, are also quoted. Therefore the CSCI require a report on what actions Milbury Community Services intend to take to remedy the situation. Requirement 1. DS0000017532.V325262.R01.S.doc Version 5.2 Page 11 The Inspector noted from a Milbury Head Office written assessment of the performance of the home, unsigned but dated 6th March 2007, shown to him by the Senior Support Worker, that the home’s Statement of Purpose needed to be revised. As this is still a work in progress, a requirement has been made in this report. Requirement 2. As the Service User’s Guide must contain a summary of the Statement of Purpose, that also will need to be revised. Requirement 3. The home has one service user vacancy. The Senior Support Worker reported that the room had been vacant for almost two years but that prospective service users were being considered, and that a possible new service user and their family representatives were due to visit the home shortly. The Senior Support Worker reported that the home had not received any formal referral or assessment papers as yet. The Inspector was therefore not able to assess NMS 2. DS0000017532.V325262.R01.S.doc Version 5.2 Page 12 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 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ assessed and changing needs are not fully documented in the care plans. Care plans are not subject to review as frequently as required. There is a lack of evidence to demonstrate that service users are being fully involved in drawing up care plans. Service users are consulted and offered choices collectively. As risk assessments are not complete, there is a lack of evidence to demonstrate that service users are encouraged to take risks as part of an independent lifestyle. EVIDENCE: The Inspector examined in detail (case-tracked) two service user’s care files, chosen at random. The Senior Support Worker explained that although the files contained detailed written care plans, this system had been discarded due to a misunderstanding about person-centred plans (PCP). Scrap-books had been created that contained photographs and receipts for goods bought, and which could be
DS0000017532.V325262.R01.S.doc Version 5.2 Page 13 understood by service users, and could be produced as evidence of what was actually taking place. It was reported that the current management of the home recognises the value of the scrapbooks whilst realising that formal written care planning must continue alongside the service user-friendly PCP approach. The former system has therefore been brought back into use but is not yet fully updated. Reviews of care plans are not complete. The Inspector noted that one care plan had not been reviewed since April 2006, and another not since 12th July 2006. The Senior Support Worker reported that key workers meet with service users individually to discuss the care plan but the Inspector did not see clear evidence of service user involvement in the care planning and review process. Therefore Requirements 4 and 5 are restated. The care plans do however give an indication of what service users prefer to do. The Senior Support Worker reported that service users are formally consulted about their wishes and are offered choices that enhance their independence. Weekly Residents Meetings have commenced and the Inspector noted the existence of minutes of the meetings. The Senior Support Worker also reported that service users are encouraged to assist in running the home. The Inspector examined a series of risk assessments for service users. Some risk assessments were dated February 2006, some were dated February 2007, others were undated. The Senior Support Worker confirmed that risk assessments were not complete or fully up to date. The report by a senior manager from Milbury Community Services dated 6th March 2007 indicated the same finding. See Requirement 6, which is restated. DS0000017532.V325262.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 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The range and extent of arranged activities is not sufficient. More use of community resources is indicated. More meaningful leisure activities are indicated. Family relationships are adequately maintained. Service user’s rights and responsibilities are sufficiently promoted. Service users are provided with a reasonably healthy diet in pleasant surroundings. EVIDENCE: The Senior Support Worker reported that each service user had an activity plan but the Inspector did not see a written copy in timetable form (for inspection). See Recommendation 1. What is available is a series of photographs that can be shown to service users to remind them of the activity (such as day centre attendance) that is scheduled for them. The Inspector was also shown a device that played a recorded message when particular photographs were viewed. DS0000017532.V325262.R01.S.doc Version 5.2 Page 15 The Senior Support Worker reported that no service user has employment and none currently attends any educational establishments. Use is however made of The Welldon Centre and the Harrow Resource Centre. On the day of the inspection, only one service user was out of the building (at a day centre). Going to the cinema and going shopping were said to be popular activities outside of the home. The Inspector observed that three service users were smoking and watching television, and two service users were in their bedrooms. The Inspector was shown a box that was said to contain games but no activity was being organised at the time the Inspector toured the premises. More meaningful activities must be provided within the home, and a greater emphasis placed on arranged outside activities. Requirement 7 is therefore restated and Requirement 8 is made. The Inspector noted from care plans that some service users had relatives who took an interest in their care. The visitors’ book contained some entries. The Senior Support Worker reported that service users are encouraged to make their own drinks, and assist with cooking and laundry duties. The Inspector noted that staff members knock on bedroom doors, and that generally service users have a lockable cabinet within their bedroom. It was however noted that one service user enters the bedrooms of others unbidden, and may for example tear down the window curtains. Thus the privacy and dignity of service users is being compromised, and ways must be found to counter this. See Requirement 9. The Inspector examined a menu that described sufficiently varied and nutritious food. Service users are consulted at the weekly meeting about what they would like to eat. The Senior Support Worker reported that one service user habitually eats the food of others, which will not lead to a pleasant mealtime experience. DS0000017532.V325262.R01.S.doc Version 5.2 Page 16 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 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good personal support in the way they prefer and require. Service users’ health needs are satisfactorily met. The home’s policies and procedures for dealing with medicines are satisfactory, except that no record of staff signatures is being maintained. EVIDENCE: The Inspector examined two care plans in detail. He noted that the key worker system is in use. The care plans examined contained detailed guidance for staff concerning dressing and bathing, for example. Issues such as privacy and choice were also considered within the care plans. The care plans contained a summary of health needs and dietary needs. Each file had a completed document entitled ‘My health assessment’ which had been completed in a person-centred way. Each file also contained a ‘Health Action Plan’, and the Inspector noted a letter from the Manager to the home’s General Practitioner requesting medication reviews for all service users..
DS0000017532.V325262.R01.S.doc Version 5.2 Page 17 The Inspector examined the home’s medication storage arrangements, and the home’s medication administration records. Both were satisfactory but there was no record of staff signatures of those authorised to administer medication.. Requirement 10 applies. DS0000017532.V325262.R01.S.doc Version 5.2 Page 18 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 & 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. It cannot be judged if service users’ complaints if any are acted upon as the home’s complaint record, and the home’s inspection procedure were not available for inspection. Service users are adequately protected from abuse. EVIDENCE: The Inspector noted that on the wall in the foyer was a service user-friendly version of the home’s complaints procedure. The Inspector asked to see the home’s complaints register and the home’s written complaints procedure. The two Senior Support Workers could not locate either document. See Requirements 11 and 12. The Inspector asked to see, and was shown, the home’s policy and procedure on the Protection of Vulnerable Adults (POVA). He asked whether the home had a copy of The London Borough of Harrow’s procedure on Safeguarding Adults, but none could be located. See Recommendation 2. The Senior Support Worker reported that most staff members had been trained by Milbury Community Services in POVA procedures, and two additional staff members were to receive their training on the day following this inspection. DS0000017532.V325262.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are comfortable and homely, but the garden is not sufficiently safe due to a garden shed being unlocked. Bedrooms are generally sufficiently well furnished and decorated but some rooms are not adequately curtained. The number of bathrooms and toilets in use is insufficient. The home is mostly clean enough but soap and towels must be provided in the upstairs bathroom/toilet for reasons of hygiene. EVIDENCE: The Inspector toured the premises in the company of a Senior Support Worker, and entered three service users’ bedrooms with the permission of the service users. The Inspector noted that the building work and redecoration had been completed. The home was appropriately furnished and equipped. The conservatory is a particularly pleasant room. It was however noticed that two window opening handles had been broken off by a certain service user. This is
DS0000017532.V325262.R01.S.doc Version 5.2 Page 20 not just a maintenance issue as the windows could not be opened to provide the necessary ventilation. The large rear garden has been landscaped, and contains two sheds. One is used to store old electrical items collected by a service user. The other contains garden and decorating items. As some of these items (paint and white spirit) are potentially hazardous to health, this shed must be kept locked. Requirement 13. The premises overall were seen to be clean and tidy. The kitchen floor however was sticky to walk on. The Inspector noticed that the curtains in one bedroom were torn, and were missing completely in another room. The Senior Support Worker said this was because a certain service user destroys the curtains in his own room, and enters other people’s rooms and pulls their curtains down as well. The privacy and dignity of service users is being compromised, and not all bedrooms meet the required standard for furnishing as a result. Requirement 14 is restated. The Inspector visited the upstairs bathroom and toilet and found that the window was wide open, and there were no soap and towels. The Senior Support Worker said this was because a certain service user throws these items out of the window. She added that this bathroom and toilet was not generally used as a result, and only the downstairs facilities were used during the day (one bathroom and two toilets). The NMS state that bathrooms and toilets must not be shared by more than three service users. Hence the upstairs facility must be made usable at all times. Requirement 15 is restated. Soap and towels must be provided in the upstairs bathroom and toilet, for reasons of hygiene. See Requirement 16. DS0000017532.V325262.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a staff team whose members are either qualified or who are undertaking qualifications. Sufficient numbers of staff are employed and deployed in the home. Service users are well supported and protected by the home’s recruitment procedures. Adequate staff training plans are in place. Additional formal supervision sessions for staff members are indicated EVIDENCE: The Senior Support Worker reported that recruitment had taken place since the previous CSCI inspection and that there was now a full staff team in place of 2 seniors and 6 support workers. The Deputy Manager post was still vacant but the Inspector observed an internal recruitment notice on the office wall. The Inspector examined the previous week’s staff rota and noted that three staff members were always on duty, and sometimes four, which was the situation on this inspection day. This was an improvement on the situation reported in the previous inspection report. The Senior Support Worker reported that leaving the manager aside, one member of staff is a Registered Mental Nurse, one has completed an NVQ in
DS0000017532.V325262.R01.S.doc Version 5.2 Page 22 care award, and six are undertaking the award. This is also an improvement on the situation reported in the previous inspection report. The Inspector asked to see the recruitment papers for two members of staff. He found that application forms had been completed, references taken up, passports and visas checked, and Criminal Records Bureau disclosures obtained. This is also an improvement on the situation reported in the previous inspection report. The only omission noted was that the Senior Support Worker did not have a current employment contract. NMS 34.6 states that all staff must receive statements of terms and conditions. See Recommendation 3. The Inspector examined the home’s training records that demonstrated amongst other things that new members of staff were undertaking induction training. POVA training and First Aid training have recently taken place. The Senior Support worker also reported that staff members had been trained to use age appropriate language to and when writing about service users, and had been trained to enhance service users’ privacy by making sure that bathroom and toilet doors were shut. The recruitment files were seen to contain copies of training certificates obtained. The Inspector examined the Senior Support Worker’s record of supervision received. This indicated that during 2006 she had received formal recorded supervision on four occasions. NMS 36.4 states that supervision must be at least six times a year. See Requirement 17. DS0000017532.V325262.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is better managed than before, but there is no Registered Manager in post. Service users views are taken into account but a new development plan is required. The health, safety and welfare of service users is not sufficiently promoted and protected. EVIDENCE: The present Manager, who was on annual leave on the day of the inspection, has been in post only for a few months. Both Senior Support Workers reported that working at the home was more of a pleasure, and standards had improved, since the new Manager had taken over. The Inspector noted improvements also, and the number of outstanding inspection requirements has declined. The Manager is said to have the NVQ level 3 award in care. As DS0000017532.V325262.R01.S.doc Version 5.2 Page 24 the Manager is not yet registered with the CSCI, an application is required. Requirement 18. The Inspector noted on the wall of the foyer a Development Plan for 2006. Judging by the statistics of customer satisfaction, service users had been consulted. A further survey, and plan for the year ahead, are required. Requirement 19. The Inspector noted that risk assessments for the property as a whole are not complete. He examined a gas safety certificate, and noted that electrical devices have been tested. The home does not appear to have an overall electrical safety certificate, nor a water safety certificate. Requirement 20 is therefore restated. The Inspector checked records of fridge and freezer temperatures. These are normally taken daily and the temperature ranges were satisfactory, but during the month of March 2007, there were six days when temperatures had not been recorded. Requirement 21. The Inspector checked the hot water temperature and found it to be rather cool. Records are taken regularly and show the temperature to be about 36 degrees Centigrade. The recommended temperature is 42 degrees Centigrade. See Recommendation 4. The Inspector noted that the back door from the kitchen to the garden was not marked as a ‘fire exit’. The Senior Support Worker said this was perhaps because a service user tears down such notices, but she was not aware that this was likely to be an escape route. It would be if there was a fire in the hallway or in an area of the kitchen that prevented escape into the hallway. Fire evacuation notices, procedures and staff training in this respect must be reviewed. Requirement 22. DS0000017532.V325262.R01.S.doc Version 5.2 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 Standard No Score 1 2 2 3 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 x 27 2 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 2 13 2 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 2 x 2 x x 2 x DS0000017532.V325262.R01.S.doc Version 5.2 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 YA1 Regulation 12(1)(a) Requirement Timescale for action 01/06/07 2. 3. 4. YA1 YA1 YA6 5. YA6 The home must be conducted in such a way that the health and welfare needs of all service users are met. Therefore the CSCI require a report concerning how the care needs of one service user who displays challenging behaviour can best be met without adversely affecting the other users of Flambard Road. 4(1)©,Sch1 The home’s Statement of Purpose must be updated. 5 The home’s Service User’s Guide must be updated. 15(1) It must be ensured that care plans accurately reflect the residents’ needs, aspirations and agreed goals of care and support. This process must include the resident and their representatives wherever possible. (Previous timescale of 20/07/06 not met). 15(2) Care plans must be reviewed at least every 6 months and this process must include the resident and their representatives. Care plans must be subsequently revised
DS0000017532.V325262.R01.S.doc 01/06/07 01/06/07 01/05/07 01/05/07 Version 5.2 Page 27 6. YA9 13(4) 7. YA12 16(2)(n) 8. 9. YA13 YA16 16(2)(n) 12(4)(a) 10. 11. YA20 YA22 13(2) 22 12. 13. 14. YA22 YA24 YA25 17(2)Sch 4(11) 13(4)(a) 23 as agreed at the review. (Previous timescale of 20/09/06 not met). Risk assessments in respect of 46 Flambard Road require development in order to ensure that residents can take risks safely as part of an independent lifestyle. (Previous timescale of 20/07/06 not met). It must be ensured that the agreed social and recreational goals/needs of residents are facilitated where possible. (Previous timescale of 20/06/06 not met). Greater use must be made of community facilities. The Registered Provider must ensure that the privacy and dignity of all service users is maintained (by preventing intrusions into bedrooms and destruction of property such as curtains) The medication file must contain a sample record of staff signatures. The home must have a complaints procedure that is readily available for staff members to apply and supply. The home must maintain a record of complaints, and the action taken. The garden shed containing paint and white spirit must be kept locked. The Registered Provider must ensure the residents’ bedrooms are equipped to meet their individual needs and maintained in an acceptable condition. (Previous timescales of 30/07/05, 25/01/06 & 20/07/06 not met).
DS0000017532.V325262.R01.S.doc 01/05/07 01/05/07 01/06/07 01/05/07 01/05/07 01/05/07 01/05/07 01/05/07 01/05/07 Version 5.2 Page 28 15. YA27 23 16. 17. 18. YA30 YA36 13(3) 18(2) 8(2) YA37 19. YA39 24(1) 20. YA42 23(2)© 21. 22. YA42 YA42 23(2)© 23(4) Registered Provider must ensure there are an adequate number of bathrooms and toilets that are appropriately equipped to meet the needs of residents at home. (Previous timescales of 30/07/05, 25/01/06 & 20/07/06 not met). Soap and towels must be provided in the upstairs bathroom and toilet. All staff must receive recorded formal supervision at least six times per year The registered person must give notice to the CSCI of the name of the home’s manager so that she may be registered. Service users must be consulted about the quality of care received, and the results must be used to create a development plan for the year ahead. The Registered Provider must ensure that all required tests and inspection of equipment at the home are carried out. Electrical and Water Certificates must be available at the home for inspection. (Previous timescales of 30/07/05, 25/12/05 & 20/08/06 not met). Fridge and freezer temperatures must be checked and recorded daily. Fire evacuation notices, procedures and staff fire training must be reviewed. 01/05/07 01/05/07 01/05/07 01/06/07 01/07/07 01/06/07 01/05/07 01/05/07 DS0000017532.V325262.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA14 Good Practice Recommendations Each service user should have on file a flexible written activity programme, and the home should maintain a combined version so that those on duty can see at a glance what should be happening. The home should have a copy of The London Borough of Harrow’s Safeguarding Adults procedure. All members of staff should be issued with an employment contract. Consideration should be given to increasing the temperature of the hot water for the benefit of service users. 2. 3. 4. YA23 YA34 YA42 DS0000017532.V325262.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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
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