Inspection on 27/01/06 for Milbury 694 Pinner Road

This inspection was carried out on 27th January 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Milbury 694 Pinner Road 19/07/07

Milbury 694 Pinner Road 12/09/06

Milbury 694 Pinner Road 18/06/05

Milbury 694 Pinner Road 05/08/04

Milbury 694 Pinner Road 27/04/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 694 Pinner Road 694 Pinner Road Harrow Middlesex HA5 5QY Lead Inspector Clive Heidrich Unannounced Inspection 27th January 2006 07:45 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 694 Pinner Road Address 694 Pinner Road Harrow Middlesex HA5 5QY 020 8868 1894 020 8868 1894 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) londonroad@tiscali.co.uk Milbury Care Services Limited Miss Marisa Mwape Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th June 2005 Brief Description of the Service: 694 Pinner Road is a care home providing personal care and accommodation for eight people who have learning disabilities. There were no vacancies at the time of the inspection. The home is owned by Milbury Care Services, which is a national, privately-run, care organisation operating in excess of 200 care services across the country. The London regional office, based in Henley, South London, provides senior management support to the staff and manager of the home. The home is located within a residential area of North Harrow. It is within walking distance of shops and rail links. It is on the main bus route between Pinner and Harrow. There is parking available at the front of the house. The home was opened in 1995. It is a spacious two-storey building that was not originally used for residential care but has been adapted. All the homes bedrooms are single rooms. They are all fully furnished. Most have built-in sinks. The home has two bathrooms, a shower room, and one other separate toilet. Access to the first floor is by stairs only. The home has a good-sized garden that is accessible and maintained. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across a dry morning in January. It finished at 3:15p.m. Its focus was both on compliance with previous requirements, and on assessing the core standards that were not inspected during the June 2005 inspection. The inspector met with most service users, many of whom have significant verbal communication difficulties but from whom attempts were made to understand gestures and body language. The inspector also discussed aspects of the service with staff working during of the visit, and with the manager who arrived about an hour after the start of the inspection. Additionally, care practices were observed throughout the day, most of the environment was checked on, and a number of records were sampled. Most of the service users went out to their day services during the morning. Staff provided support to those few who stayed at home. Preparations were being undertaken for a party later in the day. The inspector thanks all involved in the home for the patience and helpfulness during the inspection. Comment cards were sent out following the inspection, with the manager’s help, to people involved in with service users. Four cards from relatives, three from funding authority representatives (care managers and social workers), and one from a health professional, were returned by the time of completing the drafting of this report, which is greatly appreciated. Their views have influenced this report, but they were in summary mostly positive, with seven out of eight saying that they are satisfied with the care provided in the home. What the service does well: What has improved since the last inspection? 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 6 The standard of support for appropriate healthcare was on this occasion seen to be fully met, which improves on the previous inspection in terms of ensuring that standard check-ups in key areas take place. There have been fire-closing door devices installed on a number of doors following a recent fire authority visit. This improves both safety and access. The home now has a more suitable seven-seater car, which improves on the less-homely van that was previously used. The extensive redecoration of bathroom and toilet areas, as required at the last inspection, was mostly seen to have been well addressed. The bathrooms in particular are now attractive in appearance and are well-maintained. There were also no concerns with cleanliness and odour on this occasion. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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): None of them. EVIDENCE: There have been no vacancies in the home since the summer of 2004. Consequently the key standard was not inspected on this occasion. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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 and 9. Service users have broad-ranging care plans and risk assessments in place. A degree of reviewing and clarifying of these is needed, to ensure that the plans are clear and effective. Service users make decisions about their lives in the home. Staff intervention and support was judged as reasonable. EVIDENCE: Service users’ needs assessments and care plans were checked through. They were suitably broad-ranging. The needs assessments, and most care plans, dated from 2004. Monthly reviews of each plan were however being undertaken. In the inspector’s opinion, it was difficult to understand what the guidance was from each plan, now that each plan had altered through comments made under each monthly review. For instance, the day occupations of service users who do not go to a day service throughout the week were not up-to-date relative to feedback received during this visit. The most up-to-date written risk assessments relating to individual service users, and to general risks around the home, were being stored in a designated file. Checks of these found that an update had been undertaken 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 10 recently, to capture and address key issues, which is positive. Assessments were otherwise recorded as having no change. This was discussed with the manager, as the chances of there being no change in the needs of service users across a long time period is judged as minimal. Service users’ care plans and risk assessments need to be effectively reviewed and updated, so that key needs can be clearly captured and effectively addressed. It is suggested that care plans be re-written after each formal review meeting, and that the plans link with the goals identified for each service user. It is also recommended that there be evidence of how each goal is progressing, to help focus towards achievement of the goal. The manager stated that all service users have had recent formal review meetings. These involved additional input from service users’ family representatives and from funding authorities’ representatives. Minutes of these meetings were not yet available. The inspector noticed that in most cases, these meetings had occurred after a gap of around a year. The manager must ensure that formal review meetings are held every six months, regardless of funding authority presence at these meetings, so that the ongoing support of the service user can be effectively and openly considered amongst all involved people. In terms of service users making decisions about their lives with support as needed, the inspector generally saw staff only making interventions with service users’ choices in respect of safety and appropriateness. When service users asserted themselves however, staff backed off and reconsidered the need for the intervention. It was also positive to note that service users who were not going out could stay in bed until they were ready to get up. Staff and the manager discussed with service users about their occupation for the day. One service user chose to stay at home to undertake a supported activity, instead of pursuing the planned visit to a day service. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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): 11, 12, 13, 14, 16 and 17. Service users have good opportunities to be part of the local community, and they have reasonable opportunities to pursue appropriate leisure activities. Some service users however lack support for taking part in appropriate daytime occupations, which must be addressed. Service users are offered reasonable diets with some degree of choice involved. Their rights and responsibilities are adequately recognised, and there is some opportunity for personal development. However, planning and documentation of such development needs to be improved on. EVIDENCE: The inspector observed service users being supported with undertaking simple ordinary living skills such as clearing the table after a meal. As per standard 6, there now needs to be evidence of how service users’ skills developments are captured and evidenced, and of how further work will be supported by staff. Most service users attend day services for four or five days of the week. Three different services are used, based on service users’ needs and opportunities. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 12 The day occupation plans of service users who do not attend day services throughout the week were not up-to-date, relative to feedback received from staff and the manager in this respect. For service users who stay at home on some days, there was little evidence of structured planning for these days. Checks of the previous two weeks’ daily records found little evidence of occupation on those days. This also reflects what the inspector saw of activities during the day for those service users who stayed at home. The manager must ensure that structured activity plans are set up for service users who stay at home on some days during the week, and that there is evidence of how these plans take place and are monitored. The manager noted that the home’s designated activities coordinator is starting this process. It was positively noted that a number of group activities have recently taken place for service users. There was feedback about a number of parties that have taken place, and about going out recently to a cinema and a local temple. There is a new musician who visits weekly, whom one service user was able to feedback positively about. One service user said that they had recently been to watch their favourite football team play at their stadium. Records also showed regular attendance for individual service users at such community activities as a local church and the Tanglewood club, in-house for music sessions, and for unstructured activities such as undertaking art in the home. The home now has a seven-seater car that staff can drive in support of service users. It is seen as appropriate to the service. A designated driver is shared with other local care homes of the organization on some days of the week, to support with driving the car, whilst the home itself has three drivers amongst the staff team. The manager also noted that all service users have taxicards to assist with the cost of going out, and that some service users are supported to take buses where appropriate. In terms of rights and responsibilities of service users, staff were seen to knock on service users’ bedroom doors before entry. One service user’s right to stay in their room throughout the visit due to an illness was respected. There was feedback from a service user and a staff member that service users have keys to their rooms where they can use them. All bedrooms were seen to be lockable from the inside. The manager noted that service users’ meeting have been tried in the home. A variety of communication methods are being used for this purpose, to try to gain service users’ opinions on matters about the home. The manager spoke positively in terms of new ideas in this respect. Service users were provided with a nutritious breakfast of porridge that was served to all who were downstairs the time. Where one service user did not eat this breakfast, staff asked them what they would like instead, and it was 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 13 provided. Discussions with staff prior to this found them to be aware of and prepared for this possibility with this particular service user. Menus on display in the kitchen showed that choice is offered to service users, in the first instance, for breakfast on four days of the week. The manager explained that the need to provide variety and nutrition was the reason for providing set breakfasts on the other three days. Discussions with the manager ascertained that service users may in fact have breakfast at any time under normal circumstances. Being one staff member short this morning had necessitated breakfast not being served until most service users were up and dressed. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Progress has been made on improving arrangements to ensure that the healthcare needs of service users are identified and met. Service users receive appropriate personal support and medication support. EVIDENCE: Service users were appropriately dressed in well-maintained clothing from the start of this visit. The inspector saw evidence in bedrooms that service users are supported to maintain good amounts of personal clothing. There were no concerns with the support provided by staff to help service users to maintain appropriate appearances where needed. The health and social care professional comments received mostly included that they are supported to see service users in private. Two of the four relatives however noted that privacy is not provided when they visit, which management should consider. Checks made by the inspector found that service users have all received dental and chiropody input within reasonable timescales, as previously required. There was written evidence of service users being supported to attend appointments with GPs and other health professionals. This included one case 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 15 of medication reduction that was ongoing at the time of the visit. This is good practice. There were also detailed records of the ongoing health issues that service users have in the home. Comment card feedback from a health professional noted that staff refer for professional support appropriately, that staff handle medication appropriately, and that staff follow guidance provided by them. There are systems in place to ensure that medication is given to service users correctly, including through use of medication blister-packs that are pre-filled by a pharmacy. There were no concerns with how staff undertook the medication administration process. Records showed that service users may refuse medications if they wish. Written procedures in this respect are followed, to re-offer the medication later and in different circumstances, and with how to monitor health if the refusal remains. It was found that all the requirements of the CSCI pharmacy inspectors report, of December 2004, had been addressed. This includes for a more secure method of transporting medicines around the home when administering, and for keeping guidance on specific issues up-to-date. The manager reported that all staff had just received medication training from their pharmacist. The manager ensures that new staff are fully inducted into appropriate administration procedures, for which staff have to pass audits of their capability. She aims at 6-monthly reassessments, which is good practice. Checks of the medication stored in the home found no significant concerns. It is recommended that a date of opening be kept on liquid medications so as to assist with appropriate dates of disposal. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. A small amount of work is needed to ensure that complaints are properly captured, recorded, and addressed. There are systems in place to ensure that service users are protected from abuse. However inconsistencies with guidance, training and practices must be addressed. EVIDENCE: The manager reported that there has been one complaint about the home since the last inspection. This related to the noise from a party in the summer. It was addressed at senior management level. At the time of drafting this report, a request for information about this complaint was being dealt with by senior management. The complaint file for the home was empty. The manager must ensure that all complaints about the home are captured and recorded about, including outcomes. This would show transparency to authorised people, and would assist in showing that the complaints procedure is fully operational within the home. One service user was able to explain to the inspector that staff and the manager listen and act upon their concerns. Three of the four relatives’ comment cards noted that they are not aware of the home’s complaints procedure. Three also noted that they have raised complaints in the past. The manager should ensure that relatives are made fully aware of the home’s complaints procedures. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 17 The manager explained that she views all accident and incident forms, and that they are collated monthly for further auditing at head office. The incident forms for the service users with the most challenging behaviour were checked through. These were in the form of ABC charts that provide a good amount of detail. They also showed that the strategies in response to one service user’s challenging behaviour were not always being followed. This ties in with the lack of clarity about care plans in general, as noted under standard 6. The manager must ensure that the strategy is clear, and that staff follow it. The manager noted that a behaviour therapist who works for the organisation is due shortly to spend time working in the home in support of analysing how some service users challenge the service. There will then be training provided to all staff based on their observations during that week. This is encouraging, particularly as there was feedback on one care manager’s comment card about the need for such training. Staff also received training in non-violent crisis intervention from the local council’s learning disabilities team a few weeks before this inspection. Training records showed that there are some staff who have not had training in the protection of service users from abuse. This must be addressed. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 18 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, 25, 26, 27, 29 and 30. Improvements have been made to the environment of the home since the last inspection, especially within bathroom areas, so providing for a generally comfortable, clean, and safe environment. Service users bedrooms’ also meet their needs. A number of maintenance issues need however to be addressed from this visit, particularly in respect of the efficiency of the radiator system in some areas of the home, and in terms of there being no curtains in the lounge. EVIDENCE: The indoor and outdoor living space was comfortable and homely. There were good standards of decoration in general. The extensive refurbishment work needed for bathrooms and toilets, from the last inspection report, was seen to have been comprehensively addressed. One relative’s comment card noted that the home is always clean when they visit. There were no concerns with standards of cleanliness on this visit. An audit of the furnishings of four bedrooms was undertaken by the inspector. There were no concerns with the homeliness or the standard of furnishings. Rooms had for instance, suitable curtains, chairs, and cupboard space. The 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 19 rooms were personalized to meet the needs and lifestyles of service users, such as with football-related items and with books. There were a few significant, and a number of minor, maintenance issues, that all need addressing according to priority: • The radiators in the rooms to the left-hand-side of the house were not providing any heating. This included in the rooms of two service users, one upstairs and one downstairs, and in the staff sleep-in room. These rooms consequently felt quite cool. Electric heaters were seen to be in place in the rooms, and the manager explained that radiators had been checked by a professional the previous week. She had nonetheless rereported the issues to the organizations local maintenance department. Temperatures elsewhere in the home were judged as reasonably warm. (The manager reported that after the inspection that this issue had been addressed.) • There were no curtains in the lounge. Net curtains were in place, but this is not sufficient for privacy and homeliness at night. • The seventh step up from the ground floor gave way a little at one side. The manager noted that the whole stairs are due to be replaced, but this issue must be remedied promptly so as to avoid an accident. • There were areas of stairway and kitchen walls that had significant staining due to a leaked external pipe. The stairway area measured approximately 30x70 cm., and was orange in contrast to the white walls. The areas need resealing and consequent repainting, as also stated in the last inspection report. • The toilet seat in the shower room was very wobbly. The manager must ensure that there is a secure toilet seat in place so as to minimize the chances of accidents. • The tiling in the shower area has a significant amount of unsightly staining. The staining must be removed, or the tiling replaced, to uphold a homely appearance. • The shed in the garden was full of storage and broken items. Its lock was broken. This compromises safety and homeliness. The manager must ensure that this is addressed. The inspector observed some service users needing to lean against walls to move over steps. This occurred at the base of the stairs in one case, where there is no handrail on the left-hand-side. It also occurred on the steps outside of the house. The manager noted that the home has been assessed by an occupational therapist, and recorded evidence of this was seen in one service user’s case. However, as a pro-active measure, it is recommended for any service users who present as having any degree of need with moving around independently, that their abilities in these areas be reviewed. The manager noted that there have been fire-closing door devices installed on a number of doors following a recent fire authority visit. This is good practice. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. There were identified shortfalls, in respect of the training and qualifications of the staff team overall, and of there being sufficient staffing in the home at all times. There were no concerns about the effectiveness of those staff present during the visit. The home’s recruitment practices are almost sufficient, but Criminal Record Bureau checks must be transparent, to show that they are being suitable undertaken. EVIDENCE: The manager explained during the visit that the home has recently had a few staff members leave, both temporarily and permanently. Consequently the shift during the inspection was one staff member short until the manager arrived at around 8:30am. She proceeded to actively assist staff until the majority of service users had left for their day occupations. The manager explained that she is providing this sort of support to staff outside of office hours, including at weekends, so as to provide experienced support that needs no training, rather than using agency staff in this respect. She is also acquiring the support of staff from the organisation’s bank of temporary staff. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 21 It was positive to note that staff and the manager capably ensured that service users were all ready in time to go out to day services in a calm manner. Following a strategy meeting in December after a case of one service user physically assaulting another, it was agreed that staffing levels of four staff were necessary at all times. This was particularly due to the former service user needing to have one staff present for support with their challenging behaviour needs at all times. The staffing roster for the week before the inspection was checked through. There were five occasions where only three staff, including the manager, were working either the morning or the late shift. Given that one staff needs to be aware of the needs of the one service user mentioned above, for the safety of all service users in the home, these levels are judged as insufficient. The manager must ensure that staffing levels are upheld, through the use of agency staffing if necessary. The health professionals comment card included that there is not always a senior member of staff available to work with. They however wrote positively about communication from the home, and about the staff team’s abilities. All three comment cards from care managers also noted about staff having a good understanding of service users’ needs, and about there always being a senior member of staff to work with. Inspection observations generally reflected these opinions. The recruitment files of three newer staff were checked through. It was found that appropriate application forms, identification checks, and written references were in place. Work permit details were available where applicable. One suitable Criminal Record Bureau (CRB) check was in place. Others were not available, or showed only that the check had taken place but without outcomes or the opportunity to check relevant information. Full CRB disclosures must be made available during the inspection process to show that the CRBs are suitable and timely. The files also showed that the induction records of the staff had not been completed and signed off. The manager reported that the process had been completed, and that there is now a designated workbook that new staff now use in line with national standards. She must ensure that future inductions are completed and signed off, to ensure that new workers are provided with the skills needed to work in the home. There were reasonably clear records and certificates of the training that individual staff have attended. The manager was able to state what the general training needs of staff are, for instance with receiving update epilepsy training in February 2006. There was no written record of a plan in this respect, for the service as a whole, which is required. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 22 An audit of training of a couple of newer staff members found that they had attended most statutory and relevant short courses, such as for fire safety, food hygiene, and challenging behaviour. There should be training on understanding and working with someone with autism, in respect of the needs of a few service users who live in the home. It is positively noted that some staff attend a Learning Disability Awards Framework course through a local university. The manager stated that one staff member has relevant NVQ qualifications. A few staff are close to completing such qualifications, and a few more are due to shortly begin such a course. She must ensure that this enables the staffing team as a whole to achieve the standard of 50 of staff being NVQ qualified. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 41. Service users benefit from a home that is well run. However, as the manager has recently been temporarily managing another home as well as this one, some leadership shortfalls have occurred. Some improvements are needed to ensure that the home’s record-keeping processes, in terms of efficiency and effectiveness, serve service users’ best interests. The views of involved people underpin the home’s development, but the process must be continued through the printing of a relevant report and plan. EVIDENCE: The current manager started working in October 2004 following a period of management instability in the home. She was successfully registered with the CSCI in March 2005. The manager noted that she has almost completed the Registered Managers’ award and level 4 NVQ in care. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 24 Comment cards noted that the manager keeps them informed where appropriate. Two care managers stated that the service has improved since the arrival of the current manager, one noting that the service users are thriving on the positive changes. Current and past inspection processes show overall improvements in the standard of service. The current manager has been overseeing the management of another of the organizations homes since July 2005 pending clarification of management arrangements there. This process finished around the time of this inspection. In the opinion of the inspector, some of the requirements in this report reflect that the manager has not been able to concentrate fully on this home across that period. This should be considered if any future similar circumstances arise. The manager explained that there is one senior vacancy, and that the other senior and the deputy are acting temporarily in those positions. It was previously required for staff meetings to be held for all staff members at least on a monthly basis. Minutes of previous meetings on this occasion showed that thee issue was initially addressed fully, but that there have only been three meetings since the start of September 2005. The next meeting had not been planned for. The requirement is therefore repeated, in support of better staff communication and direction, particularly also in light of the recent limited management arrangements in the home. It was noted that the home does not have a basic computer, unlike some other homes in the organization. One care manager made comments about how this hinders the service, on their comment card. Feedback during the inspection found that this lack of facilities causes typed records such as minutes of meetings to be produced slowly, and often on management’s own computer resources. There is additionally only photocopying facilities in the home through the office fax. This caused for instance some staff recruitment records to be unavailable during this visit, as they had been sent to head office for photocopying. These records must always be available for inspection by authorised people. It remains recommended for the home to have a computer and photocopier available for use in the home, to improve efficiency and effectiveness of the service. The audit of service users’ daily records, as per standards 11-17, found that there were eight instances of the morning or evening periods not being recorded about, for the main two case-tracked service users across the previous two weeks. The manager must ensure that staff make appropriate records for each service user across each shift. There was an annual development meeting held in the home during October 2005. The manager reported that a few families and professionals attended, and that the views of other involved people were obtained through written questionnaires. The manager could state what the main goals from the process 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 25 are. The process therefore appears to have been useful. No formal report of the process has been provided to the manager, involved people, or the CSCI. This must be addressed, to help address the goals of the process and to show transparency. 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 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 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 X 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 2 12 2 13 3 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 2 2 X 2 X X 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2) Requirement The manager must ensure that formal review meetings for each service user are held every six months, regardless of funding authority presence at these meetings. Service users’ care plans must be reviewed and updated effectively, so that key needs can be clearly captured and effectively addressed. Service users’ risk assessments must be reviewed and updated effectively, so that key needs can be clearly captured and effectively addressed. The manager must ensure that there is evidence of how service users’ skills developments are captured and evidenced, and of how further work will be supported by staff. The manager must ensure that structured activity plans are set up for service users who stay at home on some days during the week, and that there is evidence of how these plans take place and are monitored. The manager must ensure that DS0000017553.V280841.R01.S.doc Timescale for action 01/07/06 2 YA6 15(2) 01/06/06 3 YA9 13(4), 15(2) 01/05/06 4 YA11 15, 17 01/07/06 5 YA12 15, 16(2)(n), 17 15/03/06 6 YA22 22 15/04/06 Page 28 694 Pinner Road Version 5.1 7 YA23 15(2), 17, 18(1)(a) 8 YA23 13(6), 18(1)(c) 9 YA24 23(2)(b, d) all complaints about the home are captured and recorded about, including outcomes, and that a record of this is available within the home. The manager must ensure that individual strategies in response to service users’ challenging behaviours are clear and up-todate, and that staff follow them at all times. The manager must ensure that those staff who have not had formal training in the protection of service users from abuse are supported to do so. The staining from a leak in the hall needs renovating. Previous timescale of 30/11/05 not met. The manager must ensure that all radiators in the home work properly, and that any faults are promptly rectified. Curtains must be promptly installed in the lounge windows. The seventh step up from the ground floor gave way a little at one side. This issue must be remedied promptly so as to avoid an accident. The toilet seat in the shower room was very wobbly. The manager must ensure that there is a secure toilet seat in place so as to minimize the chances of accidents. The tiling in the shower area has a significant amount of unsightly staining. The staining must be removed, or the tiling replaced, to uphold a homely appearance. The shed in the garden was full of storage and broken items. Its lock was broken. This compromises safety and homeliness. The manager must DS0000017553.V280841.R01.S.doc 15/04/06 01/06/06 01/05/06 10 YA24 23(2)(c, p) 12(4)(a), 23(2)(b) 23(2)(b) 15/03/06 11 12 YA24 YA24 15/03/06 15/04/06 13 YA24 23(2)(b) 15/04/06 14 YA24 23(2)(d) 01/05/06 15 YA24 23(2)(b) 01/05/06 694 Pinner Road Version 5.1 Page 29 ensure that this is addressed. 16 YA32 18(1)(c) The manager must ensure that the staffing team as a whole achieve the standard of 50 of staff being NVQ qualified. Sufficient staff must be working towards this by the timescale. The manager must ensure that staffing levels are upheld, through the use of agency staffing if necessary. Full Criminal Record Bureau (CRB) disclosures must be made available during the inspection process, to show that the CRBs are suitable and timely. The manager must ensure that future inductions are completed and signed off, to ensure that new workers are provided with the skills needed to work in the home. There must be a general training plan for the service as a whole. Staff meetings must be held for all staff members at least on a monthly basis. 01/09/06 17 YA33 18(1)(a) 15/03/06 18 YA34 17(2) sch 4 pt 6(f) 01/06/06 19 YA35 18(1)(c) 01/06/06 20 21 YA35 YA38 18(1)(c) 18(2) 01/07/06 01/06/06 22 YA39 24(2) 23 YA41 17(3)(b) 24 YA41 17(1)(a) sch 3 pt 3 Previous timescale of 30/11/05 not met. A report from the annual 01/05/06 development process must be provided to the manager, involved people, and the CSCI. Those records required under 01/05/06 legislation to be kept in the home at all times, must be available in the home at all times to authorised people. This includes staff recruitment records. The manager must ensure that 01/04/06 staff make appropriate records for each service user across each shift, so that gaps do not appear within daily records. DS0000017553.V280841.R01.S.doc Version 5.1 Page 30 694 Pinner Road 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 YA6 Good Practice Recommendations It is recommended that: • Service users’ care plans be re-written after each formal review meeting; • The care plans link with the goals identified at these review meetings; and • There be evidence of how each goal is progressing, to help focus towards achievement of the goal. It is recommended that a date of opening be kept on liquid medications so as to assist with appropriate dates of disposal. The manager should ensure that relatives are made fully aware of the home’s complaints procedures, as feedback from relatives suggested otherwise. It is recommended for any service users who present as having any degree of need with moving around independently, that their abilities and support needs in these areas be reviewed. There should be training on understanding and working with someone with autism, in respect of the needs of a few service users who live in the home. Consideration should be given as to whether the service at this home was too adversely affected by the manager’s temporary period of overseeing of another home. The registered provider is recommended to provide a computer and photocopier for the home, to support with the management and administration of the home. 2 3 4 YA20 YA22 YA29 5 6 7 YA35 YA37 YA41 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Harrow Area office Fourth 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 694 Pinner Road DS0000017553.V280841.R01.S.doc Version 5.1 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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