Inspection on 26/01/07 for Northbrook Care Home

This inspection was carried out on 26th January 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Northbrook Care Home 27/04/08

Northbrook Care Home 02/08/07

Northbrook Care Home 06/07/06

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 Northbrook Care Home 63 Northbrook Road Ilford Essex IG1 3BP Lead Inspector Jackie Date Unannounced Inspection 26th January 2007 10:00 Northbrook Care Home DS0000066343.V328725.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 Northbrook Care Home DS0000066343.V328725.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. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northbrook Care Home Address 63 Northbrook Road Ilford Essex IG1 3BP 020 8911 9110 020 8911 4900 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) Northbrook Homes Limited ** Post Vacant *** Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th July 2006 Brief Description of the Service: Northbrook Care Home opened in March 2006. It is a home for 4 adults with learning disabilities. The 2-storey house is in Ilford close to bus routes, the station, shops and leisure facilities. Although there is a ramped exit into the garden the home is not accessible to wheelchair users and the service will not be accepting residents who are wheelchair dependent. There are four single, bedrooms, each with ensuite toilet, shower, and wash hand basin. In addition there is also a communal bathroom. There is a small lounge upstairs and a dining room downstairs. At the time of the visit three women were living at the home. Residents do not attend formal day services but are supported by the staff team to do activities. The scale of charges is £1177 to £1400 per week. The manager provided this information at the time of this inspection. Information about the service provided is contained in the service users guide. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit lasted for about six hours and took place from 10am. This was a key inspection and all of the key inspection standards were tested. The manager, staff and all of the service users were spoken to. All of the rooms in the house were seen and staff, care and other records were checked. Care staff were asked about the care that residents receive, and were also observed carrying out their duties. Due to the level of their disability two of the three residents were not able to give any direct feedback about the care that they receive. Relatives and social workers were contacted and asked for their opinions of the service. Feedback was received from one relative and two social workers. The inspector also visited the home in October 2006 to meet the new manager and to receive an update on the action that she had taken to meet requirements. At that time it was apparent that improvements had already started. What the service does well: What has improved since the last inspection? There has been a lot of improvement since the last inspection. It is evident that the manager and staff team have been working very hard to improve the service and to meet the requirements from the previous inspection. There is now a new manager in post. The manager and the staff team are working together to develop and improve the service. The proprietor is supporting them to do this. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 6 All of the health and safety checks are being done and therefore the residents live in a safe home. Staff have had a lot of training to help them to provide a good service and to meet residents’ needs. The recruitment procedure is much better and the necessary checks are carried out on staff before they start to work at the home. This means that residents and their representatives can be sure that suitable staff are working at the home. The system for giving medication to residents has changed and, although there is still some paperwork that needs to be in place, is much better. Staff have had medication training. The new system is much safer and lessens the chance of residents being given the wrong medication. Care plans and risk assessments now have more information in them so that staff know how to meet residents needs as safely as possible. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate information is gathered on a prospective resident prior to their moving into the home and this gives staff a picture of the individual’s needs and how to meet these. Prospective residents and their relatives can spend time in the home to find out what it would be like to live there and to enable the resident to make a choice about living in the home, within their capacity to do so. The Service User Guide is being simplified to help them with this. Residents now have contracts/statement of terms and conditions and therefore have information about the service that they are entitled to. EVIDENCE: The manager has started to review the Service User Guide and is going to include pictures and symbols to make it more user friendly, as required by the previous inspection. The timescale for meeting this requirement has been extended to allow the manager to finish this work. Some further advice was given to the manager during the visit about improving the guide. The manager has translated the guide into Urdu and put this on tape for one of the Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 9 residents. This is good practice. A simplified guide will assist residents to find out about the home. At the time of the last inspection there was a concern about the appropriateness of the placement for a resident. Information on file indicated that she might have mental health needs and the service was not registered or equipped to meet those needs. However the psychiatrist has provided further information that she does not have a formal mental health problem. Her placement has been reviewed and is felt to be appropriate. This resident appears to be a lot more settled and said that she likes living there. She also said that she hoped that the prospective resident would be moving in soon as she liked her. Since the last inspection two new residents have moved into the home. The newest resident moved into the home in December as an emergency placement from hospital. She has since had a review and will be staying at the home. The paperwork with regard to this individual was examined. It contained an assessment by the placing authority, a referral form and also an assessment that the manager of the home had carried out. A care plan was also in place. This contained an assessment profile. Therefore sufficient information is gathered on a prospective service user to enable their needs to be identified and for a decision to be made about the home’s capacity to meet their assessed needs. A prospective resident had recently visited the home and had met the other residents. She is going to visit for lunch next and then a longer stay if she wishes. Therefore, when possible, prospective residents are given the opportunity to visit the service and to meet staff and residents before they decide if they want to live there. Residents have been issued with contracts/terms and conditions as required by the previous inspection. These were in individual files. The placing authority had not signed the contract for the newest resident but this had been discussed at the recent review and will be signed now that the placement has been confirmed. Therefore residents have detailed information about the service that they are entitled to. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ care plans and risk assessments contain sufficient information to enable staff to safely meet their needs. Residents are consulted about what happens in the home as far as they are able. Residents’ personal information is safely stored to maintain confidentiality. EVIDENCE: All of the residents have plans which give details of how they need/like to be supported. Areas covered included health, personal care, communication, behaviour, sexuality and cultural and religious needs. The care plan of the newest resident includes “when I am happy I smile”, “uses facial expressions and eye contact to communicate”. A selection of care plans were examined during the visit and the information contained in them was relevant. They also indicate what individuals like and dislike. For example one residents’ care plan Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 11 states that she does not like pasta or peas. Residents’ plans contain sufficient information so that staff can meet their needs. Daily recordings are made about what each person has done and support that they have been given. These recordings are broken down into various areas including night care, personal hygiene, communication, socialisation and meals. Therefore there is information about each individual, which can be used as part of the review process and to identify ongoing and changing needs. There are risk assessments in place. These identify risks for the residents’ and staff and indicate ways in which the risks can be reduced to enable the residents’ needs to be met as safely as possible. Risk assessments have been extended further to cover all areas of risk as required by the previous inspection. They are also relevant to each person. For example one resident smokes, the others do not. Guidelines are now in place on how to respond and deal with one residents challenging behaviour. This was a requirement of the previous inspection. This residents’ social worker said that she has been the allocated social worker since October and there have not been any incidents since then. Residents meetings are now held each month and a record is kept of these. One of the residents can and does express her views about what she wants to do and what she likes. Due to a leak this residents’ bedroom needs to be redecorated. This has been discussed with her but she has said that she wants to wait for summer before she has the work done. The minutes of the residents meetings indicate that staff use direct questions to assist them to find out what another resident wants and then she is able to sign yes or no in response. Therefore the residents are involved in the running of the home as far as they are able. They are encouraged to make decisions about what happens as far as they are able. Residents’ records and other information are stored in a lockable cabinet in the office and staff are aware of issues of confidentiality. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 12 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 good. This judgement has been made using available evidence including a visit to this service. The residents are encouraged to take part in activities and to be part of the local community. The residents are supported to keep in contact with their relatives. The residents are supported and encouraged to have a diet that is healthy and meets their need. This includes health and cultural needs. EVIDENCE: One resident said that she helped out with the cooking and also that she goes out a lot. She said that she likes to go the cinema, to the shops, the local cafe and the park to feed the ducks. She said that she goes out every day. Her social worker said that this individual is doing a lot of activities and that she now had an activity plan and things were more structured. Activities are still being developed for the other two residents but one does like to go out, Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 13 especially for lunch and to the park. She also likes to be taken out for a walk as she uses a wheelchair when out in the community. Two of the service users have regular contact with their families who visit the home. Families are invited to celebrations at the home and one resident showed the inspector photographs of her birthday party. Celebrations were also held for Eid and for Christmas. Therefore residents are supported to keep in contact with their family and relatives are welcomed at the home. Staff were observed to knock on a residents bedroom door and wait for reply before opening it. Therefore residents’ privacy is respected. One of the resident’s can and does choose what she wants to eat and also assists with shopping and cooking. This resident has diabetes and staff support her to eat appropriately. This resident was very pleased because she has lost some weight by changing her diet. Her social worker said that this resident has a healthier diet now and her diabetes is well controlled. Meals for the other residents are based on their likes and dislikes. One resident is provided with Halal meat to meet her cultural needs. Prior to moving into Northbrook this resident had a very limited diet but based on advice from the GP staff have been gradually introducing different foods into her diet and she does now eat some fruit and vegetables. There had been concerns about the weight loss of the newest resident but since moving into the home in December she has started to gain wait. Residents receive a nutritious diet that meets their individual needs. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive personal care that meets their individual needs and the staff team support them to get the healthcare that they need. The administration and recording of medication has improved greatly and residents are given regular prescribed medication safely. Guidelines need to be developed to ensure that “as required” medication is appropriately administered. EVIDENCE: Two residents require a lot of support with their personal care and the help that they need is in their individual plans. At present there is a small consistent staff team and staff were aware of how to support these residents. It is recommended that the information in the care plans be more detailed so that it clearly states how the personal care needs to be provided. For example that two staff are needed, when pads need to be changed during the night. The plans also contain information on how to recognise how a person is feeling. For example “when I am happy I smile”. The other resident does not need a lot of support in terms of personal care and staff give her the help that Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 15 she needs. This resident has had her hair highlighted and said that one of the staff did this for her. Therefore her personal care needs are being met On the day of the visit residents looked clean and well dressed. Therefore residents’ personal care needs are being met. All of the residents go to the local doctor and specialist help is received when needed. Staff take residents to all of their medical appointments. Residents’ files have details of health care issues and show that residents have regular access to health care professionals. At the time of the last inspection there was concerns that a residents healthcare needs were not being adequately met. However the issues have been addressed by the home and in addition her care plans and risk assessments contain information to assist staff to meet her needs. As stated previously in this report the social worker stated that this resident’s diabetes is now very well controlled and that she has lost some weight as she is eating a more healthy diet. Therefore residents’ healthcare needs are being met. At the time of the last inspection the administration of medication was poor and as a result of this a specialist pharmacist inspection was also carried out. Since the new manager has been in post the system for the administration of medication has changed to the Boots monitored dosage system and staff have received training from Boots. In addition the manager has also assessed the competency of staff to administer medication. Medication is now securely stored in an appropriate lockable cabinet in the main office. Examination of the MAR (medication administration record) found that these had been appropriately completed and that the medication file contained photographs of each individual and a record of any allergies. This is good practice. Recently Boots had not sent enough Medication Administration Records (MAR) and therefore the manager had to complete some by hand. The manager was reminded that for accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. Two residents take PRN (when required) medication and guidelines/protocols are needed so that staff are clear as to when and how to administer this medication. The newest resident is prescribed rectal Valium for epilepsy but the staff have not yet had training to administer this. In the interim they are instructed to call for an ambulance if she should have a seizure. As far as the manager had been able to establish the resident had not had a seizure for some time and she will ask for the medication to be reviewed. If the resident does require rectal valium then staff will need training on its administration and also a protocol will be needed to indicate the circumstances in which it should be administered. Again this will ensure that staff are clear as to when and how to administer this medication. In addition the medication policy/procedure needs to be amended to include the action to be taken in the event of an error being made. This will ensure that the correct action is taken in that event. Medication administration has improved a lot since the last inspection and meeting the above Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 16 requirements will help to ensure that residents are safeguarded and that any medication is appropriately administered. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. There is a complaints procedure that would be followed in the event of any complaints being made. There have not been any concerns raised about the care and welfare of the residents but the staff team have not received the promised adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This is needed to give residents greater protection from abuse. Residents’ bank accounts are not being robustly monitored and this does not safeguard them from the risk of financial abuse. EVIDENCE: The home does have a complaints procedure, which is displayed. There have not been any complaints recorded. One resident living at the home would be able to say if she was not happy about anything. She also has access to an advocate from Goodmayes hospital. The other two residents would be reliant on other people to raise concerns on their behalf. One relative said that her daughter was happy and that the staff were good. The local authority’s adult protection procedure is available in the home and staff have read this. The manager was aware of the action to be taken in the Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 18 event of a suspicion or allegation of abuse. The staff did not receive adult protection training that was due to take place on 20th July 2006. The new manager said that she is looking for suitable POVA (Protection of Vulnerable Adults) training. All staff must have this training, as this will give staff a better idea about what constitutes abuse and what to do if abuse is suspected. Staff spoken to said that they did not have any concerns about the care of residents. At the time of the visit the service was only dealing with the finances of one resident. The resident is able to go to the post office, supported by staff, to withdraw money. The resident’s finances were checked and cash amounts held agreed with records. Receipts were on file. A running record is kept of the amount of cash held and any withdrawals are recorded in this. Although there is a statement from the Post Office, this is not reconciled in anyway. A system needs to be in place to monitor the amount in the accounts. This should be checked as part of the monthly monitoring. This will assist in safeguarding the resident from financial abuse. There is now a budget for staff expenses and residents are not paying staff expenses. The resident that was living at the home at the time of the last inspection has been reimbursed for expenditure on staff expenses. These were requirements of the previous inspection. Northbrook Care Home DS0000066343.V328725.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, 26, 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The residents live in a home that is suitable for their needs. However the garden and the dining area require some attention to make them more homely and welcoming. The kitchen is showing signs of wear and tear and needs to be improved to be of a satisfactory standard for residents to use. EVIDENCE: The home is a 2-storey house in Ilford close to bus routes, the station, shops and leisure facilities. Although there is a ramped exit into the garden the home is not accessible to wheelchair users. However, there are two ground floor bedrooms. There are four single bedrooms, each with ensuite toilet, shower, and wash hand basin. In addition there is also a communal bathroom. There is a small lounge upstairs and a dining room downstairs. The home opened almost a year ago and with the exception of the kitchen was totally refurbished. The bedrooms are a good size and were nicely decorated with Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 20 new furniture. However one of the bedrooms sustained some damage due to a leak and does need redecorating. This has been discussed with the resident but she has stated that she wants to wait until the summer before the work is carried out. The residents living at the home do not require any aids or adaptations although two of them require wheelchairs to go out in the community. The communal areas are quite small and are still quite bare. They need to be made more homely and welcoming. The dining area on the ground floor has, in addition to the dining furniture, a large refrigerator and a small freezer. The full-size hand washbasin has been removed as recommended by the previous inspection. As stated previously the kitchen was not refurbished and is showing signs of wear and tear. There are doors that were not working properly and the cupboard under the sink is damaged. The kitchen needs to be upgraded/replaced to ensure that it of a satisfactory standard. This would also be the opportunity to remove one of the two hobs and to make room for the fridge and freezer, which would also greatly improve the dining room. The manager did say that they have got planning permission for an extension and that they are hoping to build this in the near future. This would be a very positive addition to the home as it would not only increase the limited communal space on the ground floor but would give the opportunity for the kitchen to be bigger and this would make it much easier for residents to use it as the current kitchen is quite small. An inspection of the kitchen also found that there was very little kitchen equipment and in particular very little china and crockery. What was there was “oddments”. The registered person must provide sufficient and suitable kitchen equipment, crockery, cutlery and utensils. Shortly after the visit the registered manager said that she had already purchased some items and this will be monitored during future visits. There is a garden at the rear of the building but most of it is a large concrete slab. The areas that are not concreted have not been maintained. Therefore the garden area does not look nice and would not be a pleasant area for residents to use. The previous manager said that she had ordered some garden furniture. However this was not purchased. External grounds must be appropriately maintained so that they are suitable and for use by the residents. This requirement remains outstanding from the previous inspection and must be addressed. At the time to visit the home appeared to be clean and hygienic and received a satisfactory food hygiene report in July 2006. Northbrook Care Home DS0000066343.V328725.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 judgment has been made using available evidence including a visit to the service. Staff are receiving the necessary training to give them the skills to meet residents’ current needs and provide an appropriate service for them. Staffing levels are sufficient to allow for this. Staff are properly recruited and the necessary checks carried out. This helps to protect residents and keep them safe. In addition to informal support staff receive formal supervision and regular staff meetings are held. This gives a chance for work practice and the development of the service to the discussed. EVIDENCE: There is a small female staff team in post. Some have been working at the home since it opened in March 2006. Therefore residents are supported by a consistent staff team that they know. Since the last inspection the staff team have received a lot of training to assist them to carry out their duties. This has included a structured induction training, working with people with challenging Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 22 behaviour, managing difficult situations, medication administration, first aid, infection control and food hygiene. In addition to this one member of staff has completed NVQ 2, two staff have enrolled for NVQ 2 and two have enrolled for NVQ 3. The requirements from the previous inspection with regard to training have been met. The staff team have therefore been provided with the training that they need to provide an appropriate and safe service for the residents. After the last inspection staffing levels were reviewed and the staffing ratio is now two staff on each shift, with the manager as an additional person during the daytime. Feedback from staff was that staffing levels are sufficient to meet residents’ needs. Two staff are also on duty at night. There are not any facilities for staff to sleep in at night and therefore both staff are waking nights. However the rota shows staff working all night and then again the next day. From discussions with the staff, and the manager is was evident that both staff are not awake all night and one appears to be sleeping in the lounge. Staff said that the newest resident does need the support of two staff for personal care, which is provided once during the night. This was discussed with the manager and she was advised that if two staff are on waking night duties then they must be awake. If one is awake and one sleeping in this must be clearly indicated on the rota. The manager was also informed that it is not appropriate for staff to be sleeping in the lounge and appropriate sleeping in facilities would need to be available. Night time staffing arrangements must be clarified and if staff are designated as “waking” then this must be the case. If sleep in staff are required then appropriate staff sleeping facilities must be available. A selection of staff files were examined and this included the file of the newest employee. The file of the newest employee, who had been recruited by the new manager, contained a copy of the application form, the interview test, interview notes, references, confirmation of identity, CRB(Criminal Records Bureau) check and other required details. The new manager also ensured that existing staff had CRB checks. Therefore an appropriate recruitment process is now in place, as required by the previous inspection. This helps to safeguard residents. Staff are receiving regular supervision and staff meetings are being held each month. This gives staff the opportunity both collectively and individually to discuss work practice, any concerns and the development of the service. Northbrook Care Home DS0000066343.V328725.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, 38, 39 & 42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home is well managed and provides a safe environment for the residents. The registered provider monitors the service appropriately to check the quality of the service provided to residents. EVIDENCE: The new manager started at the home in September 2006. She has a lot of experience of working with people with learning disabilities and of managing residential services. She has successfully completed the RMA (Registered Managers Award) and is in the process of completing NVQ 4 in care. The manager therefore has the necessary experience and qualifications to manage the service. The manager said that she has obtained a CRB check via the Commission but has not started the registaertion process. An application must Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 24 be submitted to the Commission for the manager’s registration. Since the manager has started work at the home the service has been developing appropriately and most of the requirements from the previous inspection have been addressed. Feedback from staff was that “things are much better at the home”. They are aware of what is happening and are involved in the development of the service. The manager gives them good support and works with them. Staff also said that they get support from the proprietor. The registered person must visit the care home at least once a month unannounced to monitor the quality of care provided. They must then write a report on the conduct of the home. A copy of this report must be given to the registered manager and a copy supplied to the Commission. Since the last inspection the proprietor has arranged for an experienced person to carry out these visits and also to provide supervision for the manager. The reports received are detailed and cover the necessary areas. They also indicate any action that is needed. Therefore the home is now being adequately monitored and residents are being safeguarded. All of the necessary health and safety checks on services to the building were made prior to registration. All of the electrical equipment is less than a year old and therefore does not require testing. The fire alarms are tested weekly and fire drills are now held monthly. The hot water temperatures are now being tested weekly to ensure that they do not exceed the prescribed temperature. This is to lessen the risk of scalding to residents. Fridge and freezer temperatures are now being tested daily to ensure that they do not exceed the maximum prescribed temperature and that they are working correctly. Records are kept of both of these checks. These were requirements of the previous inspection. The Landlords Gas safety Certificate needed to be renewed as it had expired 12 days before the inspection. This has now been done. Therefore a safe environment is being maintained. Northbrook Care Home DS0000066343.V328725.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 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 3 3 X X 3 X Northbrook Care Home DS0000066343.V328725.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 5 Requirement A simplified user-friendly Service User guide must be developed to assist residents to find out about the home. (Previous target of 30/09/06 not met). For accountability any handwritten amendments or additions to Medication Administration Records (MAR) sheets must be signed and dated by the person making the entry. Protocols/guidelines must be in place for any PRN (as required) medication. If the newest resident does require rectal valium then staff must receive training on its administration and also a protocol must be in place to indicate the circumstances in which it should be administered. The medication policy/procedure must be amended to include the action to be taken in the event of an error being made. All staff must receive POVA (Protection of Vulnerable Adults) training. A system must be in place to reconcile residents’ DS0000066343.V328725.R01.S.doc Timescale for action 30/04/07 2. YA20 13 28/02/07 3. 4. YA20 YA20 13 13 15/03/07 31/03/07 5. YA20 13 28/02/07 6. 7. YA23 YA23 13 13 30/04/07 31/03/07 Northbrook Care Home Version 5.2 Page 27 8. YA24 23 9. YA24 16 10. 11. YA28 YA33 16 18, 23 12. YA37 8 bank/building society or post office accounts. External grounds must be appropriately maintained so that they are suitable and for use by the residents. (Previous target of 30/09/06 not met). The registered person must provide sufficient and suitable kitchen equipment, crockery, cutlery and utensils. The kitchen must be upgraded/replaced. Night time staffing arrangements must be clarified and if staff are designated as “waking” then this must be the case. If sleep in staff are required then appropriate staff sleeping facilities must be available. An application must be submitted to the Commission for the manager’s registration. 30/04/07 28/02/07 31/05/07 15/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA18 YA24 Good Practice Recommendations It is recommended that the information in the care plans be more detailed so that it clearly states how personal care needs to be provided. It is recommended that the communal areas be made more homely and welcoming. Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northbrook Care Home DS0000066343.V328725.R01.S.doc Version 5.2 Page 29 - 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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