Inspection on 06/07/06 for Northbrook Care Home

This inspection was carried out on 6th July 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 no outstanding requirements from the previous inspection report, but made 28 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 26/01/07

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 Key Unannounced Inspection 6th July 2006 11:00 Northbrook Care Home DS0000066343.V303411.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.V303411.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.V303411.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 Mrs Ozgur Khan Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 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 with mobility difficulties. 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 only one lady was living at the home. She goes out everyday, with staff, to places of her choice. The scale of charges is £1177-00 per week. This information was provided in the pre inspection questionnaire, which was received on 23rd May 2006. Information about the service provided is contained in the service users guide. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit lasted for about six hours and took place from 11 am. The manager, staff and the resident were spoken to. All areas of the house were seen and staff, care and other records were checked. The process of inspection includes gathering information before, during and after a site visit. Care staff were asked about the care that the resident received and the resident was asked about what it was like living at the home and if she was happy there. After the visit the resident’s relative and other professionals were contacted and asked for their opinions of the service. At the time of writing this report feedback had only been received from one person. Any feedback received later will be included in the next inspection report. The manager and proprietor have been asked to meet with the Commission to discuss concerns highlighted during the inspection. At the time of this report being written this meeting had not yet taken place. Just over a week after the inspection took place there was an incident at the home that resulted in staff being assaulted and the police being called to the home. This incident strengthens the concerns raised in this report. This was a key inspection and all of the key inspection standards were tested. What the service does well: What has improved since the last inspection? What they could do better: This report has 24 requirements many of which are related to safeguarding the resident. These can be found at the end of the report. The service is being provided to a resident with complex and challenging needs. However the staff team are inexperienced and have not received training to meet such needs. Therefore this places both the resident and staff at risk and the resident’s needs are not being adequately met. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 6 It would appear that a service is being provided to an individual with symptoms of mental health problems in addition to their learning disability and the home is not registered to provide this type of service. The recruitment procedure is not robust and the necessary checks were not carried out on staff before they started to work at the home. This means that residents and their representatives cannot be sure that suitable staff are working at the home. The resident was admitted to the home a few days after it was registered but staffing and other systems have not been sufficiently developed to meet her needs. Concerns highlighted in this report and requirements made need to be addressed as a matter of urgency. An appropriate or safe service cannot be offered to any residents at present. 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. Northbrook Care Home DS0000066343.V303411.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.V303411.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The required information is gathered on prospective residents and they and their relatives could 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. However written information about the service is not in a format accessible to residents and therefore they will not be able to use this to assist in making their decision. Residents do not receive appropriate information about what the home provides or the service that they could expect to receive. There was not any evidence to demonstrate that the home is able to meet the assessed needs of the individual living there at the time of time to visit. EVIDENCE: The Statement of Purpose and the Service User Guide were examined. The Service User Guide is not written in plain simple language and does not contain any photographs or symbols to assist a person with learning disabilities to understand it. A simplified user-friendly service user guide must be developed to assist service users to find out about the home. The admission process for the current resident was that a telephone referral was received and various assessment documents, including a copy of the CPA (Care Programme Approach) documentation, were provided to the home. The Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 9 manager then arranged to carry out an assessment and to talk to various professionals and the individual concerned. The resident said that she visited the home before she came to live there. The information obtained indicated that the individual concerned had, in addition to a mild learning disability, symptoms indicating possible mental health problems, challenging behaviour, and required ongoing monitoring by a psychiatrist. The staff team at the home have little or no experience of working with people with learning disabilities and no experience of working with people with mental health problems. They have not received any training since the service opened. In addition the service is not registered to meet the needs of people with mental health problems. Therefore the Registered Person(s) were unable to satisfactorily demonstrate that they were able to meet the assessed needs of the resident. The home must arrange a multi agency review to determine if the placement is appropriate for the individual concerned. If this is the case the home must apply to be registered for people with mental health problems. See also the section in the report with regard to staffing for more information. A copy of a blank residents’ contract was seen but the resident living at the home did not however have a signed contract or statement of terms and conditions. The manager said that it was with the social worker. Therefore it was not possible to confirm that residents have detailed information about the service that they are entitled to. Northbrook Care Home DS0000066343.V303411.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 & 10 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Residents’ support plans and risk assessments do not contain sufficient information to enable staff to fully or safely meet their needs. Residents’ personal information is safely stored to maintain confidentiality. EVIDENCE: The resident has a support plan, which shows what she can do and what she likes. This does not include any goals or specify any ways of working with the person. There is a behaviour management plan. Although this clearly describes some behaviour, the action to be taking in the event of this behaviour is not clear. For example it says “educate her about healthy eating”. There were no clear guidelines on managing challenging and aggressive behaviour. Feedback from one of the professionals working with the resident was that “there are no consequences to the persons behaviour and no structure in dealing with this. They support her well but she is being allowed to get away with things.” The manager said that this support plan is constantly reviewed in house as they are still getting to know the resident. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 11 Care plans need to be developed further to ensure that they contain the full information about residents’ needs, and how to meet them. In addition to this there must be clear guidelines on how to respond and deal with challenging behaviour. This will ensure that staff have full information to enable them to meet a persons needs and that they will respond in a consistent and planned manner to difficult behaviour. As there is only one resident, specific residents meetings are not held, but from discussions with the resident it was apparent that staff talk to her about what is happening and what she wants to do. Also that she is involved in decisions about the home. There are risk assessments in place. These identify risks for the resident and indicate ways in which the risks can be reduced. These need to be extended further to cover all areas of risk. For example smoking and aggressive behaviour. This will mean that risks can be reduced and that the residents’ needs can be met as safely as possible. 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.V303411.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The resident is encouraged to take part in activities and to be part of the local community. The resident is supported to keep in contact with her relatives. The resident is supported and encouraged to have a diet that is healthy and meets her health requirements. EVIDENCE: The resident said that she helped out with the cooking and also that she goes out a lot. She goes to the cinema, to the shops, the local cafe and to Southend. She said that she goes out every day and was looking forward to going to the cinema to see the Pirates of the Caribbean. She also talked about the programmes on television that she liked to watch. She was happy with the activities that she did and it was apparent that she chose exactly what she wanted to do and when. She also said that she visits her mother regularly. She has a key to her bedroom but she chooses not to use it. Staff were Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 13 observed to knock on her door and wait for reply before opening it. Staff were also observed sitting and chatting to the resident. As previously stated there is only one resident and she chooses what she wants to eat and also assists with shopping and cooking. A referral has been made via the GP to the dietician as the resident has diabetes. The staff discuss healthy eating and the need not to have some foods with the resident but due to her behavioural difficulties it is not always possible to ensure that she eats appropriately. However the staff team continue to encourage and support her to have a healthy diet. Northbrook Care Home DS0000066343.V303411.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The resident receives personal care that meets her individual needs but there is not sufficient information to enable the staff team to meet all her health care needs. The administration and recording of medication needs to be improved to ensure that residents are given prescribed medication safely. EVIDENCE: The resident does not need a lot of support in terms of personal care and staff give her the help that she needs. The resident said that since she has lived at the home she has had her hair done, her nails painted and her ears pierced. Therefore her personal care needs are being met The resident goes to the local doctor and specialist help is received. This includes input from a psychologist and a psychiatrist. The resident’s file has details of health care issues and show that she has regular access to health care professionals. Records are kept of medical appointments and these show that the resident has had checks from the optician and dentist. However the resident’s support plan does not contain any detailed information in terms of diabetes, what problems could occur or how these should be dealt with. In Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 15 addition, an initial assessment document records that the resident has had mental health problems and significant challenging behaviour. There is no information about how to recognise these problems, working with the behaviour and the action to take. Therefore there is not sufficient information available to enable the staff team to appropriately and safely meet the resident’s overall health care needs. The registered person must ensure that the health care needs of residents are assessed and recognised and that procedures are in place to address them. This will mean all of an individuals needs health care needs will be met. At the time of the visit none of the staff team had received any medication administration training and the manager was administering all of the medication. This included returning to the home in the evening and at weekends to administer medication then. The resident is not able to self administrate medication. Medication is stored in a locked filing cabinet in the office and medication administration records are hand written by the manager. The medication policy and procedure was not robust and for example did not contain any information on homely remedies. There were not any guidelines for the administration of the residents “as required medication”. A lot of this is not good practice and needs to be addressed by the registered persons. As a result of this the Pharmacist Inspector will be visiting the home to carry out a more in-depth inspection and will be making specific requirements and recommendations as a result of this. Therefore a general requirement is being made from this inspection that the registered person(s) must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medication received into the care home. This will ensure that residents are safeguarded and that any medication is appropriately administered. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 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 & 23 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The resident would be able to make complaints about the service if she wished to. All staff are due to receive adult protection training to ensure that they are clear about what constitutes abuse and what to do if abuse is seen or suspected. This will give residents a greater protection from abuse. The resident’s finances have not been appropriately managed or monitored and this places her at risk of financial abuse. EVIDENCE: The home does have a complaints procedure but there have not been any complaints recorded. The 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 local authority’s adult protection procedure is available in the home and the manager said that staff have read this. The manager was aware of the action to be taken in the event of a suspicion or allegation of abuse. None of the staff have received adult protection training but this was due to take place on the 20th July 2006. 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 the resident. The resident is able to go to the post office to withdraw money, staff accompany her. The resident’s finances were checked and cash amounts held agreed with records. Receipts were on file. Although a running record is kept Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 17 at the amount of cash held there is no record of the amount in the Post Office account and therefore the manager cannot check that this is correct. Therefore a system needs to be in place to monitor not only the cash held in the office but the amount in the accounts. This will assist in safeguarding the resident from financial abuse. Examination of records found that the resident is paying staff expenses. This is not acceptable and must be stopped. There has not been a formal agreement about this, it is not stated in the statement of purpose or service user guide and was not identified as an additional charge in the pre inspection questionnaire provided to the Commission. There should be a service budget to pay for staff expenses. In addition the resident must be reimbursed for any expenditure on staff expenses. This will be monitored during future visits to ensure that residents’ finances are being appropriately managed and safeguarded. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 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, 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 resident lives 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. 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 user and the service will not be accepting residents with mobility difficulties. 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 approximately 3 months ago and with the exception of the kitchen was totally refurbished. The bedrooms are a good size and are nicely decorated with new furniture. The resident living at the home does not require any aids or adaptations. The residents said she liked having her own room and her own shower. She has started to personalise this room. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 19 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 there is also a fullsize hand washbasin, with a tiled surround. This was the sort that would normally be found in a bathroom. This hand basin is obtrusive and is not a regulatory requirement. It is recommended that this be removed. This will give more space in the dining area and create a more homely and domestic environment that will be more welcoming to both residents and visitors. 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 manager said that she had ordered some garden furniture. External grounds must be appropriately maintained so that they are suitable and for use by the residents. At the time to visit the home appeared to be clean and hygienic and has just received a satisfactory environmental health report. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 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, 35 & 36 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The registered persons have not ensured that staff have the competence to undertake the tasks required of them. Staff are relatively inexperienced and have not had the necessary training to give them the skills to meet the resident’s current needs and provide an appropriate service for her. Staffing levels are not sufficient to provide a safe service to people with challenging behaviour. Staff were not properly recruited as the necessary checks were not carried out before they started working at the home. Therefore residents have not been safeguarded. EVIDENCE: The staff team comprises of three female support staff and the manager. The staff team have very little experience of working with people with learning disabilities and challenging behaviour. In addition to this since starting to work at the home they had not received a structured induction or any other training to assist them to carry out their duties. This places both staff and residents at risk and means that the staff team do not have the necessary skills and experience to meet the challenging needs of the resident living there. All staff Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 21 must receive structured induction training within six weeks of appointment. They must then receive the necessary training to meet the needs of the residents. Specifically, to work with the current resident, the staff team need training in working with challenging behaviour, in awareness of mental health issues and symptoms, and understanding, defusing and managing aggressive behaviour. In the case of a service for adults with challenging behaviour more experienced staff that have already had training in working with people with challenging behaviour need to be part of the shift. This will ensure that an appropriate service is provided to residents and that less experienced staff receive support and guidance to deal with situations as they occur. The usual staffing ratio is one member of staff on each shift, with the manager as an additional person during the daytime. As previously stated the resident has complex and challenging needs. At the time of the inspection the resident became verbally aggressive towards the Inspector. Approximately 10 days after the inspection the resident assaulted staff and the police were called to the home. Staffing levels and risk assessments must be reviewed and adjustments made to ensure that staffing levels are safe for both the staff and the resident. This was discussed with the manager after the incident in which staff were assaulted and she was advised that urgent interim action was needed. The manager has started one to one supervision with the staff and staff said that they get good support from her. As it is such a small staff team information is communicated during handovers between shifts as staff regularly meet at these times. The staff files for the three people employed were examined. Each person has a copy of the application form on file and also confirmations of their identification. However there are not two references on file for each person. One persons file states that two verbal references were received but there are no details of these references on file. Two of the staff have CRB (Criminal Records Bureau) checks but these were not obtained before they started working with the resident. The third member of staff is working at the home but has not had CRB clearance. None of the staff had POVA (Protection of Vulnerable Adults) checks before they started employment. Therefore the required checks were not carried out before staff commenced employment and the recruitment procedure is not robust. Therefore the recruitment process does not safeguard residents. A robust recruitment procedure must be in place and all of the necessary checks carried out on staff before they commence employment. This should be in accordance with current CRB guidance. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, & 42 Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. The Registered Persons policies and procedures do not safeguard residents. The quality of the service provided is not adequately or robustly monitored by the registered person and this does not safeguard residents or staff. Most of the required health and safety checks are carried out and a safe physical environment is maintained. EVIDENCE: The manager has a lot of experience of working with people with learning disabilities and of managing residential services. She has successfully completed NVQ levels 2 & 3 in care, a Certificate in Management Studies and the Registered Managers Award. Feedback from staff was that the manager gave a lot of support and help in a friendly way. 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 Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 23 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. The home has been open since March 2006 and the proprietor carried out one monitoring visit in May 2006. Therefore the home is not being adequately monitored and once again residents are not being safeguarded. Although the home does have written policies and procedures, previous sections in the report have indicated areas in which these policies and procedures have not been adequate and do not safeguard residents. Requirements have been made in this report with regard to the procedures for the administration of medication and for recruitment. See standards 20 and 34 for further details. 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 two fire drills have been held. However the hot water temperatures and the fridge and freezer temperatures have not been tested as the home has not got the necessary thermometers. Hot water temperatures at outlets accessed by residents must be checked each week to ensure that they do not exceed the prescribed 43°C. This is to lessen the risk of scalding to residents. Fridge and freezer temperatures must be checked each day to ensure that they do not exceed the maximum prescribed temperature and that they are working correctly. Records must be kept of both of these checks. The overall conduct of the service at this first inspection is of grave concern to the Commission and will result in additional monitoring visits until the Commission can be satisfied that the well being of residents is being safeguarded and promoted. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 24 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 1 4 3 5 2 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 2 25 3 26 3 27 3 28 2 29 3 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 1 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 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 2 2 X 3 X 1 2 X 2 X Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 25 N/A 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 service users to find out about the home. The Registered Persons must arrange a multi agency review to determine if the placement is appropriate for the resident living there. If this is the case the home must apply to be registered for people with mental health problems. The organisation must provide the service user with a fully costed contract/statement of terms and conditions as detailed in standard 5.2. Care plans need to be developed further to ensure that they contain the full information about residents needs, and how to meet them. There must be clear guidelines on how to respond and deal with individuals’ challenging behaviour. Risk assessments must be extended further to cover all areas of risk. The registered person must DS0000066343.V303411.R01.S.doc Timescale for action 30/09/06 2. YA3 12,18 15/09/06 3. YA5 4,5 31/08/06 4. YA6 15 15/08/06 5. YA6 15 15/08/06 6. 7 YA9 YA19 13 12 15/08/06 15/08/06 Page 26 Northbrook Care Home Version 5.2 ensure that the health care needs of residents are assessed and recognised and procedures are in place to address them. 8. YA20 13 The registered person(s) must make appropriate arrangements for the recording, handling, safekeeping, safe administration and disposal of medication received into the care home. A system must be in place to monitor not only residents cash held in the office but the amount in their accounts. Staff expenses must be paid for by the service provider. The resident must be reimbursed for any staff expenses that they have financed. External grounds must be appropriately maintained so that they are suitable and for use by the residents. All staff must receive structured induction training. All staff receive the necessary training to meet the needs of the residents. All staff must receive training in working with people challenging behaviour All staff must receive awareness of mental health issues and symptoms training. All staff must receive training in the management of aggressive behaviour, to include defusing difficult situations and appropriate methods of control and restraint. Experienced and trained staff must be on duty at all times to lead shifts. Staffing levels and risk assessments must be reviewed and adjustments made to ensure that staffing levels are safe for DS0000066343.V303411.R01.S.doc 15/08/06 9. YA23 13 31/07/06 10 11. 12. YA23 YA23 YA28 YA24 13 13 23 31/07/06 31/08/06 30/09/06 13. 14. 15. 16. 17. YA35 YA32 YA35 YA32 YA35 YA32 YA35 YA32 YA35 18 18 18 18 18 31/08/06 31/12/06 15/08/06 30/09/06 30/09/06 18. 19 YA32 YA33 18 18 30/09/06 31/07/06 Northbrook Care Home Version 5.2 Page 27 both the staff and the resident. 20. YA34 18 A robust recruitment procedure must be in place and all of the necessary checks carried out on staff before they commence employment. 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. Hot water temperatures at outlets accessed by residents must be checked each week to ensure that they do not exceed the prescribed 43°C. Fridge and freezer temperatures must be checked each day to ensure that they do not exceed the maximum prescribed temperature. 31/08/06 21. YA39 26 31/08/06 22. YA42 13 31/07/06 23. YA42 13 31/07/06 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 YA28 Good Practice Recommendations The bathroom style hand basin and tiling be removed from the dining area. Northbrook Care Home DS0000066343.V303411.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northbrook Care Home DS0000066343.V303411.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. 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