Inspection on 11/01/07 for Old Registry (The)

This inspection was carried out on 11th 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Old Registry (The) 19/01/06

Old Registry (The) 19/09/05

Old Registry (The) 23/03/05

Old Registry (The) 11/10/04

Old Registry (The) 21/03/04

Old Registry (The) 10/02/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

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Edenvale

Wadham Avenue

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 Old Registry (The) 70 Aldborough Road South Seven Kings Ilford Essex IG3 8EX Lead Inspector Stanley Phipps 11 th Unannounced Inspection January to 6 February 2007 15:38p th Old Registry (The) DS0000025931.V328780.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 Old Registry (The) DS0000025931.V328780.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. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Old Registry (The) Address 70 Aldborough Road South Seven Kings Ilford Essex IG3 8EX 020 8590 7076 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) Mr Alan John Philp Mrs Pamela Joan Philp Mr Robert Steer Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Moderate to high level of disability. Date of last inspection 19th January 2006 Brief Description of the Service: The Old Registry is registered to accommodate 8 adults with learning disabilities. Service Users have high levels of dependency and limited communication and cognitive abilities. The home is operated by Alpam Homes, a private organisation, which operates three other registered care homes for people with learning disabilities in the London Boroughs of Redbridge and Newham. Alpam Homes also own and operate a day care centre (Highview House), for service users who live in their care homes. The service is staffed on a twenty-four hour basis to ensure that service users needs are met as and when required. The home is situated in a residential area of Seven Kings, in the London Borough of Redbridge and is close to shops, places of worship, community facilities and transport routes to central Ilford, London and Essex. The building is in keeping with other properties in the area and does not set service users apart from the local community. It also is well decorated, furnished and maintained. The premises are not fully accessible to wheelchair users, although there are bedrooms and a bathroom/shower room on the ground floor. A statement of purpose is made available to all service users in the home and is kept in the main office. This document is also made available to relatives and stakeholders, as they may be important in referring service users to the home. A service user guide is also given to each service user upon admission to the home. Fees range from £995.00 to £1350.00 and may vary dependent on individual levels of need. Fees do not cover newspapers, clothing and personal effects. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as some of the non-key standards. The visit was done over two days beginning at 15.38 p.m. on the 11/01/07 and ended on the 6/02/07, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff, service users and their relatives, as possible. As part of the inspection, informal discussions were held with five service users, detailed discussions held with the manager and a formal interview with one of the staff on duty. Informal discussions were held with other staff and as well as an interview with one service user. Several records were assessed including: menus, risk assessments, staff training records, service user plans, policies and procedures and records pertaining to health and safety. A tour of the environment was also undertaken. The inspection also considered written feedback from service users and staff. The inspection found that service users continue to receive a good standard of care in the home. Some improvements are required to enhance the overall quality of life for service users, as well as ensuring, full compliance with the National Minimum Standards for Younger Adults. What the service does well: The registered persons continue to ensure that service users are engaged in activities best suited to their interests and this includes socially and personally. To this end they provide their own day care services, but service users are not limited to this facility only. Depending on their needs and interests they may attend other facilities in the community and this is positive. What is also important is that they are given some choice in determining what is best for them. The registered persons have also demonstrated that they are prepared to support staff through training and staff supervision, which has a positive impact on outcomes for service users. At the Old Registry, there has been consistency in providing a safe, warm and homely environment for service users who were all happy with living in the home. The staff and management of the home has been supportive and continued to ensure that service users maintain effective links with their loved ones. From speaking with service users, they appreciate these links. This is positive. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 6 Generally service users enjoy meals provided by the home in that they are offered choices and the meals are varied and, in line with their nutritional requirements. This is integral to maintaining a healthy lifestyle and as such, has a positive impact on the health and welfare of service users. What has improved since the last inspection? 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. Old Registry (The) DS0000025931.V328780.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 Old Registry (The) DS0000025931.V328780.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): (1,2,4,5) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have the benefit of having updated information about the home. As part of the admissions process they are given opportunities to visit the home to determine it’s suitability, prior to choosing to live there. Detailed assessments are carried out to ensure that service users needs could be met at the Old Registry. Although service users also have the benefit of a contract, they are unaware of the charges for their placement at the home. This is an area for improvement. EVIDENCE: An updated statement of purpose and service user guide was in place at the home. Both documents are made available to service users as required by regulation. This ensures that individuals are aware of the services and facilities, the aims and philosophy of the service and, the terms and conditions of living in the home. It is therefore crucial, in enabling service users to make a decision about the suitability of the service with regard to meeting their needs. A copy of the service user guide is provided to each individual and relatives that are involved in supporting service users were aware of this. From case tracking the two most recently admitted service users, detailed assessments were found in place for both individuals and this included risk assessments. This process ensured that the home was able to make a determination in conjunction with the service users and their relatives, as to whether their (service users) needs could be met in the home. There was also good evidence that pre-assessment information was obtained from the Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 9 referring authorities and this helped in gathering a good picture of the service user’s requirements. Both service users had detailed plans in place, arising from the assessments, which outlined how their individual needs were to be met. In conversation with both service users, they reported that they had visited the home prior to coming to live there. This is a routine part of the home’s admissions process, which gave the service users an opportunity to feel what it is like to live in the home. In essence they both had a ‘taste’, albeit short, of life in the home. They enjoyed short visits to the home and were happy with the experiences, which were duly recorded. It was pleasing to see that both service users were happy with the choice they made, as they were comfortable with life at the Old Registry. At the time of the inspection, most of the service users had a statement of terms and conditions (contract), for living at the Old Registry. One was being drawn up for the service user most recently admitted to the home. This document detailed the obligations of both parties and was in a format that the service user or their relative could understand. From a sample viewed they were, signed off by both parties in acknowledgement of the terms. However, contracts were devoid of the fees charged and by whom they were payable. This was discussed with both the registered provider and the registered manager as it is a regulatory requirement to make this information available to service users. The registered person was concerned about confidentiality and a discussion took place as to how this could be preserved. It was made clear by the inspector that this information could not be excluded from the service user’s knowledge, contract or access under the preserve of confidentiality. It is the registered person’s legal responsibility to make the information available to all service users. The inspector agreed to supply the registered provider with the most recent legal guidance on making fees available to service users. A requirement regarding information on fees would be made in this report. Old Registry (The) DS0000025931.V328780.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): (6,7,9) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having their needs detailed in their service user plans, so that they could be provided for. They are encouraged to make decisions about their life, within a risk management framework. In doing so, service users are supported to enjoy an independent lifestyle, within their individual capabilities. EVIDENCE: Service user plans were in place for all individuals living in the home. They were specific and detailed how care and support is to be provided, on an individual basis. Service users were involved in the development of their plans, which were monitored on a monthly basis by a relevant key worker. This provided opportunities to ensure that the changing needs of service users were reflected. One example could be drawn from the fact that physical interventions had to be made to promote the safety of a service user and a plan was drawn up to reflect this. The registered manager was also monitoring the interventions made to ensure that they are appropriate and in the service users best interest. This involved looking at; frequencies, the staff on duty when violence occurs and, how it was handled. It was noted that a log of each incident was noted as required by Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 11 regulation. Service user plans and their reviews were therefore maintained to a good standard. Service users also have the benefit of annual reviews that involved the input of a social worker and in most cases they had been already carried out. There was evidence that relatives were also involved in some of the reviews that were carried out and it was clear that their wishes were taken into consideration. Changes arising out of these reviews were reflected in the service user plans. The organisation was in the process of introducing person centred planning into the home, which should enhance the quality of care provided to service users. From speaking with service users it became apparent that they were involved in making decisions around their lives and this ranged from the activities they chose to the meals they ate. They were not limited to choice, despite the fact that some were unable to make their choices independently. There was evidence that appropriate action is taken to promote choices. One case involved Social Services intending to move an individual to another service, without carrying out a review of her needs and, from the records, without consultation. The home made appropriate arrangements to secure advocacy support for the service user concerned. Though it was a challenge to get the service user’s view on this due to the level of communication, it was clear that she was settled, happy and stable in the home and had the trust of the management and staff working there. It was positive to see the individual concerned enjoying life in what she considers to be her home i.e. the Old Registry. What was also positive was that there were a range of forums to enable service users to make choices, e.g. service user meetings, reviews, key work sessions and the involvement of relatives and/or advocates. One service user was observed playing games on his laptop and was really into it – something he chose to do. Service users receive support in managing their finances through an appointee employed by the registered persons, and records are held in relation this. Risk assessments were in place for all service users living in the home. They were updated and developed within the risk management framework of the home. They were individually undertaken, taking into consideration the aspirations, skills and abilities of each service user. They are used in a positive manner in minimising risks and it was clear from the low level of accidents and/or incidents occurring in the home, that they served the best interests of the individuals living at the Old Registry. From talking to service users and assessing their records, it was clear that they get out and about quite regularly. In this respect they are encouraged to maintain their independence whilst ensuring safety in their lives. A missing persons procedure is in place to ensure that staff are guided in dealing with unexplained absence form the home. Old Registry (The) DS0000025931.V328780.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): (12,13,15,16,17) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users are appropriately engaged in activities they choose and generally enjoy. They are actively involved with their community, engaged with their relatives and are quite happy doing so. The management and staff promote both the individuality and, rights of all service users. Meals provided at the Old Registry continue to meet the nutritional requirements of individuals in the home. EVIDENCE: All service users were involved in some form of day care activity aimed at learning and developing various skills. On of the most recently admitted service users attends college up to two days per week where he uses a computer to master his skills around clip art. The individual concerned indicated that he enjoyed doing this and is given good support to continue with his programme. He also attends the Highview Day Centre for up to three days. It was clear that each service user had a programme of activity based on choice, ability, interest and cultural preferences. At the day centre service users enjoy arts and craft, as well as relaxation and various levels social skill development. This is a strong area of the homes operations. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 13 There was good evidence to confirm that service users use the community facilities, as they are usually out on most days. Apart from day care, most of the service users attend evening clubs up to three days per week, they also go out to the theatre, pubs, banks and local shops. One service user had recently been to Romford shopping and quite enjoyed the experience. It was noted that another enjoys going to Tescos for the food shop. What was encouraging was that service users had a choice in not only how, but where they wanted to go and more importantly what they wanted to do. For example one individual did not like evening clubs and preferred to spend time on his laptop, another did not like attending noisy clubs and was supported to be in an environment that was more comfortable. Both service users are supported to enjoy how they spend their time. Other good examples that demonstrated service user inclusion in the community include; one individual attending the local sports centre to play football, while another enjoys playing basketball. It was clear that all service users are given opportunities to use the community and two other facilities used by service users are the Chadwell Day Centre and Mulberry Lodge. This is a strong area of the homes operations. From looking at records and speaking with service users and staff, there was evidence that wherever possible, family networks are encouraged in the home. This is usually where there is family contact and service users are also encouraged to maintain their personal friendships. One good example is where a service user has a friend that visits every two-months and this is invaluable to the service user concerned. Importantly staff recognises this and so the service user is enabled to enjoy the experience. As a matter of fact the friend is invited to the service user’s review and this is really positive. In another case, the relative of a service user was involved in making arrangements to ensure that the service user is able to pursue his spirituality. The management and staff worked positively to enable this. Contacts with relatives ensure that special occasions like birthdays and Christmas are celebrated, which mean so much to the service users. This continues to be a strong area of the homes operations. In discussions held with staff, they were aware of promoting the rights of service users and had an understanding of the GSCC’s code of conduct. They had a good understanding of service user’s needs including that of their methods of communication. From observation service users were treated with respect and had access to all areas of the home. Some service users held keys to their bedrooms and for those that did not – a risk assessment was in place. Service users’ obligations are detailed in their contracts and rules regarding smoking and alcohol are outlined in the service user guide. Service users also have access to advocacy services, which are advertised on their notice board. The registered persons did engage the use of advocacy in Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 14 the case where attempts were made by the local authority to move someone from the home – without a review and/or appropriate consultation. This was particularly important in that the individual was unable to independently make her wishes known. This meant that her best interest was at risk of being compromised. Credit must be given to the home for acting swiftly in engaging the use of an advocate in the matter. The service user at present remains happy in her home. This is a strong area of the homes operations. It was noted that a new kitchen had been fitted and looked attractive, making the kitchen an inviting place to be. There were adequate supplies of fresh and frozen food, including fruits and vegetables. Food was stored appropriately throughout the home. Menus were assessed and were varied with service users having a choice of what they could eat. This is discussed in monthly service user meetings. It was pointed out at the inspection that service users breakfast is to be recorded. Service users spoken to, informed that they enjoyed all meals provided by the home. One service user spoken to stated ‘I like the food they prepare for me’. It was disclosed that he enjoys curry, which is provided in the home. It was noted that healthier eating options were available to service users e.g. low fat milk and brown bread. There was evidence that staff were monitoring service users healthcare in relation to their dietary requirements. This involved monitoring individual weights, providing guidance on food where required and, liaising with external professionals as the need arose. Staff handling food had, food hygiene training and, the inspector was satisfied that the nutritional needs of service users were adequately provided for. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18,18,20) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from receiving personal support in accordance with their needs and wishes. Appropriate staffing interventions ensure that both their physical and emotional needs are met. Medication practices in the home ensure the safety of service users requiring support with their medication. However, a record of all drugs entering the home must be maintained. EVIDENCE: Staff continued to work closely with service users and their agreed service user plans in providing personal support to them. This is important as the range of special needs of the service user group is quite varied and as such, would be best provided in line with the preferences of each individual. The key worker system also ensures that staff gather important information about individual likes/dislikes and preferences upon which they engage with the service users. This includes their style of clothes, methods of communication and indeed how they prefer being called. In observing interactions between staff and service users it, service users were quite happy with their engagement with staff. Feedback received from one relative indicated a high level of satisfaction with the way in which care and personal support was provided by the home. The staff team is mixed both in terms of gender and ethnicity, so that service users have a choice of staff they could work with. One individual knew his key Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 16 worker and happily described some of the experiences he had as a result of the relationship. All service users have their individual dress code and are encouraged to maintain it in line with their cultural preferences. One service user was sporting a wavy perm while another of African Caribbean descent was happy with having traditional haircuts. Both looked well groomed and pleased with their choices. Adequate arrangements are in place to ensure that service users if required have access to specialists such as, the physiotherapist, speech and/or an occupational therapist. All service users are registered with a GP and good professional relations are maintained to ensure that they have access to appropriate healthcare services. Whilst service users are unable to independently manage their healthcare, staffing input ensures that all aspects of their healthcare needs are followed up and provided for. There were updated and detailed records to indicate that service users were in receipt of services from the opticians, dentists, chiropodist and the consultant psychiatrist. At the time of the visit there was little input from the learning disability nurse, but contact details were in place should the need arise. Records also indicated that staff were monitoring service user’s weight and, they were capable in ensuring that any deterioration in service users health is acted upon. A satisfactory medication policy and procedure was in place in the home and staff were aware of it. From assessing the training records it was observed that all staff with the responsibility for administering drugs have been provided with training in medication. At the time of the visit none of the service users were able to independently manage their medication and as such, staffing support in this area is critical to promoting their safety and wellbeing. There were some key areas of good practice e.g. noting service user’s allergies, having service user’s photos on the charts and having guidance and reference material for staff on medication and, on various conditions such as constipation, indigestion and diarrhoea. Medication storage was generally satisfactory as was the recording of medication administered to service users. The registered manager acted to ensure that service users on ‘as required’ medication for long periods without being used – were reviewed by the GP. This ensures that drugs are not stocked up unnecessarily, but ensures that service users’ medication is reflective of their needs. There was also a system in place to audit and monitor the amounts of ‘as required’ medication in the home. However, it is equally important for the registered manager to ensure that all medication in the home is recorded at the point of entry into the home. There was evidence of liquid oral medication not being recorded in line with medication guidelines and this needs to improve. Old Registry (The) DS0000025931.V328780.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 good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints policy and procedure is available for the benefit of service users and their relatives. At the Old Registry sound procedures were also in place protecting service users from abuse. EVIDENCE: An updated complaints procedure is in place and available to service users. It was noted some individuals are able to voice their unhappiness with their experience of the service, while others rely upon their relatives or significant others to assist them. For those who are able to, they stated that they would complain, if they were unhappy with something in the home. From interviews with staff, they viewed complaints as a positive feature in promoting the rights of service users. Staff were also clued into when service users were unhappy and this is determined on an individual basis and in accordance with their individual communication methods. From the written feedback received, all service users felt that the staff always listened to what they say, while one did not know who to speak to if they were unhappy, with two stating that they did not how to complain. There were no complaints at the time of the inspection and the complaints procedure is advertised on the walls of the home. A satisfactory adult protection procedure is in place at the Old Registry and it includes clear guidance on ‘whistle-blowing’. The local authority’s adult protection protocol is also in place at the home for the benefit of staff. Most of the staff team had training on adult protection and from interviews and discussions held with a staff - they understood their responsibility in protecting Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 18 vulnerable adults. There were no adult protection issues in the home at the time of the visit. Service users therefore remain safe at the Old Registry. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24,25,27,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, clean and safe environment, one that is homely and generally fit for its purpose. This includes; the communal and private spaces as well as the toilets and bathing facilities. The environment could be enhanced by changing the carpets on the first floor landing and by adding a bit decoration to the upstairs bathroom and the toilet. EVIDENCE: During the course of the inspection the home was clean, bright and airy with furnishings and fittings that were homely and maintained in a good state of repair. Its location is close to local amenities and all service users were observed accessing the building with ease. Each of the service users spoken to expressed, their happiness with living at the Old Registry and written feedback received confirmed that. Positive comments were also received from relatives in the past about the quality of the accommodation and the registered persons generally do a good job at maintaining it. However, it was noted that the carpet on the first floor landing was quite worn, dull and in need of replacing. This needs to be carried out to maintain the ambience of the home. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 20 The lighting, heating and ventilation was satisfactory and there was evidence that the home was maintained in line with the requirements of the local fire, public protection and, health and safety agencies. There is a good system in place for reporting repairs and a dedicated member of staff carries out routine maintenance in the home. At the time of the visit one of the taps in a service users bedroom did not have a supply of water and this was duly reported for action. The bedroom ceiling of another service user room bore evidence of watermarks and again, this was highlighted for attention. It is anticipated that these works would have been carried out in earnest. Several service users were keen to show their private spaces and they were all found in a good condition. They were very personalised and kitted out to individual taste and style. One service that had recently moved from another home commented ‘I prefer my bedroom here as it is smaller and more cosy’. Another commented ‘I chose the colour and I prefer a wooden floor’. They were all very pleased with their bedrooms. One bedroom was draped with Tottenham Hotspurs memorabilia and distinguished the service users support for his club. Several rooms were also fitted with modern televisions and sound systems that suited each individual’s interests. Pictures were on walls as selected by individual service users and it gave them a sense of ownership and belonging. This is a strong area of the homes operations. There were adequate bathrooms and toilets that were generally clean and suited to the needs of the service user group. They were appropriately cited and were designed to promote both the independence and privacy of service users. It was noted that the facilities on the ground floor were much more homely than that on the first floor. Both the toilet and bath on the first floor contained the basics and should provide a bit more to enhance the experience of individuals using them. They neither looked nor felt homely and although service users did not particularly comment on them – they needed enhancing e.g. some pictures. The laundry area was assessed was generally satisfactory and in a good condition. The floor surfaces were also satisfactory and the equipment is suitable for safely cleaning soiled linen in the home. Hand washing facilities were placed throughout the home and this is useful in promoting hygienic practices. Policies and procedures remained in place to ensure the safe management of spillages, dealing with soiled laundry and generally guiding staff in relation to infection control. Old Registry (The) DS0000025931.V328780.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): (32,34,35) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are generally supported by, staff that are qualified to carry out their roles. Staffing recruitment is generally robust, which acts as a safeguard for protecting vulnerable service users. Training and development is provided to ensure a good standard of service delivery, although there must be evidence that all staff have the benefit of a structured induction. EVIDENCE: Feedback received from service users, indicated that they were happy with the efforts of staff in supporting them. Service users had various levels of communication skills and staff were adept to them. Staff were observed interacting in a positive manner with service users and were quite motivated in doing so. From interviews and discussions held with staff, they demonstrated a good understanding of the needs of the service user group. Detailed and updated records ensured that a consistent service is provided at the Old Registry. More than fifty per cent of the staff team had achieved an NVQ Level 2 in Care and so they had an understanding of the principles of good basic care. Plans were in place for staff to go on to NVQ Level 3 and for others to start their NVQ Level 2. This should have a positive impact on the overall quality of the service provided at the Old Registry. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 22 The recruitment files of the two most recently employed staff, were assessed and were generally found in good order. Criminal Reference Bureau checks were carried out for both individuals as required by regulation. One of the staff was recruited via an agency and in general this was carried out robustly. The registered manager did accept a CV as opposed to an application form and was advised that the process of recruitment must be consistent for all staff working in the home. A medical declaration was not sought in this case, however the inspector was satisfied the individual concerned provided full health details to the registered manager. All other recruitment information was in place. The recruitment process therefore ensures that service users are not put at risk, by engaging with staff that may be unsuitable to work with them. The training records were assessed and a range of training was provided for staff. They included; NVQ Level 2 in Care, food hygiene, first aid, optical awareness, managing aggression, challenging behaviour, podiatry and adult protection. Further training is planned to include person centred planning, refresher adult protection and fire training, and NVQ Levels 2 and 3 in Care. The registered persons may wish to consider the provision of equality and diversity training to ensure that the staff develop a greater understanding of both the needs and issues, which may affect the diverse service user group at the Old Registry. It could be concluded that the training provided was in line with the philosophy and principles of the service. However, in one of two training files assessed there was no evidence that the staff had an induction. This as discussed with the manager and he expressed that the paperwork might have gone astray. Induction training is mandatory for all staff to ensure that they are given the best possible preparation for their role. The staff concerned did indicate their experience of an induction, but again this could not be evidenced. However, this did not include first aid training and/or infection control – which is part of the mandatory statutory training. This needs to be improved. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39,42,43) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A dedicated manager is in place to run the service. Management systems are also in place to provide good quality care at the Old Registry. This includes systems for promoting health and safety. The overall service would be enhanced by; ensuring that an internal audit is carried out annually and, formal supervision is provided for the registered manager. EVIDENCE: The registered manager has achieved his NVQ Level 4 in Management and Care qualification and has been running the service over two years now. He has the support of the staff and service users alike, as well as a good understanding of his roles and responsibilities for ensuring that the service is run in line with its aims and objectives. He attends a quarterly management forum that is chaired by his manager and this is useful in maintaining good standards of care in the home. Staff spoken to, were of the view that he provided a clear sense of leadership and guidance in his role as manager. This is positive. Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 24 At the time of the visit the policies and procedures were reportedly under review. However, there was evidence that great strides were undertaken to monitor the quality of the services provided at the Old Registry. Regular monthly provider visits are carried out with reports sent to the Commission. A service user survey was carried out in 2006 and an annual development plan was in place for the service. Plans were in place to have this reviewed in August 2007. Service users’ progress and development is determined at both internal and annual reviews held on them. There was evidence that the registered manager sought the views of external professionals and relatives with regard to the service. However, an internal audit of the service is yet to be carried out, which would assess the overall quality of the service provision. This needs to be carried out as part of the organisation’s quality review of the service. Health and safety practices throughout the home were of a fairly good standard and this is crucial to maintaining a safe environment at the Old Registry. Most of the staff received health and safety training and, demonstrated an understanding of the principles in maintaining a safe environment. Health and safety records were assessed and found to be in order. Some of the records assessed included; fire, gas, electrics, electrical testing, and Legionella. A health and safety inspection was carried out on the 30/1/07 and was reportedly, satisfactory. The registered manager needed to ensure that health and safety policies as with all other policies were signed off and dated. In monitoring the conduct of the service, there was evidence that adequate arrangements were in place for insurance with regards to the loss of assets and business interruption costs. The registered persons also had private arrangements for financial monitoring. A business and financial plan was not requested at this inspection, but would be assessed at the next inspection. The registered manager provided evidence of an emergency plan should there be reason to evacuate the home. Whilst some systems are in place for quality monitoring of the service, there was no evidence of arrangements for the formal supervision and appraisal of the registered manager. He attends quarterly management meetings and reportedly has regular contact with his line manager. This needs to improve to both meet the minimum standard 43.3(iii) and to enhance the overall management of the service in relation to; the manager’s professional development, guidance and support. Old Registry (The) DS0000025931.V328780.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 3 2 3 3 X 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 3 ENVIRONMENT Standard No Score 24 2 25 4 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 x LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 3 2 Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 26 NO 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 YA5 Regulation Requirement Timescale for action 30/04/07 2 YA20 3. YA24 4. YA27 5. YA35 6. YA39 5A(2)(a)(i)(iii)(b) The registered persons are to provide each service user with the details on the fees payable and by whom. 13(2) The registered persons are to ensure that a record is kept of all medication, including those in liquid form. The record must include; the name of the drug, the date and, the quantity received. 23(2)(d) The registered persons are required to replace the carpets on the first floor landing. 23 (2)(d) The registered persons are required to improve on the decorations in the upstairs bathroom and toilet. 18(1)(c)(i) The registered persons are required to provide structured induction training for all staff with records kept. 24(1) The registered persons are required to carry out an annual internal audit of the service. 30/04/07 31/05/07 15/05/07 15/05/07 30/05/07 Old Registry (The) DS0000025931.V328780.R01.S.doc Version 5.2 Page 27 7. YA43 18(2)(b) The registered persons are required to provide regular formal supervision and an annual appraisal for the registered manager in line with standard 43.3 of the National Minimum Standards for Younger Adults. 30/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Old Registry (The) DS0000025931.V328780.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: 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. 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