Inspection on 06/11/07 for Orchard Close (4 )

This inspection was carried out on 6th November 2007.

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

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

Other inspections for this house

Orchard Close (4 ) 02/06/06

Orchard Close (4 ) 28/09/05

Orchard Close (4 ) 02/06/05

Orchard Close (4 ) 17/02/05

Orchard Close (4 ) 20/08/04

Orchard Close (4 ) 02/03/04

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 Orchard Close (4 ) 4 Orchard Close Morton Road London N1 3AS Lead Inspector Claire Taylor Unannounced Inspection 6th November 2007 10:45 Orchard Close (4 ) DS0000031851.V354882.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 Orchard Close (4 ) DS0000031851.V354882.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. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Close (4 ) Address 4 Orchard Close Morton Road London N1 3AS 0207 354 9436 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) maureen.power@islington.gov.uk Islington Social Services Maureen Power Care Home 6 Category(ies) of Learning disability (6), Physical disability (6) registration, with number of places Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd June 2006 Brief Description of the Service: Orchard Close is a care home for younger adults with learning disabilities who may have complex needs such as physical disabilities and, or sensory impairment. The home provides 24-hour care and support and has its own transport. Built in 1990, the home is owned and operated by Islington Council. There is a main lobby with communal sitting rooms and dining areas. All the bedrooms are single occupancy and there is a pleasant secure garden. Located in a quiet residential cul-de-sac near Rotherfield and Morton Roads, the home is situated relatively near to community facilities such as shops, pubs and a park. Public transport is available but not necessarily accessible for people with physical disabilities. Essex Road rail station is nearby, and Highbury & Islington and Angel tube stations are within 20 minutes walking distance. There are several local bus routes and these have a limited number of wheelchair accessible buses. More detailed information about the services provided can be found in the home’s Statement of Purpose and Service User Guide – copies of these documents can be obtained directly from the home. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors carried out this unannounced visit. Various records were looked at in relation to care planning, staffing and the general operation of the home. There was also a walk round the premises. People living in the home do not have the capacity to share their views regarding their care. In order to make judgements about the care that service users receive, observations of care practices and discussions with the manager and staff took place. All registered services are required to complete an annual quality assurance assessment (AQAA) every year. It is a self-assessment that is used to show how the home makes sure of good outcomes for the people using it as well as any future developments being planned. The AQAA also provides the CSCI with statistical information about the individual service and trends and patterns in social care. Some information from the completed AQAA forms part of this report. As part of the inspection process, comment cards were sent out to four relatives prior to the visit. Questionnaires were also given to five staff. None were returned on this occasion. Discussions were also held with one district nurse and two Occupational therapists who were visiting. Some concerns regarding fire safety were identified during the visit. As a consequence an official letter known as an “immediate requirement” was issued. This advised that the identified concerns must be put right within 48 hours or enforcement action may be taken. The home complied within the timescale and sent the required documents to the Commission. All those who took part are thanked for their time and contribution to this inspection. What the service does well: People living in the home have both learning and physical disabilities, some of whom have complex needs and limited communication abilities. Plans of care are person centred, well created and closely reflect the specific needs of the person. This means that staff have clear information on how to support their needs. Staff closely monitor the health and wellbeing of the people living in the home and work in partnership with other agencies to ensure that individual health care needs are met. Feedback from other professionals included “a proactive team who communicate well” Any changes in individual needs are acted upon and adjustments to their care and support are put in place. Although improvements are needed with record keeping, the manager and staff have a good knowledge about each person’s needs, likes and dislikes. They were seen to be caring and sensitive in their approach and support individuals with dignity and respect. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although only six people were living at the home during this inspection, records showed that a seventh person had been admitted for a period of two months and that an unregistered bedroom was used earlier in the year. This is a serious breach of regulations and the registered provider must ensure that the home only accommodates the correct number of people its registration category allows for. Failure to do so may have a detrimental effect on the quality of care and put people at risk. The Commission may consider taking enforcement action if there is such a breach of regulations again. Whilst redecoration and improvements to the building have taken place further work must be done to make sure the home is safe and more comfortable for the people living there. Health and safety practices need improving and some concerns were identified. A vast number of fire doors were propped open by wooden or rubber wedges. There was a lack of fire safety notices throughout the building and no up to date fire risk assessment. This means that the safety of people living and working in the home could be compromised in the event of a fire. A fire safety inspection by the local authority is also needed. Some bedrooms need to be personalised and made more homely. One person also requires better storage facilities that meet their needs and lifestyle. Structured activities are needed within the home to provide more interest and stimulation for individuals. So that the rights and best interests of people living in the home are better safeguarded, several improvements are needed with record keeping. This also applies to some aspects of record keeping required by law. The Commission needs to be informed more promptly of any events that affect the well being of people living in the home. Staff files are currently held centrally by the owning organisation but as required by law and regulation, certain records need to be kept on site in the home. This will show that the employer has undertaken all appropriate checks and vetted its staff correctly. Training records for staff did not give assurance that staff were up to date with their training and consequently that they have the necessary skills and knowledge to meet the needs of the people living in the home. Similarly, the lack of routine staff supervision may affect the quality of care provided. Staffing rotas must be written more clearly so that they provide an accurate and true record of staff working in the home. Monthly reports concerning the conduct of the home need to be sent to the Commission. This will demonstrate Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 7 how the organisation monitors progress within the home and identifies areas for improvement. Service users’ wishes concerning ageing, illness and death still need to be established so that their beliefs and choices would be respected. A system is needed to ensure that food products are checked and rotated on a regular basis. When medication is not given the reason must be clearly recorded to enhance accuracy and maximise safe practice. As highlighted at the previous two inspections, there is still a lack of access to computer IT systems for staff other than managers. The responsible individual should address this inequality so that all staff are kept fully informed of best practice and Council issues. 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. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 8 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 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 9 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): 2, 3 and 4 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home provides introduction opportunities for prospective service users and their families to make an informed choice about whether to live there. Arrangements are in place for assessing people’s needs so that staff are aware of how to support them. Although needs are assessed, the home had earlier this year breached its registration category by accommodating seven people instead of six. This means that service users could have been put at unnecessary risk during that time. EVIDENCE: Since the last inspection, two people have moved in, one person has left and one person had died. Records were examined in some depth and a serious breach of regulations had occurred earlier in the year. Over a time period of two months (May 25 2007 to July 19 2007), the home had been accommodating seven service users when it was only registered for a maximum of six. The Commission may consider taking enforcement action if there is such a breach of regulations again. The home did not make an application to increase its occupancy to seven until August 2007. At the time of this visit, the application was in its final stages of approval. Care records showed that a needs assessment was carried out for the newest person prior to their admission in September 2007. The home’s assessment is designed to Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 10 identify what levels of support the person requires. Areas covered include hobbies, social/ cultural needs, dietary preferences, medical history and personal care. A copy of a recent local authority needs assessment was also available. The staff made sure that the individual was fully involved in the process leading up to moving and likewise, that they understood their needs. Staff had spent time getting to know the person by visiting them in their previous placement and the person’s former key staff worked in the home to help them settle in. Records showed that an appropriate review meeting had been held 6 weeks after moving in. Two other people’s plans of care were checked and each contained a completed needs assessment. This shows that the home makes sure prospective people’s needs are fully assessed. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 11 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 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Care plans are person centred and closely reflect the care and support required to meet people’s assessed needs. Individuals are provided with the necessary support to take risks so that independence is maximised as far as possible. EVIDENCE: Including the newest person’s, care plan records were sampled for three people. Person centred planning has progressed well. Plans are well structured and developed with the individual service user and their keyworker. Person centred plans (PCP) focus on individual likes/dislikes, strengths, and aspirations. Pictures and photos are included to support the written text making them more meaningful. A PCP was seen for the newest person. It is suggested that each person has a copy of their plan in their bedroom. Individual daily records were thorough, relevant, and gave an indication of each person’s experience of their day. Monthly report summaries are written by keyworkers to evaluate whether goals and objectives are being met and to Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 12 summarise the daily events records. The manager advised that daily care records are destroyed after a year in line with the home’s policy. This does not meet the care homes regulations and has been discussed further on in the report under “Management and Administration”. Whilst the service users’ ability to make informed choices is limited, staff nevertheless try to consult them on everyday decisions that affect them. Daily records and observation of staff working reflected this. Relevant risk assessments, matched to individual needs were in place. A risk assessment tells the staff how to make sure that each individual is kept safe from anything that might harm them. Guidelines are frequently reviewed or as changes to needs occur. Records in two people’s files confirmed this. The person who recently moved in had an accident one night and fell off their bed. As a consequence, the manager and staff promptly reviewed the risk plan. The bed was fully lowered and a soft mat provided to minimise the risk of injury. Reviewed guidelines were seen for another person who may behave in a way that puts themselves or others at risk of being physically harmed. I.e. there had been some incidents of hitting out at staff and attempts to scratch or bite. The manager and keyworker had written up guidance and risk assessments for managing the behaviour. This enables staff to support the person in a way that maximises safety and reduces the risk of harm or injury. Other risk plan examples seen included personal hygiene, eating, safety in the home and accessing the local community. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are supported in undertaking activities that they enjoy in the local community. Suitable activities are needed within the home however to provide more interest and stimulation for individuals. Individuals are fully supported to maintain important links with family and friends. Meals are nutritiously balanced and offer a healthy and varied diet for the people who live there. EVIDENCE: People living in the home have highly dependent needs including physical disabilities and limited verbal communication. Staff therefore tend to organise activities based upon each individual’s assessed needs and knowledge of their preferences. Care records sampled showed that individuals are provided with regular opportunities to experience their local community. During this inspection, two people went on an outing to Epping Forest with one staff and a volunteer. This had been planned by one of the keyworker staff who was Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 14 leaving. Other activities include walks and outings to places of interest such as the theatre. The service users attend a local day centre on a sessional basis. Two individuals were out at the centre during the inspection. Within the home however, there was a limited range of entertainment and leisure activities. There was a television, music system and two large beanbags for individuals to have relaxation time. More activities are therefore needed so that individual social needs are met and people can experience a more fulfilling lifestyle within their home setting. The manager acknowledged that improvements are needed and had begun to address this. At a recent team meeting, staff were consulted about their ideas for an activity programme based upon their knowledge of each service user’s needs and preferences. Some multi sensory equipment had been purchased including a colour change lamp, textured fabrics and a bubble machine. The manager explained that there are plans for the second lounge area to be used as the activity room. Two Occupational therapists were visiting and confirmed that the home had sought advice on activities and the development of a multi sensory room. A part time cook is employed and the manager informed that there is no set menu in place. However she ensures that the meals are balanced and nutritional and cater for the dietary needs of the individuals using the service. Records are kept of the food provided for two people. The other four people living in the home require artificial feeding. Service users are offered a choice of meals, which meet their dietary and cultural needs, and which respect their individual preferences. Records of food and fridge/freezer temperature checks were in place. Orchard Close (4 ) DS0000031851.V354882.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, 19, 20 and 21 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Promotion of health is well observed. Welfare is closely monitored to ensure that the physical and emotional needs of people living in the home are met. The home’s medication practices are generally well organised although improvements to record keeping will ensure better safety and consistent treatment for each service user. People’s wishes concerning ageing, illness and death still need to be established so that their beliefs and choices would be respected. EVIDENCE: People living in the home have a range of complex healthcare needs. The manager and staff were knowledgeable about each individual’s required personal and healthcare support routines. Staff were seen to address service users respectfully and respond to their different means of expression. Due to specific needs, four service users require long term artificial feeding. The district nurse team oversee the associated care with PEJ feeding for two people and a PEG feed for a third person. Another person’ s nutrition is provided via a gastrostomy. The manager stated that all staff have been trained to manage this person’s care. Records were not available to evidence this however. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 16 Sampled care plans contained information on how support should be given to meet people’s personal care needs. Where support is required with personal physical care, guidance was available on how specific tasks should be undertaken. E.g. manipulation and correct resting positions for the four individuals who use wheelchairs. Staff were observed carrying out a variety of tasks competently. Individuals are supported to access routine health appointments and checks. This includes regular contact with GPs, Consultants and other health care professionals as necessary. E.g. Physiotherapy, dietician, psychology and dentist. Advice and guidance is sought from other healthcare professionals on a regular basis and each service user is fully supported to access relevant specialist services. Records for one person confirmed this- a referral was made to neurology due to a significant increase in their epileptic seizures. During the visit one staff met with two Occupational therapists to discuss moving and handling guidelines for the person who had recently moved in. This shows that the staff team monitor people’s healthcare needs closely and take prompt action to address any changes. Feedback from other professionals included “a proactive team who communicate well” The medication administration records were audited. There were several instances where prescribed medication had been omitted or administered but not signed for. Although there were acceptable explanations for this, these explanations had not been recorded. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. A large amount of prescribed medication was being kept in a cupboard in the office. The manager was advised to return the stocks that were not needed. Accurate records for the receipt and disposal of medication were in place. A number of individuals are prescribed rectal diazepam due to their epilepsy needs. The manager stated that all staff are trained in the procedure but again, there were no records to evidence this. As previously required, the home has yet to establish each service user’s wishes concerning ageing, illness and death. The manager explained that a meeting was planned for December to discuss these sensitive issues with the relatives and families. This is because the people living in the home do not have the capacity to make their wishes known. Orchard Close (4 ) DS0000031851.V354882.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 and 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Concerns about the care provided are listened to and acted upon. The home’s practices and procedures help protect people from abuse although records must show that staff have been trained in safeguarding vulnerable adults. EVIDENCE: Since the last inspection, one anonymous complaint was made to the Commission. This was referred to the registered provider for investigation. The outcomes and findings showed that the organisation takes complaints seriously and took the necessary action to deal with the concerns raised. Some of the concerns raised were substantiated and resulted in changes to some of the home’s practices. The home has policies to help safeguard the service users welfare. E.g. management of finances, safeguarding adults procedures and a whistle blowing policy to state what action to take should staff suspect anything untoward. The manager stated that all staff working within the home are fully trained in Safeguarding Adults and know how to respond in the event of an alert. Records did not show however that staff have been appropriately trained. People living in the home need full support with their finances and are reliant on staff or family to manage their monies. Appropriate documentation was in place with regard to income/expenditure made on their behalf as well as policies to safeguard their personal interests. The manager informed that small amounts of money are kept in separate wallets/ purses for each person with a running balance sheet appropriately maintained for sundries, such as toiletries. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 18 Records are kept of financial transactions and daily checks are made at the staff handover to ensure that these are correct. Orchard Close (4 ) DS0000031851.V354882.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, 26, 27, 29 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Redecoration of the home has meant that service users live in more welcoming and comfortable surroundings that also meet their physical care needs. Improvements are needed however to ensure that all bedrooms are more homely and personalised for some individuals. Facilities inside the home are clean and generally safe although a fire safety inspection is needed. EVIDENCE: Following extensive refurbishment, the home now has a well-maintained environment, which provides aids and equipment to meet the physical care needs of the people living there. There are ceiling hoists in all the bedrooms and more suitable washing facilities such as two adapted showers. The home has been redecorated throughout and appeared clean and tidy. All the bedrooms were viewed and whilst most were personalised with people’s chosen possessions, one person’s room looked bare and did not give a homely impression. Having moved in to the home in May of this year, this person’s room had still not been personalised to reflect their identity or chosen Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 20 interests. There was also a lack of storage space. The individual has an artificial PEG feed and requires catheter care that is provided by the district nurse team. A catheter bag and gloves was seen on the radiator and PEG feed equipment was being kept on top of a bedside cabinet. Appropriate storage facilities must therefore be provided for this person. In addition the extension lead and loose electrical leads by the bed must be secured. This not only looks unsightly but also represents a trip hazard. The vacant bedroom was being used for storage and contained equipment that belonged to the service user who died in August of this year. The manager stated that the items were due for return to the Occupational Therapy department. A number of call bells were out of reach and the manager stated that the current service users are unable to use them. She gave reassurance that the call bell would be made accessible if a service user is able to use it. The call bell system was tested and in good working order. The regulatory records from the local Fire authority and Environmental Health departments were not up to date. Considering that the building has been extensively refurbished, the manager must ensure that the premises comply with the requirements of the local fire brigade (LFEPA) so that people living and working at the home are not put at unnecessary risk. Several other concerns regarding fire safety were identified and have been discussed further under “Management & Administration” standards. A part time staff is employed to carry out domestic duties. Good hygiene practices are observed and systems well managed to control the spread of infection. Protective clothing is available to staff and appropriate arrangements were in place for the safe storage and disposal of clinical waste. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is a staff team who are committed to meeting the needs of the service users. Recruitment practices help to ensure that people are cared for and protected. Record keeping needs improvement as a further safeguard however. Staff training and development must improve as it does not give full assurance that staff are able to meet people’s needs. The lack of routine staff supervision means that individual job performance is not regularly monitored which may affect the quality of care provided. EVIDENCE: There are suitable numbers of staff to meet the current needs of the service users although the home is still dependent on using agency staff to cover its vacancies. The manager reported that there was one deputy and four support worker posts to be filled. Although the manager stated that a core team of agency staff work in the home, the continued reliance on agency staff does not assure consistency of care for the service users. Staff allocation allows for four carers to be on morning duty, four in the afternoon and one waking night staff with one sleeping in. The manager reported that staffing levels would be increased to five on each day shift once a seventh person is admitted. The duty Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 22 rotas reflected these staffing levels but did not provide an accurate record of who worked. Rotas were written in pencil and did not identify the full names of the staff or who was in charge. This must be addressed for better clarity and legal purposes. Recruitment procedures are thorough to ensure that staff are vetted correctly and service users are safeguarded. Discussions with staff confirmed that appropriate employment checks were carried out prior to starting work. Staff recruitment records are currently held centrally by the owning organisation and were therefore not available for this inspection. The Commission has developed a “staff proforma” form that should be completed for each employee and kept in the home. The form can be used to evidence that appropriate recruitment checks have been undertaken by the employing organisation as well as other documents required by law. Four staff files were sampled. From the staff training records, it was noted that they were not always up to date and there were gaps in mandatory training. It was very difficult to ascertain if the staff were up to date with their training. Two staff had no records of training on their files. Given that the home uses regular agency staff, it would be better practice if these staff sign confirmation when they have completed an induction. In addition the manager should keep a record of all training that agency staff have undertaken. This will then show that they have the necessary knowledge and skills to meet the needs of the service users. The manager or deputy undertakes staff supervision to discuss concerns, monitor job performance and offer guidance. Records showed that yearly job appraisals for one staff were up to date but some staff had not received supervision for several months. Some of the concerns raised in the anonymous complaint also identified a lack of staff supervision. Record keeping must therefore improve to show that the staff have received the necessary training and support to do their jobs effectively and meet people’s needs. Regarding what the home could do better, the completed AQAA stated “Recruit to vacancies more quickly” and “Provide individual supervision to staff more consistently” Orchard Close (4 ) DS0000031851.V354882.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, 41, 42 and 43 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The manager has the relevant qualifications to run the home. Arrangements are in place for monitoring the quality of care provided although significant improvements are needed with record keeping to ensure that the rights and best interests of the service users are fully safeguarded. Some practices do not fully promote and safeguard the health, safety and welfare of the people using the service. The home’s fire precautions need attention as people’s safety could be compromised. In addition, staff are not up to date with key health and safety training. EVIDENCE: Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 24 Maureen Power, the manager, has worked in the home for over ten years. Discussions and observation confirmed that she is knowledgeable about each service user’s specific needs and how to support them. The manager has completed the NVQ level 4 qualification and Registered Managers Award. A range of quality assurance systems are used to measure the success of how the home is achieving its aims and serve the best interests of the people who live there. Examples include regular care plan reviews, meetings and an annual quality action plan. Record keeping could be better organised as staff spent unnecessary time locating some of the required documents for inspection. A service user passed away in August of this year and although the monthly summary report was available, the staff could not locate the original daily care records for this person. The manager stated that daily care records are destroyed after a year in line with the home’s policy. This does not meet the care homes regulations and records must be retained in the home appropriately. Other records such as monthly reports on the conduct of the home made by the registered provider are currently held electronically on the home’s computer. These should be accessible to all staff and the responsible individual must also ensure that a copy of the monthly report is sent to the Commission in accordance with regulation 26. Accidents and incidents are recorded appropriately although the home must ensure that the Commission is notified of any events that affect the service users’ well being e.g. concerning falls and/ or admissions to hospital. The manager must ensure that all staff are aware of the guidance for notifying the Commission of significant events. The servicing and maintenance records for the home were sampled. Ceiling hoists, beds and the mobile hoist had all been checked regularly to ensure safe operation. Gas and electrical safety checks were up to date. Some health and safety practices need improving however. The majority of fire doors were propped open by wooden or rubber wedges. There was a lack of fire safety notices throughout the building and no up to date fire risk assessment. This means that the safety of people living and working in the home could be compromised in the event of a fire. An immediate requirement was issued and the home complied within the given timescale to put the concerns right. Weekly fire alarm tests and regular fire evacuations were being carried out. As discussed earlier under staffing standards, records did not demonstrate that staff were up to date in key health and safety training. I.e. fire, moving and handling, first aid, food hygiene and infection control. It was also noted that some food products had passed their use by date. The cook informed that these products were not in use; however they were in the kitchen. This could potentially result in serious repercussions to the health and welfare of people living in the home. As highlighted at the previous two inspections, there is still a lack of access to IT systems for staff other than managers. The owning organisation, Islington Council relies heavily on IT for maintaining communications. Staff again commented that they would benefit from better access to the IT systems. Staff frequently use the computer for key tasks related to care planning for the people living in the home. Annual leave appraisal, booking training, and Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 25 information about new policies and procedures are all IT based. The responsible individual must therefore address this inequality. Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 2 4 3 5 X 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 X 26 2 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 2 36 1 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 2 13 3 14 2 15 X 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 1 3 X 2 X 1 1 2 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA3 Regulation 12(1)(a) Care Standards Act Part II 14(1)(c) & 24 Requirement The registered provider must ensure that the home only accommodates the correct number of people it is registered for. Failure to do so may have a detrimental effect on the quality of care and put people at risk. Immediate from the date of this report. The Commission may consider taking enforcement action if there is such a breach of regulations again. 2 YA14 12(1-3) 16(2 n) Further activities are needed within the home to provide service users with a more stimulating and fulfilling lifestyle that will suit their interests and abilities. When medication is not given the reason must be recorded clearly on the administration chart. This will enhance accuracy and maximise safe practice. 31/03/08 Timescale for action 06/11/07 3 YA20 13(2) 31/12/07 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 28 4 YA21 12 (2)(3) The Registered Persons must ensure that the wishes of service users in the event of illness, dying, and death, are known and recorded. Repeated requirement. Timescale of 30/09/06 not met. Extended as manager had made arrangements to meet and discuss with service users relatives in December 2007. 31/12/07 5 YA23 13(6) 17(2) As a further safeguard to the service users welfare, records must show that staff have been appropriately trained in reporting and detecting abuse. The home arranges for a visit from the local fire brigade (LFEPA) to ensure that the premises comply with current fire regulations and people are not put at risk in the event of a fire. Individuals must be provided with sufficient furniture and storage facilities in their bedrooms to meet their personal needs and lifestyles. All individuals must be supported to personalise their bedrooms so that they meet their needs and preferences and are more homely for them. In one service user’s bedroom, the extension plug socket and loose electrical leads by the bed must be secured as they represent a trip hazard. 31/01/08 6 YA24 23(4) 31/12/07 7 YA26 23(2 m) 31/01/08 8 YA26 16(2 c & d) 31/01/08 9 YA42 13(4) 31/12/07 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 29 10 YA33 17(2) shc.4(7) Staffing rotas must be recorded in more detail and written in ink so that they provide an accurate and true record of staff working in the home. All required staff records must be kept in the home to show that the employer has undertaken all appropriate checks and vetted its staff correctly. Records must be retained in accordance with schedule 2 of the care homes regulations. Training records must be available to show that staff have the skills and experience to meet the needs of the people living in the home. A training needs assessment must be carried out for the staff team as a whole, and used to inform future planning and identify the benefits for people using the service. Each staff must have routine formal supervision so that their job performance is regularly monitored and any training needs can be identified and actioned. The responsible individual must ensure that visits are carried out monthly and reports are sent to the Commission. This is to show how the organisation monitors the conduct of the home and identifies areas for improvement. DS0000031851.V354882.R01.S.doc 31/12/07 11 YA34 17(2) 19(4 b) 31/01/08 11 YA35 19(5 b) 31/01/08 12 YA35 18(1 c) 31/01/08 13 YA36 18(2) 31/01/08 14 YA39 26(5a & b) 31/12/07 Orchard Close (4 ) Version 5.2 Page 30 15 YA41 17(2, 3 & 4) Schedules 3 &4 The correct records for all people who use the service must be held by the home so that their rights and best interests are more fully safeguarded. 31/01/08 16 YA41 37 The Commission must be 31/12/07 notified more promptly of all significant events that affect the service users’ well being. The manager must ensure that all staff are familiar with the reporting of incidents and accidents under Regulation 37 of the Care Homes Regulations. A fire risk assessment must be completed that is relevant to the new layout of the building and includes the current fire precautions within the home. Immediate requirement issued and complied within given timescale. Written evidence was sent to the Commission. 08/11/07 17 YA42 23(4)(c)(v) 18 YA42 23(4)(a) Fire doors must not be propped open unless they are 06/11/07 secured by a suitable device that activates on the fire alarm sounding. Immediate requirement issued and complied within given timescale 19 YA42 23(4)(a)(b) The registered provider must arrange for suitable fire door closures to be installed and DS0000031851.V354882.R01.S.doc 31/01/08 Orchard Close (4 ) Version 5.2 Page 31 provide an action plan to the CSCI that outlines how this will be addressed and timescales. Without adequate fire precautions, the safety of people living and working in the home may be compromised. Immediate requirement issued and complied within given timescale. Written evidence was sent to the Commission. 20 YA42 23(4)(c)(iii) Appropriate fire safety notices must be put in place. Without adequate fire precautions, the safety of people living and working in the home could be compromised. There must be a system in place to ensure that food products are checked and rotated on a regular basis to promote and make proper provision for the health and welfare of the service users. Records must show that staff are up to date with key health and safety training to ensure that service users needs can be fully met and health and safety practices are correctly followed. 31/01/08 21 YA42 13(4)(c). 31/12/07 22 YA42 17(2) 18(1)(a) 19(5)(b) 31/01/08 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 32 23 YA43 18(a)(c)(i)(ii) The Registered Persons must 31/03/08 ensure that staff have equitable access to key IT information. This must include access to training and appraisal documents and systems, as well as up-to-date information about the general activities of the Council. Repeated requirement. Timescale of 1/03/07 not met. Extended. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Each service user should have a copy of their person centred plan in their bedrooms so that staff have on hand information about their support needs. Training records for agency staff should be kept in the home to show that they have the knowledge and skills to meet the service users needs. Agency staff should also sign in acknowledgment once their induction is complete. 2 YA35 Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard Close (4 ) DS0000031851.V354882.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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