Inspection on 07/03/06 for Pathways

This inspection was carried out on 7th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pathways 30/08/07

Pathways 09/08/06

Pathways 07/09/05

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 Pathways 11 Gloucester Drive Hackney London N4 2LE Lead Inspector Kristen Judd Unannounced Inspection 7th March 2006 11:25 Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Pathways Address 11 Gloucester Drive Hackney London N4 2LE 020 8860 2619 020 8862 6862 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) www.pathwayscare.net Care Support Service Ltd trading as `Pathways` Ms Joanna Mary Brunt Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th September 2005 Brief Description of the Service: 11 Gloucester Rd is registered with the Commission for Social Care Inspection to provide care and accommodation for eight young adults who have learning disabilities and was registered in July 2004. From 27th July 2005 the home is known as Pathways. The home is a quite residential road in Frinsbury Park area of the London Borough of Hackney and is well positioned to access a range of community amenities, local parks and transport links. The aim of the home is to provide a specialised service in working with service users with complex needs, in particular challenging behaviour and autism. It is a large house on four floors which provides adequate communal areas. There is a small courtyard area. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced which started at 11.25am. This inspection followed up the requirements made at the unannounced visit held on 7th September 2005. The inspector spoke a service user, staff and the registered manager during the inspection. A tour of the environment was undertaken and samples of the homes records were examined. There have been 8 requirements and 1 recommendation made following this inspection. Verbal feedback was given to the registered manager at the end of the inspection. The inspector wishes to thank the staff and service users for facilitating this unannounced inspection and actively contributing to the regulatory process. What the service does well: 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. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 6 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 Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion however they were met at the previous inspection. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 The inspector believes that service users needs are being met by staff. However all of the service users needs must be reflected in the individual service users plans and be supported by comprehensive risk assessments to ensure that service users are not put at undue risk. EVIDENCE: Two care plans were examined which contained information about the service users daily routines, personal care and daily living issues in addition to behavioural issues and guidelines for dealing with individual service users. However through cross-tracking of relevant information it was noted that guidelines for one service user implemented on January 2005 and updated in April were out of date and did not relevant the current needs. For example the guidance indicated that the service user was escorted when in the community, however the service user was now going out alone for set periods of time. The risk assessment had been updated with regard to the service user gong out alone however it stated that this was for one hour at a time. At the time of inspection the service user had progressed to going out alone between 10am-10pm. This must be appropriately assessed. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 9 The care plan was examined however information regarding personal care issues highlighted the review had not be added to the care plan. It was also noted that concerns regarding diet and mental health had not been amended. The care plan clearly required updating following the review. Additionally daily reports were poor and gaps were noted. The three monthly summary dated 29/12/05 was part completed and not signed. The file was very disorganised and it was difficult to find information. The second file was better although the risk assessment should have been reviewed in August 2005. Risk assessments must be reviewed and updated appropriately when needs change to accurately reflect the current situation. There was evidence to suggest that service users are involved in the day-today running of the home, participation in activities of daily living and involvement in choice of daily activities. Service users are encouraged to maintain their personal space, preparation of drinks and light snacks dependent on their ability. Service users are free to come and go from the house as they choose in line with risk assessments. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 &17 The home offers service users the opportunity to participate in daily living tasks. EVIDENCE: Service users’ are involved in the day-to-day routines of the home. Service users are offered a key to their own bedroom dependant on their needs. Through observation and discussion with the registered manager, it evident that daily routines and house rules do promote independence and individual choice for the service users in line with individual assessed needs. There are three meals offered daily when service users are present in the home, with additional drinks and snacks. The inspector saw evidence of menus that were varied. The home was found to have ample food supplies. The inspector saw the food storage facilities; dry stocks were appropriately stored. The freezer was seen which needed to be defrosted. It was also noted that foods in the fridge was not dated as to when opened. Additionally a jar of sauce, which had been opened, was stored in the cupboard however the instructions clearly stated ‘store in fridge’ once opened. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 &20 It was the inspectors view was that medication was not being accurately administered; this must be addressed as a matter of urgency. EVIDENCE: Through observation during the inspection the inspector was satisfied that the service users continue to be supported to maintain their personal identity and choice. Service users’ require a range of support with personal care from prompting and supervision to assistance with regards to bathing. The inspector was satisfied that the registered manager and staff are fully aware of service users’ needs and makes appropriate referrals when required. For example service users files contained documented medical appointments to GPs and dentist. The inspector was satisfied through indirect observation that the staff are very flexible with regards to meal times, bedtimes and activities. The daily routine is managed around the service users on a daily basis. The inspector was informed that staff had two day medication training booked. Medication is provided by the chemist in doset boxes. The medication storage was disorganised. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 12 Five spot checks that were made on additional medications stored one was incorrect by one tablet, another was out by twelve. It was noted that one of these medications had been added to the service users doset box, this is considered poor practise. The inspector also noted that an ‘as and when required’ medication was not available in the home. The inspector checked medication records, which indicated that the medication had been out of stock for fifteen days. Gaps were noted on the MAR sheets, which were also poorly completed. The inspector was informed that weekly stock checks should be completed however the last recorded check was 28/2/06. These issues must be addressed as a matter of urgency. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion however both were met at the previous inspection. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26, & 30 It is the inspectors view that there are issues regarding the standard of the environment that need to be addressed to ensure a suitable environment for all service users. EVIDENCE: The inspector was satisfied that the premises are suitable for the stated purpose, and it is accessible to service users. The service users’ bedrooms are of adequate size. There is sufficient light, heat and ventilation. During a tour of the premises it was noted that many areas still required plaster to be replaced and cracks to be filled in particular around doorframes. The inspector was informed that works were planned for the end of March 2006. Bedroom 5 still has a severely stained carpet, which should be cleaned, and if needed replaced. The inspector was informed that funding had been agreed for the replacement There is domestic support provided monthly however this is a large home that cares for service users with unpredictable behaviour. It was still evident Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 15 throughout the home there was a need for areas such as walls, skirting and woodwork that needed dusting/cleaning. Areas in the kitchen such as worktops and cupboard doors were ‘sticky’. The fridge also needed cleaning where foodstuffs had been spilt. The cooker had parts broken; the inspector was informed that approval had been given for the registered manager to order a new appliance. The bathroom on the first floor was in need of repair as there were missing tiles, paper stuck to the window for privacy and there was no lock on the door. The inspector recognises that the registered manager actively works towards ensuring that the environment is adapted to meet service users needs. Staff are in the process of painting a mural in one service users room of the outside as this calms the user. Additionally furniture has been built in to house a television as these sought of items need to be made secure. There are two laundry facilities one of domestic size that is situated in a small room in the main office area for service users to use and an industrial machine with sluice facility in a second area of the office. This is not ideal, at the time of inspection it was cluttered and there is clearly a lack of space and the space was cluttered. It remains a recommendation that the registered manager monitor the usage with the current service users, as the home gains full occupancy there may be a need to reconsider the position of these machines. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35 It is the inspectors’ view that the home has an experienced and effective staff team who work well together to meet service users needs. EVIDENCE: The inspector was satisfied through discussions and observations made during the inspection that the registered manager and staff are aware of their own roles and responsibilities and have developed good relationships with service users and are fully aware of service users needs. Rotas indicate that staffing levels are satisfactory and there is sufficient staff on duty to meet the needs of the service users. There is a minimum of three members of staff on duty throughout the day and one waking night plus a sleep in. Rotas seen at the time of inspection accurately reflected the staff on duty. There is an on call emergency procedure in place. The deputy manager post and administrator are now filled and both staff member were present during the inspection. The registered manager holds files for staff in line with regulation. The inspector examined two file that contained copies of passports, identification and health checks, references and confirmation of Criminal Bureau checks being completed. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 17 Staff meetings are held regularly, minutes were seen for meetings held in January, February and March 2006. Minutes evidenced relevant issues are discussed such as procedures, review of incident/accidents, organisational issues and the Protection of Vulnerable Adults. Evidence of training certificates was seen on staff files training courses such as Fire training and Health and Safety. The inspector was informed that all permanent staff have completed the LADF induction training and that they are currently waiting on certificates. Training is planned in the coming months for person centred planning, Mental Health and Epilepsy. The inspector was informed that three staff are currently doing the NVQL3 when completed staff are awarded with an increase in salary. Additionally one staff member is currently undertaking the assessors’ course. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 41&42 The inspector believes that the home is run by a registered manager who is competent to run the care home in line with its stated purpose. EVIDENCE: Through interviewing the registered manager, the inspector was satisfied that the home is managed in an open and positive way. The inspector continues to be satisfied that the registered manager is competent and experienced to run the care home in line with its stated purpose. All the staff and service users were friendly, open and appeared comfortable within the care home. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 19 Records were seen during the inspection in relation to Schedule 4 of the Care Standards Act. Recordings were generally of good standard and improvements have been made however as previously stated care plans and risk assessments are not up to date. There are also concerns with regard to the recording of medication requirements have been made against the relevant standards. Monthly-unannounced visits are being made however it was noted that there was no visit undertaken for October 2005. There were two reports for November 2005 however this only counts as one as the visit have to be conducted within the calendar month. This remains an outstanding requirement. Up to date health and safety certificates were in place. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 x 3 3 x Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15.2 Requirement Timescale for action 31/05/06 2 YA9 13.4 (c) 3 YA17 16.2(i) The registered manager must ensure that care plans are updated following review to clearly identify service users needs and how those needs are to be met. The registered manger must 31/05/06 ensure that all unnecessary risks to the healthy and safety of service users are identified are so far as eliminated. (Timescale 31/10/05 not met) The registered manager must 30/04/06 ensure that all foods are appropriately stored and dated. (Timescale 30/09/05 not met) The registered manager must ensure all medication is recorded and administered safely and accurately. (Timescale 15/4/05 not met) The registered manager must ensure that all of the damaged areas of the home be repaired and decorated. (Timescale 24/12/05 not met) 30/04/06 4 YA20 13.2 5 YA24 23.2 31/05/06 Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 22 6 YA26 16.2(c) 7 YA30 23.1 8 YA39 26 The carpet in SR room must be 31/05/06 cleaned thoroughly to remove stains or replaced. (Timescale 31/10/05 not met) The registered manager must 30/04/06 ensure that all areas of the home be kept clean (Timescale 30/09/05 not met) The responsible individual must 30/04/06 ensure that visits be completed and recorded monthly. The reports must be available for inspection. 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 YA30 Good Practice Recommendations It is recommended that the registered manager monitor the usage with the current service users, as the home gains full occupancy there may be a need to reconsider the position of these machines. Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Pathways DS0000065292.V277111.R01.S.doc Version 5.1 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!