CARE HOME ADULTS 18-65
Portway (200) 200 Portway Stratford London E15 Lead Inspector
Helen Fontaine Unannounced Inspection 27th July 2005 at 10:00am 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 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 Stationary 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. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service 200 Portway Address 200 Portway, Stratford, London, E15 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8552 9164 No Fax East Living Limited Miss Asha Jama Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 6th October 2004 Brief Description of the Service: Portway is a six bedded, Victorian house, which provides care for six service users with learning difficulties. Ther are three floors. All bedrooms are of signle occupancy. There are two baths, one shower room and 4 toilets. The ground floor is accessible to wheelchair users. There ia a garden with furniture and a summerhouse. The providers of the care home are East Thames Care Ltd. The home has been registered as a care home since January 2000. The home is situated across the road from West Ham Park. The Stratford shopping area is nearby and there are good local transport links. Care is provided by Support Workers. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Unannounced Inspection took place over 2 hours and was carried out as part of the yearly process of Announced and Unannounced inspections. One unannounced visit has been made since the last announced inspection. Letters sent to the registered person following those visits can be obtained from the Commission for Social Care Inspection Office on request. Inspectors looked around some parts of the building and a number of records were inspected. Two of the six resident’s, one member of staff and one visitor were spoken to. What the service does well: What has improved since the last inspection? What they could do better:
The home remains without a Manager and has a temporary Manager acting up from the present staff group. This situation has been going on for sometime and although interviews have taken place, there is still no time scale for this situation to be resolved. As a result of the added pressure on the staff the Policies and Procedures and other paper work in the office is not in a state that things can be found. The upstairs bathroom was locked at the time of the inspection, the Support Workers Spoken to informed the inspector that the toilet was blocked. Staff were in the process of trying to clear this blockage and felt that it would be mended quicker if they undertook this rather than calling for a plumber. This may well breach Health and Safety legislation and place the members of staff undertaking this at risk from infection.
Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 6 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. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 There an adequate written and costed agreement, which is signed by the tenants. However the files are not kept in an orderly way, that makes finding them easy. EVIDENCE: Individual records are kept for each of the residents and the inspection of two of these records was undertaken. Although the files were not kept in an orderly manor and took the Support worker some sorting through to find them, each one had a signed contract. During this inspection the files also had full reviews, which also included a review with the social worker from the Local Authority. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 9 Service user are supported to have an independent lifestyle. EVIDENCE: During the inspection a tour of the building was undertaken, one resident agreed to the inspector visiting their room. This resident had their own key and was able to decide who and when people entered their room. This was also evidenced by the Care Plan and risk assessments. The Care Plan and a risk assessment also allowed this resident trips accompanied by staff and the planning to assist the resident to experience activities of shopping in the community. The visitor also said that their relative came to visit them regular, accompanied by a member of staff. All the residents took part in community activities, benefiting from a communal ground near. This allowed the residents to take responsible risks, as communal activities present unplanned interaction. One resident has not been able to experience meeting stranger, the staff have assisted the resident to experience this and this resident was not distressed by the unplanned visit of the inspector. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 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 standard(s) 13 Service Users are encouraged and supported to be part of the local community. EVIDENCE: During the inspection of documents a local directory of activities was present and was used by the staff to plan activities. One resident during the inspection asked to attend a Barbeque and staff said that if the weather was good they could attend a local event. The relative spoken to, said that their relative attended activities and was clear that they did not attend a Day Centre. The relative was very clear and said “that their communication had improved”, the relative felt that the improvement was due to the community activities. It was noted during the inspection that residents came back and planned other activities with the help of the staff. Some of the residents chose to go and sit in the summer house and take a cup of tea with them. Some of the other residents went out with staff, choosing to go out into the community. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 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 standard(s) 20 The home does have adequate policies and procedures for dealing with medicines. EVIDENCE: The mediation cabinet was seen and all the medication was marked and stored correctly. During the inspection medication documentation was looked at and it was noted that some of the staff are just initialing the document and signing the entry. However all the medication was documented when it was received or returned. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 23 All Service users are protect from abuse and there is no neglect or self-harm. EVIDENCE: During the inspection a document clearly displayed for residents and visitors giving information on disclosure of abuse. This information had symbols and was in a variety of languages, giving access by all those residents and staff at the home. However the Support Worker despite searching, was not able to produce the homes own police or that of the Local Authority on Adult Abuse. The visitor spoken to, the member of staff and the residents all said that they felt safe and had no concerns over being at risk of abuse. All said they felt the staff protect the residents from any kind of abuse and it was observed that Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 24 and 27 The home is comfortable and safe, however the toilet upstairs was blocked and it was inappropriate for the Support Worker to try and clear it. EVIDENCE: During the inspection a tour of the home was made and a new Fridge was seen in the kitchen. The home had decided to completely replace the Fridge rather than try and repair the broken one. The Freezer was also inspected and it was noted that Freezer was in need of defrosting, but was not of a state that meant that it was not keeping the food at the required temperature. It was also noted during the tour of the home that the furnishing , fittings, adaptations and equipment were all good quality and were unobtrusive and ordinary. The resident that showed the inspectors their room said they were happy with furniture and they were able to change this when ever they wanted to. During the inspection a tour of the building with the Support Worker took place and it was seen that both bathrooms had new extractor fans, both of these worked. It was also checked and confirmed that both the shower curtains had been cleaned, neither of them was dirty. It was noted during this tour that the
Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 14 upstairs bathroom was locked, the Support Worker said that the toilet was blocked. The Support Worker said that he was endeavouring to clear this himself, rather than having to call a plumber out. It was concerning that staff undertaking this, might be placing them at risk from infection. There issues here of protective clothing and substances being splashed on to ordinary clothing and then coming into contact with residents. The home does need to introduce a policy of having a plumber on call that can deal with this kind of incident. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 15 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 The homes recruitment polcies and practices to support and protect the Service Users. EVIDENCE: During the inspection staff files were inspected, the staff file of the newest member of staff when it was checked found that the employment document had not been signed. As some of the staff files were locked away it was not possible to establish if the original had been signed. The Support Worker agreed to make sure that it was signed the next time the staff member was on duty. It was seen that there was a number of training certificates in the file, these covered all necessary areas. No CRB checks were available for inspection as these were also locked away. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 16 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40 and 43 The homes policies and procedures do safeguard the Service Users rights, however the absense of a competent and Registered Manager of the service is a concern. EVIDENCE: During the inspection the Support Worker was asked to produce the Adult Protection Procedure, but despite a search through the files in the office the Acting Manager was unable to produce it . The Support Worker was not aware when asked, that there was a Vulnerable Adult Procedure issued by the Local Authority. There were a number of other policies and procedures, observed available in the office during the time of the inspection. The Support Worker said “we are in the middle of sorting these all out as there are new policies and procedures being produced. The Support Worker was able to show a number of folders in a box which the Support Worker said are waiting to be taken away.
Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 17 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 2 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x x x 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x 1 x x x Standard No 11 12 13 14 15 16 17 x x 3 x x x x Standard No 31 32 33 34 35 36 Score x x x 2 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Portway (200) Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x x 1 x x x G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 18 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. 2. 3. 4. YA23 YA24 17(2) 13(4) All procedure for responding to to suspicion or evidence of abuse or neglect must be available. The premises must have all toilets working and clean. Unblocking toilets should be undertaken by specialist company 20/10/05 20/10/05 Standard YA40 Regulation 17(2) Requirement Policies and procedures must be properly kept and maintained for ease of access. Timescale for action 20/10/05 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 37 Good Practice Recommendations The Home should have a Registered Manager in post. Portway (200) G57 G06 S22846 Portway V241486 270705 Stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Gredley House 1-11 Broadway London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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