Inspection on 27/02/06 for Prudential Care Home Ltd

This inspection was carried out on 27th February 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Prudential Care Home Ltd 13/10/08

Prudential Care Home Ltd 16/10/06

Prudential Care Home Ltd 01/08/05

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Prudential Care Home Ltd 7a Grant Terrace Castlewood Road London N16 6DS Lead Inspector Sheelagh Doherty Unannounced Inspection 27th February 2006 13:40P Prudential Care Home Ltd DS0000061208.V284658.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 Prudential Care Home Ltd DS0000061208.V284658.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. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Prudential Care Home Ltd Address 7a Grant Terrace Castlewood Road London N16 6DS 0208 211 1957 0208 351 2842 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) Prudential Care Home Ltd Mr John Gerard Kearns Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registration is for 4 adults, both sexes, with enduring mental health problems with forensic psychiatric histories and/or subject to sections 37/41 of the Mental Health Act 1983, MH. 1st August 2005 Date of last inspection Brief Description of the Service: 7a Grant Terrace is an end of terrace building situated in a quiet residential area with good access to public transport. The home has easy access to a wide range of local facilities and amenities. The home is registered to provide services for four adults with a forensic mental health history who are not assessed as yet ready to live independently. Staff at the home support residents to regain and retain independent living skills that will enable them to move into supported accommodation. All referrals to the home are as a result of Care Programme Approach meetings and the home does not accept emergency referrals. The home offers both short-term and long-term placements. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place in the early afternoon/ early evening. The main purpose of the inspection was to review the home’s progress in implementing the requirements and recommendations of the last inspection and to assess the home against key National Minimum Standards. All of the requirements and recommendations had been met and the inspector found that the service was operating in line with National Minimum Standards. Two residents were permanently resident at the home, one resident was on holiday leave and one resident, present during the inspection, was going through the assessment process to determine whether the home was a suitable placement for him. Since the last inspection the manager, who is an experienced mental health practitioner, has successfully completed the registration process with the Commission and is beginning to develop the service so that residents can live in a comfortable, homely and therapeutic environment. Residents were complimentary about the service being provided and said that they felt able to express their views openly and that these would be acted upon. Thanks are extended to the residents, staff and registered manager for their assistance with the inspection process. All were very helpful. What the service does well: The home offers a very high standard of accommodation which contributes to the relaxed and positive atmosphere in the home. The manager’s aim is to provide an environment in which residents can flourish. Residents feel that they are listened to and are able, if they wish, to contribute to the day-to-day operation of the home and this will be further developed in the future. Staff are very positive about the changes that have been implemented since the new manager took over and feel that they are now able to provide a good service to the residents with direction and support as necessary. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 6 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. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,4,5 Both the Service User Guide and the Statement of Purpose provide appropriate information about the service to enable prospective service users to determine whether they wish to move into the home. The pre-admission assessment process is comprehensive, developed for each individual and undertaken with the involvement of the resident, their family [if appropriate] and the community mental health team. EVIDENCE: All residents are admitted via the Care Programme Approach and undergo a comprehensive pre-admission assessment process prior to finally moving into the home. The home does not accept emergency admissions. One resident, present during the inspection, was going through the assessment process. He discussed the process with the inspector and was satisfied that he was fully involved and informed about the process. Although his care was still under the direction of the hospital team he was spending long periods of time in the home and finalisation of his placement was imminent. He stated that he was happy to move into the home. Each resident has a statement of terms and conditions of occupancy and these were seen on file. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 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 the following standard(s): 6, 7, 8, 9, 10 The manager has significantly improved care-planning systems and records now include a detailed assessment, an individual plan of care and supporting documentation. Residents are involved in development of their care plans and have access to them if they wish. Confidentiality is respected. EVIDENCE: All residents have a care plan in place, including the resident going through the pre-admission process. Care plans are developed with the resident and, in one instance there is a joint care plan in place so that there is continuity of care across the multi-disciplinary teams involved with the service user. Care plans include a detailed history and risk assessments for both in house and external activities. These include actions taken to minimise risk and are agreed with the resident and, if appropriate, with the multi-disciplinary team, with whom the manager and staff work closely. A daily record is kept for each resident and care plans are evaluated using this information. Significant events are also recorded on a separate log, kept in the care file, for ease of reference. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 10 Activities are recorded and staff assist and support residents as agreed with them. Records include a statement of cost which is very detailed and includes information about the service provided to each individual. The confidentiality policy is included in the Service User Guide and each file contains a list, agreed with and signed by the resident, of those people who may have access to it. Staff spoken to were aware of the need to maintain confidentiality and also in what circumstances they may need to share information with a more senior member of the team. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 11 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): 11,12,13,14,15,16,17 Residents are able to access the local community facilities as they wish and have unrestricted access to the home. They have keys to both their own room and the main door of the house. Residents are encouraged to take responsibility for themselves and to further develop independent living skills. EVIDENCE: Residents are free to come and go in the house as they wish, within the terms of any risk assessment. They attend local groups such as MIND, use local facilities such as the gym and attend places of worship as they wish. They are encouraged to maintain family contacts and to entertain friends and family in the home, as was observed on the day of inspection. They can have guests to stay, if they wish. The manager and staff are currently trying to move residents towards taking more responsibility for their own lives and for developing and maintaining independent living skills. Some residents are slower to respond to these attempts but some progress has recently been made in terms of the number of residents attending the weekly community meeting. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 12 Residents are assisted to develop budgeting and food shopping skills and to prepare their own meals. Assistance and support is offered as appropriate to each individual. An assessment of safety in the kitchen is conducted before residents are allowed unsupported access. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 13 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 Residents receive support according to their needs and wishes. Medication storage and management systems are in place and were being adhered to. EVIDENCE: Current residents are generally self-caring though some may require prompting at times. All residents are registered with a general practitioner and are encouraged and supported, as necessary, to attend appointments and to have an annual health review. Residents have an allocated key worker with whom they meet once a week to discuss, among other things, any concerns or worries they may have. Residents can attend local groups, e.g. MIND, for support and advice should they wish to speak to someone independent of the home. There are policies and procedures in place for safe management and administration of medication. All staff have received training from the pharmacy responsible for supplying medications and staff are mentored and supervised, though not formally assessed for competency, before being allowed to take responsibility for this task. Currently no residents are responsible for their own medication. An assessment would be undertaken to determine competence and safety should any resident wish to self-medicate. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 14 As part of the Care Programme Approach risk assessments and relapse plans are in place for non-compliance with medication. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 All staff have received training in adult protection. Residents said that they felt there views were listened to and acted upon and were aware of the complaints policy and procedure. EVIDENCE: The ethos of the home is one which actively encourages residents to express their views and to be involved in the day-to-day operation of the home. Residents said that they felt free to voice their opinions and that they were either acted upon or they were given explanations of why this was not possible. There is a clear complaints procedure which includes details of the responsible individual and the Commission, should residents wish to raise concerns to people outside the home. They are also advised of their right to raise concerns with their care co-ordinator. Information is in the Service User Guide and on the wall in the reception area. There have been no complaints All staff have received training in protecting vulnerable adults from abuse and the action to take should abuse be witnessed or suspected. Staff were able to discuss this knowledgeably with the inspector. The policy and procedure has been updated to ensure that it includes the local authority adult protection procedures and the manager informed the inspector that an officer from The London Borough of Hackney had recently undertaken an inspection in relation to adult protection procedures and that the outcome had been satisfactory. A copy of that inspection report should be forwarded to the Commission. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 30 The standard of accommodation is very high. EVIDENCE: The home is fairly recently opened and it is evident that thought has gone into providing a high standard of accommodation which suits the needs of the residents and which provides a comfortable, homely and relaxed environment. The décor and the furnishings, both in bedrooms and in the communal areas of the home are of good quality. Each resident has their own room which they can arrange as they wish, bringing personal items with them when they move in to create their own personal space. Communal areas are spacious, bright and airy and well appointed. There are sufficient bathrooms and toilets for the number of residents living in the home and these are furnished, as they would be in a private house. The home was clean and tidy and staff and residents obviously take pride in their environment. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Staff roles are clear and staff spoken with were aware of their responsibilities. Staff receive regular training and supervision. The manager has worked to ensure that records and checks for both newly appointed staff and current staff are in place. EVIDENCE: There was one support worker and the manager on duty throughout the inspection. Staffing levels were agreed at the time of registration and are maintained to that level. The manager stated that more staff would be rostered on duty should the needs of the residents require this. There is one waking night staff and a senior member of staff on-call – this is recorded on the duty rota. Three staff files were checked and all contained all the information required before a member of staff starts work and included a job description, a person specification and terms and conditions of employment. Staff spoken with said that, since the new manager took over, there has been a great improvement in staff training and support. Staff were familiar with the needs of the residents and aware of action to take if they did not feel confident in dealing with a given situation. Staff supervision is undertaken regularly and staff found this helpful. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 18 The manager has identified that further staff training and development is required to ensure the home becomes a therapeutic community. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 41, 42 The manager is continuing to implement management systems to ensure that the home is well run and meets National Minimum Standards. Records required to promote and protect residents rights are generally being maintained although one accident had not been recorded in the accident book, though it had been recorded in the personal file of the resident. There is a policy and procedure in place for management of all aspects of health and safety. EVIDENCE: The registered manager has worked hard to implement all the requirements and recommendations of the last inspection, especially in relation to development of policies and procedures and management systems to underpin the day-to-day operation of the home. Policies and procedures are clear and detailed so that staff and residents know how the home operates. Information about protecting residents’ rights is available in the documentation of the home and underpins all policies and procedures. In discussion with Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 20 residents, staff and the registered manager it was evident that this has a high priority in the home. Health and safety is maintained through monthly maintenance checks, and the manager stated that any remedial action is dealt with in a timely manner by the proprietor. Risk assessments are in place both in house and external to protect the health and safety of residents and staff. Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X X X 3 2 X Prudential Care Home Ltd DS0000061208.V284658.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? NO 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 YA20 Regulation 13[2] Requirement The registered manager must ensure that staff are formally assessed as competent before taking responsibility for administration of medication. Supporting documentary evidence must be available. The registered manager must ensure that all accidents are recorded in the accident book. Timescale for action 31/07/06 2 YA42 17[1a] 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Prudential Care Home Ltd DS0000061208.V284658.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 Prudential Care Home Ltd DS0000061208.V284658.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. 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