Inspection on 02/10/07 for Queensdown Road, 1

This inspection was carried out on 2nd October 2007.

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

The inspector found 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 Queensdown Road, 1 1 Queensdown Road Hackney London E5 8NN Lead Inspector Harbinder Ghir Unannounced Inspection 2nd October 2007 9:45 Queensdown Road, 1 DS0000067129.V352322.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 Queensdown Road, 1 DS0000067129.V352322.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. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Queensdown Road, 1 Address 1 Queensdown Road Hackney London E5 8NN 020 8985 6908 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) EObayoriade@outward.org.uk Outward Mr Emmanuel Obayoriade Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd February 2006 Brief Description of the Service: Outward Housing Association owns the home. This care provision is a care home for six adults with moderate to severe learning disabilities. The home is located in a quite residential road overlooking Hackney Downs. It is in close proximity to Mare Street shopping areas, local amenities and there are good transport links. Permit parking is in operation. The nearest British Rail stations are Hackney Downs and Hackney Central. As informed by the manager the range of fees currently charged by the service range between £849 to £993, excluding a contribution fee. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Regulation Inspector Harbinder Ghir. The inspection took place on the 2nd October 2007 between 9.35am and 4.00pm. The manager of the home was available throughout the day of the inspection. During the inspection the inspector was able to talk to residents residing at the home, staff and relatives were contacted via telephone. The inspector also sat through a staff handover as part of the inspection. A community learning disabilities nurse was also spoken to; comments are included in the report. The London Borough of Hackney who is the host authority for the service was contacted, inviting their comments on the service they are commissioning. They did not provide any feedback to be included at this inspection. As part of the inspection the inspector toured the home, read records of people who use the service and examined documents in relation to the management of the home. At the end of the inspection the inspector was able to provide feedback to the manager and the staff team present. A completed AQQA by the registered manager was received by the Commission for Social Care Inspection prior to the inspection. The inspector would like to thank everyone involved in the inspection process. What the service does well: What has improved since the last inspection? Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 6 At the last key inspection 12 requirements were made in the following areas; correct medication recording; updating care plans; reducing health and safety risks posed to residents; storage of food; updating the policies on death and illness; Safeguarding Adult Protection policies and procedures to be available at the home; staff training; staff supervision; regulation 26 monthly visits. At this inspection 11 of these requirements had been complied with. I was pleased to see that these requirements had been complied with at this inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service completes comprehensive pre-admission assessments, to ensure they can fully meet the needs of prospective. residents. Trial visits are offered to all prospective residents, to ensure residents have information on the services and facilities provided at the home. Each service user has an individual written contract of the statement of terms, to ensure they agreed to the services provided at the home. EVIDENCE: There has been one recent admission to the home, which was an internal transfer of a resident from another Outward Care home. On examining the resident’s file, the service had completed a comprehensive pre-admission assessment, which also consisted of a number of observations and assessments undertaken by staff at the home, meetings with the family and health care professionals to ensure the service could meet the identified needs of the resident. Assessments and information had also been obtained by health and social care professionals. The resident was admitted on a three-month trial Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 9 basis subject to a review. The admission has been successful with the individual becoming a permanent resident at the home. Evidence was also seen of other residents consulted and involved in the admission process. Letters were written to each individual informing them of the new admission and to discuss any concerns they may have with the manager of the home. The resident undertook various trial visits to the home and staff from the resident’s previous home were also transferred to Queensdown Road on a number of occasions with the resident to provide familiarity and support to the resident while visiting a new environment. Daily case recording sheets evidenced that the individual had an overnight stay and was able to socialise with other residents and join them for meals. The resident was also able to see his room with his family and made suggestions on how he would like things changed in his room. For example the resident stated that he wanted curtains instead of blinds, he didn’t want carpet and wanted the medication cupboard moved away from the sink area. On viewing the resident’s room, these changes had all been implemented. The service is commended on meeting the needs and aspirations of new residents and working in partnership with them throughout the pre-admission process. Each resident had a contract of residency, including information on explaining residents’ rights and responsibilities in the tenancy agreement. Both documents were provided in picture formats, which were clear and easy to follow. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is a comprehensive care planning system in place, which provides staff with the information needed, to meet the needs of residents. The right for residents to exercise choice and control is promoted by the service and they are actively consulted on, and participate in, all aspects of life in the home. Risk assessments are undertaken routinely, to ensure residents are supported to take risks as part of an independent lifestyle, and are always updated according to residents’ changing needs. Service users’ financial interests are safeguarded, but improved systems need to be in place to ensure that records of residents’ outgoings and incomings of money are recorded promptly. EVIDENCE: Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 11 Care plans seen evidenced that the service involves individuals in the planning of care that affects their lifestyle and quality of life. Care plans were comprehensive; people centred and clearly set out residents’ health, personal and social care needs. Information was found specific to the religious, cultural and social care needs of residents and how the service was to meet these needs. Some residents who had identified their religious preferences as following the Christian faith were supported to attend church every week by staff. The information provided in care plans was very detailed and individualised, and clearly recorded and described how residents wanted their needs met. For example one resident’s care plan informed how they would like to be woken up in the morning, the care plan stated, “I like to start the day with social conversation as this makes my day.” Another resident’s care plan stated “Anyone supporting me with a bath or shower must be patient, because I scream when the water touches my face.” Care plans were written from the residents point of view and concentrated on promoting the independence and aspirations of residents. The documents also including information in picture formats and some residents had made their own personal picture booklets, included information on their likes, dislikes, how they communicate and what they are able to do independently and tasks they require assistance with. A resident, with the support of staff and Speech Language Therapist, had compiled a list of words they used for communication and to ensure everyone at the service understood their way of communicating. A summary of the care plan was also kept in each resident’s room, ensuring the plan was available to residents at all times. The service must ensure that all information included in the plan, accurately reflects the needs of the resident. On viewing a residents’ care plan, it identified the individual as needing prompting at night to use the toilet to reduce his incontinence and a monitoring chart was implemented. However, the deputy manager informed me the resident no longer required prompting and had become independent at using the toilet at night and the incontinent advisor a month ago had instructed to cease the monitoring chart. The care plan had not been updated with the new information and the changing needs of the individual. A requirement in relation to the above findings will be stated as Requirement 1. Care plans were reviewed on a six monthly basis. However, residents also have a meeting every two weeks with their key worker to discuss any concerns they may have. Key workers also completed monthly progress reports covering any new risks posed to residents and any concerns with regards to health issues, communication needs, relationships, personal care and finances. Risk assessments were completed for residents and identified risk areas in care plans including, the event of a fire, risks that may be presented by the building, mobility, falling and wandering. Risk assessments included clear Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 12 guidelines for staff to follow in managing risks posed to people who use the service. Risk assessments were reviewed regularly and amended. Residents were involved in the daily running of the home as far as their abilities allowed. One resident was observed cleaning the kitchen and washing her dishes after finishing her cup of tea. Residents were also encouraged to express their views in resident meetings on the running of the home and changes they would like made, which were held every two weeks. The service is responsible for the finances of residents. Two residents’ records of money held were checked with the money held in safekeeping, which was found to be incorrect. The amount counted held by the home was less than the balance recorded. The resident was still in receipt of the money, which had not been recorded. The outgoings and incomings of money were not recorded straight away, which complicated the system. The manager must check the recordings of expenditure to ensure they are correct and all incomings and outgoings of money are recorded straight away. This is Requirement 6. Queensdown Road, 1 DS0000067129.V352322.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): 11, 12, 13, 14, 15,16, 17 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life, promoting their opportunities to be part of the local community. Daily routines respect the rights of residents ensuring their needs are met in the way they prefer. Residents are offered meals that promote their choices and respect their individual preferences. Residents are supported to maintain family links and relationships inside and outside the home. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 14 EVIDENCE: People who use the service are involved in meaningful activities of their own choice and according to their individual interests and capability; they have been fully involved in the planning of their lifestyle and quality of life. Residents were seen to be going out with the support of staff to the gym, college and shopping trips during the inspection. One resident had returned from a shopping trip to Oxford Street in order to buy an outfit for her birthday party, which staff were supporting her to organise to take place over the weekend. Another resident showed the inspector their car, which staff drove for the resident to enable the resident to go out. Other activities included residents going to day centres, for walks and using local community facilities. An annual holiday is planned every year and this year the residents had visited Great Yarmouth, which they all stated that they enjoyed in a recent resident meeting. Three residents have been on holidays with staff and families to the USA, and another went to St Lucia, and a third resident visited Spain. Staff support residents to maintain family links and friendships inside and outside the home. One resident is supported to use his mobile phone to enable him to contact his family every evening to support him to maintain close family relationships. This need had also been highlighted in his care plan, and information informed staff that if he was unable to contact his family this could cause him to become upset and present challenging behaviour. Another resident was going to celebrate their 40th birthday by having a party on the weekend, and had invited family and friends. On viewing residents’ meeting minutes, residents also commented positively on how much they enjoyed the recent barbecue the service had organised. A relative spoken to as part of the inspection commended the events organised within the home which family and relatives are invited to. She stated, “Staff regularly put on family events, which we really appreciate.” Daily routines promoted the rights and choices of residents. Care plans further reflected this, as daily case recording sheets identified residents going to bed at their preferred time and getting up when they liked. On arrival at the home, residents were observed to be getting up at different times. Some residents had already gone to the day centre. Others were just getting up and were being supported with their personal care. The home provides meals, which are varied and nutritious and meet the dietary needs of residents. There is no set communal menu, but residents choose their meals from an extensive folder of pictures of foods, meals and ingredients. Staff support residents to devise their individual menu for every two weeks during their key worker meetings. Individual menus were seen for each resident, which were varied and nutritious. Residents also could refuse their choice of meal on the menu on the day and staff prepared alternative Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 15 meals specified by the resident. Residents also go out and do the shopping and devise a shopping list with the support of staff. Evidence was also seen of residents going out to local restaurants and being provided with take away meals of their choice. The service has positively met the cultural dietary needs of residents. Three residents who are from African backgrounds have been allocated key workers with the same heritage and are supported to cook meals, which are culturally appropriate to them and visit restaurants that provide cuisines of their choice. The daily nutritional intake for each resident is recorded, to ensure his or her nutritional intake was monitored. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 16 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, 21 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive personal support and care in the way they prefer and require. Medication practices always ensure the safety of people who use the service. The ageing, illness and death of service users are handled with respect and as the individual would wish. EVIDENCE: Each resident has a devised health action plan which is in picture format. The plan identified their daily routine including the type of support they need in relation to personal hygiene and according to their level of care needs; it gives Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 17 a comprehensive overview of their health needs and act as an indicator of change in health requirements. All residents have a designated key worker to promote their privacy and dignity, and all personal care is provided in private. Attention is paid to personal preferences in relation to the provision of personal care, for example whether one prefers a shower or a bath. Residents are also provided with the same gender care where specified. For example, one female resident is provided with personal care by only female staff as this is her stated preference. Personal support takes account of individual preferences and residents’ choice of dress and appearance is respected. Residents are supported by staff to attend appointments with healthcare professionals and their health is closely monitored and prompt referrals are made. There was evidence of staff taking female residents to well women checks and the involvement of multli-disciplinary healthcare professionals where required were made to dentists, chiropodists, GP’s and community psychiatric nurses. Professionals spoken to, spoke positively about the staff team, in regards to meeting the needs of residents. A Community Learning Disabilities Nurse who had previously visited the home and had provided training to members of staff informed “They were doing a good job the last time I was working with X. I could go to the home anytime and they were very co-operative. The staff were good and were very supportive to residents.” The deputy manager of the Autism Spectrum Disorder Service was also spoken to who provides information and training to staff at the home and one to one support to residents. She spoke very positively about the home and stated “There is a very good atmosphere at the home, it is homely and we are always made welcome. When I talk to staff, they take things on board and are very willing to learn new strategies. I am very happy with the service, they really do respect service users.” The home has an efficient medication policy supported by procedures and practice guidance, which staff understand and follow. Medication administration records (MAR) were closely examined. Medication records are fully completed, contained required entries, and are signed by appropriate staff. Regular checks are recorded to monitor compliance. Each resident has a medication cabinet located in their bedroom, which is kept locked when not in use. Steps have been taken to find out the wishes of residents in the event of their death, including contacting relatives or representatives where the resident is unable to express their views. There are policies and procedures for staff to follow in the event of a death; to ensure death of service user is handled with respect and as the individual would wish. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 18 Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users can be assured their views are listened to and acted on. The service needs records all complaints and concerns to ensure any dissatisfaction with the service is recorded regardless of source. All staff have received up to date training in Safeguarding Adults, which ensures the protection of residents. EVIDENCE: People who use the service are supplied with a complaints procedure that they can understand. The procedure is available in picture format and the service is looking into developing a video version. The complaints procedure is clear, concise and easy to follow and was displayed in the entrance of the home. A complaints logbook is kept by the home, which was viewed. Three recent written formal complaints were logged. The service investigated the concerns highlighted satisfactorily, and clearly recorded details of the investigation and any actions taken. The Commission for Social Care Inspection has not been informed of any complaints. Evidence was also seen of verbal complaints and Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 20 concerns recorded by the service and what actions they took to investigate the concerns. All staff had attended Safeguarding Adults training which is also covered in the induction programme. The service has comprehensive Safeguarding Adults procedures and protocols in place. The service has obtained Safeguarding Adult procedures devised by The London Borough of Hackney, Haringey and Islington. There was also comprehensive guidance for staff on how to record incidents of abuse, using body charts, preserving evidence, and there was also a picture guide for residents on the types of abuse. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents live in a comfortable environment and décor is of a good standard and provides a homely and pleasant living environment enhancing residents’ comfort. But further environmental safety checks and prompt maintenance would improve the environment of the home. EVIDENCE: The home is three-storey town house overlooking a public park, located in the London Borough of Hackney. The house was comfortable, bright, airy, clean and free from offensive odours. Furnishings and fittings in communal areas were of good quality, domestic and unobtrusive. The home provides two main lounges; a kitchen and two bathrooms. Residents’ rooms were seen during the inspection. The rooms were comfortable with adequate furnishings and were also personalised by residents. Two residents had decided to have a fridge in Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 22 their room. All residents were provided with a key to their room and some residents’ preferences were to keep their rooms locked while others kept them open. All rooms can be overridden by staff in an emergency. Specialist equipment for residents was provided where required and bathrooms and toilets were fitted with appropriate aids and adaptations to meet the needs of people who use the service. However, one shower has been out of use for over a month which residents and staff expressed concern about. A recent residents’ meeting highlighted residents not being very happy at the shower being out of use and how long it was taking for it to be repaired. Staff spoken to also expressed concern that “Management have been slow in responding to our concerns regarding the shower.” Another member of staff spoken to stated “Since the shower has been out of use, it is very hectic in the mornings, service users get frustrated as there is queue to use one bathroom.” The use of one bathroom is not sufficient in meeting the needs of six residents who require different levels of personal care support. It is Requirement 2 that adequate bathrooms are provided to meet the care needs of residents living at the home. A further tour of the rear garden area identified that the area was generally unkempt with ladders stored in the garden. A log of fridge and freezer temperatures was seen, which staff did not consistently complete, as there were no recordings for some days. Temperatures of hot meats were also not logged before being served to residents to ensure they were at the right temperature. Opened packets of foods were not stored in airtight containers, which could increase the risk of infection. All parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated, including the taking and logging of temperatures for hot meats before being served to residents. This will be stated as Requirement 3. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 23 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, 36 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Recruitment practices are robust and ensure residents are in safe hands at all times. Adequate staff training is provided to all care staff, to ensure they are equipped with the skills and are competent to do their jobs. The service has a good skill mix of staff, but needs to review it staffing levels at night and at peak times, to ensure adequate numbers of staff are on duty to meet the needs of residents. EVIDENCE: The service does not store staff recruitment files at the home, these are kept at the service’s head office. A data sheet was provided for each member of staff confirming their CRB number, the names of individuals who provided references, which was examined for four members of staff at the inspection. A Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 24 letter was also received from the service’s Human Resources department, confirming that all recruitment checks were completed before any member of staff was employed. Files viewed all evidenced that staff had been on induction programmes and all received ongoing training, including training in manual handling, POVA, medication administration, fire safety, first aid, person centred care, health action planning, working with families, bereavement, autism, aspergers and challenging behaviour. Specialist training provided, included sexuality and people with learning disabilities and the mental capacity act. The home also has a ratio of 50 of NVQ qualified staff. Some members of staff spoken to commented positively on the training opportunities provided by the organisation but felt more in-depth is in needed in understanding autism, as four residents have a diagnosis of Autism, which the Outward Autism Spectrum Disorder service provide support and one to one sessions to. One member of staff stated, “We need more training in autism. Management and the chief executive have listened but nothing has been provided.” Another member of staff spoken to stated, “We need training in how to deal with autism, we have the people coming in from the spectrum service but they go and we work with the service users on a 24 hour basis.” It is recommended that training needs be reviewed with staff to ensure they are equipped with the skills and competences to meet the needs of people who use the service. This will be stated as Recommendation 1. The staff rota was viewed. There are three members of staff on duty in the mornings and the afternoon shifts can vary from two to three members of staff. At night there is only one waking night staff on duty. The home provides a service to residents who have a range of complex needs. One member of staff on duty may be placed at risk if they are working alone. Staff spoken to highlighted that one member of staff on duty at night is not sufficient. Another member of staff stated “Staff are scared to work at night alone.” Staff also commented that more members of staff are required at peak times, and to support residents to go out more. One member of staff stated, “Residents have to stay in as there are not enough people on shift to assist residents to go out.” A relative spoken to stated “It would be nice for X to go out on a few more walks, but staffing levels do not always allows this.” The issues of staffing levels were discussed with the manager who informed that the service has recruited two volunteers to work 35 hours a week at the home, but a start date is not in sight. It is Requirement 4 that appropriate risk assessment are put in place for staff to identify the level of risks they may be exposed to at night and that staffing levels are reviewed to ensure members of staff are protected at all times and residents needs are met by adequate levels of staff during the day. Staff supervision records evidenced that staff were supervised at least six times a year, ensuring staff are provided with the skills, training and knowledge to perform the tasks required by their employment role. Members Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 25 of staff spoken also commented that they were supervised regularly. All members of staff were also apprised annually to review performances against job descriptions and agree career development plans. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 People using the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from an experienced manager who recognises their needs and adequately manages the home. The systems for service user consultation are in place, but must also include views from stakeholders to ensure the home is run in the best interests of residents. The welfare of staff and residents is promoted by the home’s policies and procedures. EVIDENCE: Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 27 The registered manager has achieved his level 4 NVQ qualifications in Management and Care. The registered manager communicates a clear sense of direction, leadership and openness. One member of staff informed, “We can talk to the manager, I am happy here. The management takes things on board and they do get concerned about service users and staff. We are a very good team, and we work together.” Another member of staff stated “The manager is ok, he does identify our training needs, and they are very approachable.” Annual quality assurance systems are in place, and questionnaires completed by residents and family were seen. Survey formats for residents were simple and easy to read and were also in picture format. The deputy manager informed he was still waiting to receive more completed survey forms from families, relatives and their representatives. However, it was identified that stakeholders had not been included in the quality assurance programme. Evidence was also not seen of any previous survey results compiled and collated and results actioned where there was dissatisfaction by the manager. Health professionals, social services and any other stakeholders in contact with the home must also be involved in quality assurance surveys, to ensure their views are sought on how the home is achieving goals for residents. The results must be communicated to residents, family and stakeholder and a copy of the results must be made available to the Commission for Social Care Inspection on request. This will be stated as Requirement 5. Health and Safety records were inspected. All documentation was in order and appropriately completed. Fire drills were completed regularly. Monthly regulation 26 visit reports were available to view at the home, and the Commission for Social Care Inspection has also been sent copies of these reports. Visits have been completed on a monthly basis and provide sufficient information on the day-to-day operations of the home. Residents’ views have also been sought at these visits, which have been included in the reports. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 28 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 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 2 25 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X 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 3 3 3 X 2 X X 3 X Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 29 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 (1) (2) (a) (b) (c) (d) Requirement The registered persons must ensure that care plans are amended according to the changing needs of residents. Repeated Requirement. Timescale of 31/05/07 not met. The registered persons must ensure that that adequate bathrooms are provided to meet the care needs of residents living at the home. The registered persons must ensure that all parts of the home to which residents have access to must be so far reasonably practicable made free from hazards to their safety and unnecessary risks to residents are identified and so far as possible eliminated. The registered persons must ensure that appropriate risk assessment are put in place for staff to identify the level of risks they may be exposed to at night and that staffing levels are reviewed to ensure members of staff are protected at all times and residents needs are met by adequate levels of staff during DS0000067129.V352322.R01.S.doc Timescale for action 31/12/07 2 YA27 23 (i) 31/12/07 3 YA30 YA24 13 (4) (a) 31/12/07 4 YA33 18 (a) 31/12/07 Queensdown Road, 1 Version 5.2 Page 30 the day. 5 YA39 24 The registered persons must ensure that quality assurance surveys must be collected and collated and that stakeholders in contact with the home are involved in the process. That results are then communicated to residents and family and a copy of the results is made available to the Commission for Social Care Inspection on request. The registered persons must ensure that they check the recordings of expenditure for residents to ensure they are correct and all incomings and outgoings of money are recorded straight away. 31/01/08 6 YA7 16 (l) 17 3 (a) 31/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations It is recommended that training needs be reviewed with staff to ensure they are equipped with the skills and competences to meet the needs of people who use the service. Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 31 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 Queensdown Road, 1 DS0000067129.V352322.R01.S.doc Version 5.2 Page 32 - 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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