Inspection on 06/02/07 for Roland Care Home (North Circular Road)

This inspection was carried out on 6th February 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 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

Roland Care Home (North Circular... 26/09/07

Roland Care Home (North Circular... 28/10/05

Roland Care Home (North Circular... 01/12/04

Roland Care Home (North Circular... 10/05/04

Roland Care Home (North Circular... 06/01/04

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

CARE HOME ADULTS 18-65 Roland Care Home (North Circular Road) 231 North Circular Road London N13 5JH Lead Inspector Peter Illes Key Unannounced Inspection 6th February 2007 09:30 Roland Care Home (North Circular Road) DS0000010621.V313466.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 Roland Care Home (North Circular Road) DS0000010621.V313466.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. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roland Care Home (North Circular Road) Address 231 North Circular Road London N13 5JH 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) 020 8886 0755 020 8211 4539 Mr Dushmanthe Srikanthe Ranetunge Miss Yolanda Martin Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The home may continue to accommodate a specific service user who is physically disabled. This condition will be reviewed should the care needs of the service user increase to a point where the home is unable to meet them. The home may only accommodate service users in the 2 bedrooms located in the loft extension after they have been subject to an assessment by a competent person representing the service user and nominated by the placing authority. In the case of a service user who is self funding, the assessment must be undertaken by a competent person who is independent of the home. This assessment must clearly that the service user is able to escape from their room in the event of a fire, without the assistance to staff. A copy of this assessment must be retained in the home and be available for inspection. Any such assessments held by the home, must be subject to regular external review in accordance with the changing needs, abilities or condition of the service user. Temporary variation agreed for one named individual JH aged 65 years for the duration of his stay. 28th October 2005 4. Date of last inspection Brief Description of the Service: 231 North Circular Road is a care home registered to provide accommodation and personal care for a maximum of 6 adults with mental disorders. The home was opened in 1990 and is one of 4 care homes belonging to Roland Homes, a company owned by Mr and Mrs Ranetunge. The home is a two-storey terrace house with a loft extension. On the ground floor there is an open plan lounge/dining/kitchen area, a communal toilet (which is wheelchair accessible) and two single bedrooms (one of which has a shower cubicle which is wheelchair accessible). On the first floor there are two single bedrooms, a bath/ shower room, a separate toilet and a combined office/sleeping in room. In the loft there are two single bedrooms (each with an ensuite toilet facility) and a bathroom. At the front of the house there is a paved area for parking and at the rear of the house there is a garden which is partly paved and is accessible to service users. The home is situated within half a mile of shops, restaurants, transport and other community facilities located along Green Lanes in Palmer’s Green. The home currently charges from £675 per week depending on the assessed Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 5 needs of the service user. Information, including the contents of CSCI reports is made available to stakeholders. The home’s brochure states that the aim of the home is that service users will be provided with individual programmes of care, regularly reviewed to maximise stability and preserve independence. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection visit to the home was on the 20th March 2006. This was a brief visit and primarily involved a discussion with the registered provider. The previous inspection to that took place on the 28th October 2005 and included inspecting the majority of the key standards. The October 2005 inspection is referred to as the last main inspection in this report. This unannounced key inspection took approximately 7½ hours with the registered manager being present or available throughout. Mrs Ranetunge, one of whose roles is as the provider organisation’s service manager, was also present for the majority of the inspection. There were 6 service users accommodated at the time of the inspection and no vacancies. All the service users accommodated at the time were men. The inspection included: meeting and speaking to all of the service users, three of them independently; discussion with the registered manager, service manager and independent discussion with two care staff. Further information was obtained from a tour of the premises, a pre-inspection questionnaire and feedback cards from service users as well as a range of documentation kept at the home. What the service does well: The home provides sensitive and effective care and support to service users with mental health needs, some of whom exhibit behaviour that can challenge the service. The registered manager and her staff team have a range of skills and knowledge to help service users with their individual needs. The home has detailed and good quality recording systems to assist staff with this. The home works well with other homes in the provider organisation. This helps provides continuity and support for service users, staff and managers that benefits all concerned. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 7 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. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of prospective service users are assessed in detail to ensure that the home can meet their needs. Once admitted service users needs are reassessed on a regular basis to assist the home continue to meet their changing needs. EVIDENCE: One new service user had been admitted to the home since the last main inspection. This service user’s file was inspected and showed a range of detailed multi-disciplinary assessment information. Evidence was also seen that this had been made available to the home before a series of trial visits and subsequent admission to the home was agreed for that person. This information included pre-admission assessments from a psychiatrist and an occupational therapist as well as a statutory community care assessment of need. The file also contained details of staff from the home visiting the service user in their previous accommodation and the service user visiting the home as part of the assessment process. This latter record complied with a requirement made at the last main inspection. The files of another two service users were inspected at random and these both showed that assessments of need had been carried out prior to the service users being admitted. All three service user files inspected showed details of regular reviews of the service user’s needs, both multi-disciplinary care planning approach (CPA) reviews and additional in-house reviews by the Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 10 home. Care plans for service users had been updated as necessary to give staff guidance on how to meet service users changing needs. It was noted that a condition of registration relating to the home temporarily accommodating a service user aged over 65 years was no longer required and will be removed following this inspection. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users assessed and changing needs are well documented in their care plans to help in meeting these needs. Service users are assisted to make as many decisions for themselves as they can to promote their independence. Service users are also supported to take appropriate risks in their lives to assist them to safely enjoy the lifestyle they prefer. EVIDENCE: Three service users care plans were inspected. These were all detailed and reflected the latest assessment information seen on the respective files. The plans identified needs and gave guidance on how to meet these needs including in the following areas: self care, domestic skills, daily living skills, social skills, personal relationships, work/ occupation, leisure/ recreation, community participation health, behaviour and medication. These areas were broken down into specific goals with clear guidance for staff on how to support the service user achieve these. The home runs a clear key worker system with both service users and staff spoken to understanding how this worked. Records of key worker sessions were sampled and showed that these referred to Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 12 progress with identified goals recorded in the care plan for that service user. The care plans were reviewed three monthly and had been signed by the people attending the reviews, one care plan review seen had a note to say that the service user had declined to sign the documentation on that occasion. Service users spoken to confirmed that they were involved in developing and reviewing their care plan. It was also noted that the care plans reflected the cultural, religious and sexual needs of service users and how sensitive support was to be offered in respect of these. Staff were observed interacting with service users throughout the inspection in an appropriately respectful manner. All the current service users were male. They were seen to be assertive and on occasions verbally aggressive to other service users and staff. The inspector was impressed by the way that staff and the registered manager dealt with these situations including how they were able to effectively diffuse potentially aggressive behaviour. Evidence was seen that staff have received training in managing challenging behaviour to assist with managing potentially difficult situations. Service users receive varying degrees of support in managing their finances. One has an appointee from their referring authority, one manages their own finances and the home directly supports the other four. Some service users have their own savings accounts with the account book being held by staff. The home also keeps personal allowances for some service users with a record kept of each individual’s running total and cash held in an individual cash box that is securely kept in the home. The running total and cash held for one service user was inspected at random with the record matching the cash held. Service users spoken to were happy with their individual arrangements for dealing with their finances. Some service users have restrictions or limitations on their choices in place. These were seen to have been recorded on care plans and in risk assessments. Service users spoken to were aware of these restrictions although one service user was not particularly happy about all of these. One service user told the inspector that he had recently initiated a written agreement with the home to limit his alcohol consumption and was pleased with this. Other restrictions documented included staff support needed by a service user when he was in the community and access to the home’s main food store. All three service user files inspected contained a range of relevant risk assessments that were used to inform their care plans and care practice. Evidence was seen that the risk assessments were regularly reviewed, including with the individual service user. A list was seen on each file inspected that indicated that all staff had read and understood the risk assessments. Roland Care Home (North Circular Road) DS0000010621.V313466.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy appropriate activities including within the local community and have access to holidays run by the provider organisation. Contact with relatives and friends is promoted and encouraged in accordance with the service users wishes. Service users rights are responsibilities are respected and promoted within their daily lives. Service users also enjoy balanced and varied meals and are encouraged to indicate their preferences regarding meals. EVIDENCE: Five of the service users accommodated attend external day services for varying periods during the week. One of the service users attends a day service for Asian people and another attends a group for Asian people at a mainstream day service. One service user attends a gardening project as part of their day service. The service user involved in this stated that he really enjoys this although was disappointed because the gardening project had not been running for the past few weeks because of accommodation difficulties at the project. One service user does not access external day services through choice although staff are encouraging him to review that decision. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 14 Evidence was seen that all of the service users access local community resources during the day and/ or the evening, the majority of them independently. The inspector was informed that the home itself organises a weekly trip out for those that want to attend. These outings have recently included to the shops, cinema and to local restaurants. Some service users attend the local swimming pool on a regular basis and one service user stated that he really enjoyed this when he felt able to go. Roland Homes, the provider organisation, also holds monthly social events that are open to service users in all four homes. Service users stated that they enjoyed these with some forming friendships with service users living in the other homes. One service user is Jewish although told the inspector that they were not orthodox and were happy with the facilities provided at the home. Another service user is Hindu although the registered manager stated that he refuses to discuss his religion with staff or other care professionals. The registered manager went on to say that the service user is satisfied with the routines and facilities at the home. This service user’s wishes are respected and the situation is kept under review by the staff. The inspector was satisfied that both staff in the home and within the provider organisation have the skills and knowledge to offer appropriate support to this service user should he choose to accept this. The provider organisation also runs annual holidays for service users that wish to attend. In 2006 this included a holiday to Birmingham and a visit to a chocolate factory there. One service user that attended stated that he enjoyed this. The inspector was informed that the provider organisation was considering a holiday to Brighton in the summer of 2007. In addition the inspector was informed that some service users have significant savings that may effect their benefit levels in future. These service users are being encouraged, through their key workers, to consider individual trips or holidays of their own. One service user was keen to tell the inspector that he was considering a trip abroad as a result of this. Most of the service users have relatives. Some service users have regular contact with their relatives including regular visits to them. Other service users either are not keen to make contact or their relatives may not be keen on regular contact. Evidence was seen that the registered manager and staff work hard to assist service users make and develop relationships with relatives if they wish to, although with varying degrees of success. Staff were seen to interact with service users appropriately and treat them with respect and dignity throughout the inspection. On occasion during the inspection staff needed to diffuse situations arising between two of the service users. They were seen to do that both professionally and effectively. House rules are displayed in the entrance hall to the home and service users spoken to were aware of these. Service users were seen to have access to keys to their rooms and those that were able to were seen to enter and return to the home independently during the inspection. Service users were aware of general restrictions e.g. where they are allowed to smoke and were also seen Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 15 to have access to all of the facilities in the home. The main communal area that consists the lounge, dining room and kitchen can get busy and service users confirmed that they could see visitors in their rooms as long as staff were aware of this. A general menu was seen that included a range of healthful and varied meals. Two service users had separate menus and took varying responsibility for shopping and cooking their meals as part of their care plan. Evidence was seen that the home accesses the service of a dietician if there are concerns about meeting individual service users dietary requirements e.g. one service user suffers from diabetes. One service user stated that he enjoyed the food although complained about the chips being too hard at a recent meal and that he had raised this with staff. Service users are invited to write comments about each meal on an appropriate record kept in the kitchen. Evidence was seen that meals and food are part of a standing agenda at regular service user meetings. The home had a satisfactory stock of food that matched the menu, was within its use by dates and was appropriately stored. Records of health and safety checks in the kitchen were seen and were satisfactory, these included a hazard analysis chart, records of fridge and freezer temperatures and temperature checks of food when cooked. Roland Care Home (North Circular Road) DS0000010621.V313466.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate personal support in accordance with their needs and preferences. Their mental and physical healthcare needs are met including through referrals to a range of community based health professionals. Service users are also generally well supported with their medication although an improvement is needed to ensure that service users remain fully protected in this area. EVIDENCE: Service users personal support needs were identified in the care plans sampled and also in the risk assessments seen. These recorded needs ranged from significant individual support with personal care to occasional verbal prompts regarding hygiene. Service users and staff spoken to indicated that the personal support that service users received met their needs. Service users are all registered with a G.P. and evidence was seen on files inspected that service users are supported to attend a range of appointments with relevant healthcare professionals as required. These appointments included with their: G.P., psychiatrist, dentist, optician, community psychiatric services, therapy appointments, and a range of general outpatient Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 17 appointments and health care screening at local health facilities. One service user suffers from diabetes. Evidence was seen in this person’s file that his condition is being appropriately monitored by both the home and by healthcare professionals. The registered manager has been trained to cut the toe nails of service users with diabetes and a record of this was seen on the service user’s file. The home has a satisfactory medication policy that was seen along with a list of staff signatures to indicate that they had read and understood the policy. Each service user file inspected contained an up to date individual medication profile. None of the service users were prescribed controlled drugs at the time. One service user was taking responsibility for administering his own medication and staff were monitoring this. The medication and medication administration record (MAR) charts for three service users were inspected. These satisfactorily recorded stocks of medication received and held by the home. The medication and MAR charts were generally satisfactory. However, the medication and MAR chart for one service user indicated that one prescribed medication should be administered four times a day but it was being administered on a PRN (as required basis). The registered manager stated that the PRN administration was correct and that the labelling on the medication was incorrect. A requirement is made that the service user’s G.P. must review this medication and to ensure that the directions for administering the medication are correctly recorded on the medication container, the MAR chart and the individual medication profile. Staff that administer medication had received current training regarding this. Satisfactory daily records of the temperature that medication is stored at were seen. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to express their views and concerns and have these appropriately addressed by the home and other relevant authorities. Service users are also protected by satisfactory adult protection policies and procedures. EVIDENCE: The home had a satisfactory complaints procedure that was seen and had been reviewed in March 2006. A copy of this and other key policies were kept in a folder in the lounge and were accessible to service users. The home also had the details of the Commission displayed on the notice board in the entrance to the home stating that the Commission could be contacted if a complainant remained dissatisfied following making a complaint. Service users spoken to stated that they knew how to make a complaint and that issues they had raised with staff were acted upon. No complaints had been made to the home since the last main inspection. The home had an adult protection procedure and both the registered manager and the service manager were fully conversant with the actions needed should an allegation or disclosure of abuse be made. This included the need for the local authority to be informed and to coordinate any investigation. Staff spoken to were also able to describe what to do if an allegation or disclosure was made. Evidence was also seen on staff files inspected that staff receive training and refresher training in adult protection. No allegations or disclosures of abuse had been reported to the home since the last main inspection. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a home that meets their needs although the interior decorations in the main communal area are in need of attention. The home was clean and tidy throughout creating a homely environment for service users, staff and visitors. EVIDENCE: The home is a two-storey terrace house with a loft extension. On the ground floor there is an open plan lounge/dining and kitchen area, a communal toilet (which is wheelchair accessible) and two single bedrooms (one of which has a shower cubicle which is wheelchair accessible). On the first floor there are two single bedrooms, a bath/ shower room, separate toilet and a combined office/sleeping in room. In the loft there are two single bedrooms (each with an ensuite toilet facility) and a bathroom. The home has a rear garden that contained two shed/ outbuildings. One of these contains a freezer and is used for storage, the other contains the home’s laundry facilities. It was noted that a new gate had been created and fitted into the fence of the rear garden. The inspector was informed that this was done following a review of the home’s fire precautions to allow those in the building to be able to leave the garden safely in the event of a fire. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 20 At the last inspection a requirement had been made that the paintwork in the lounge is redecorated and that the areas in the hallway that have been affected by wheelchair marks are redecorated. This had been complied with although new marks made by a wheelchair were observed. In addition the decoration in the lounge/ dining/kitchen area was looking quite tired in the inspector’s view. Paintwork, especially on the skirting boards and kitchen windowsill, needed attention. In addition to this the carpet was significantly worn, appeared grubby and needed replacing. The inspector was told that the communal areas of the building receive significant and ongoing wear and tear due to the complex needs of the service users. The inspector was also told that because of this furniture in this area needed regular replacement. The service manager stated that the provider organisation planned to undertake building work to the lounge/ dining/kitchen area. Part of this area is an extension to the main building and has a flat roof. The inspector was told that the plan was to fit glass panels in the flat roof to improve the natural lighting to the interior. The service manager went on to say that it was intended for this work to be undertaken in the early summer of this year to minimise disruption to the home from the winter weather. In view of this a requirement is made for the lounge/ dining area and kitchen to be redecorated and new floor covering provided but within a negotiated timescale. A requirement was also made at the last main inspection that the home explores options for bathing facilities for a resident in a ground floor bedroom, without ensuite facilities. This had been complied with and a shower unit had been added to the first floor bathroom and this met the needs of the service user in question. The home had satisfactory laundry facilities and storage for chemical cleaners. The home was clean and tidy throughout during the inspection. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and effective staff team are deployed in sufficient numbers to properly address service users needs. A robust recruitment procedure contributes towards service users protection. Service users are also supported by staff who are appropriately trained and supervised to assist them further in meeting service users needs and in there own personal development. EVIDENCE: A requirement was made at the last inspection that 50 of staff achieve the national vocational qualification (NVQ) level 2 or 3 in care. The inspector was pleased to see that this requirement was being complied with and noted the provider organisation’s ongoing commitment to NVQ training for all its staff. Records were seen to evidence that the majority of staff have either achieved or are working towards NVQ level 2 or 3 in care and one staff member was working towards level 4. Both care staff on duty during the inspection had achieved NVQ level 2 in care. The inspector was told that care staff could work at any of the provider organisation’s registered homes although were primarily based at one of them. The provider organisation’s rationale for this is that short term vacancies can be covered without resort to the use of agency staff and the inspector was Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 22 informed that this generally works well. The staff rota was seen and was satisfactory with staff on duty matching those recorded on the rota. The rota showed two staff working from 9am to 6pm and one staff on duty of an evening and sleeping-in over night. The registered manager’s hours are in addition to this. There is an on call manager available out of office hours for advice or assistance. Two new staff had been appointed since the last main inspection. The staff files for these two and the file for a longer standing member of care staff were inspected. All three files showed evidence that the home operated a satisfactory recruitment procedure with each file seen including a satisfactory application form, proof of identity, written references and a satisfactory criminal records bureau (CRB) check that included a protection of vulnerable adults (POVA) clearance. Staff files also evidenced that the home provides a range of appropriate staff training. Evidence of a satisfactory induction was seen, the provider organisation has reviewed and improved its induction training for new staff. Induction training is now formally linked to the Skills for Care training agency standards and when fully implemented will provide evidence of competency that would contribute to demonstrating NVQ competencies. Evidence was also seen of core subject training and refresher training. The registered manager had recorded on a recent pre-inspection questionnaire that training had been provided for staff in the past 12 months including in the following areas: food hygiene, medication administration, infection control, fire prevention, first aid, nail cutting/ management and protection of vulnerable adult’s training. Evidence to support his was seen from documentation sampled in the home and from care staff spoken to independently. Evidence was also seen that staff receive formal 1 to 1 supervision at least every two months and often monthly. Staff stated that this supervision was useful and that they also received informal supervision as required on a dayto-day basis. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and staff benefit from the home being effectively managed by the registered manager. Service users also benefit from the homes quality assurance systems that incorporate their views on the service. Effective health and safety procedures contribute to protecting service users, staff and visitors to the home. EVIDENCE: The manager of the home is now registered as such with the Commission as was required at the last main inspection. The registered manager has 3 years management experience including 1½ years at this home and was knowledgeable about the needs of both service users and issues relating to the management of the home. She also stated that she has just completed her registered managers award (RMA) and is awaiting her certificate. As stated in the Lifestyle section of this report, the inspector witnessed staff diffusing potentially aggressive situations between service users during the inspection. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 24 The registered manager dealt with one of these incidents towards the end of the inspection and the inspector was particularly impressed with the way she accomplished this. It was the inspector’s view that the service user in question may well have been using the presence of the inspector to dramatise the situation and further test the reaction of the registered manager. Staff spoken to were complimentary about the manager’s abilities and style. Two of the service users spoken to independently made a particular point of praising the manager. One, when asked about staff at the home, included that “Yolanda was really marvellous” and the other indicating that if he had a problem he would always talk to the registered manager as he trusted her. The home has a range of ways of obtaining feedback from service users about the quality of care in the home. This includes an effective key worker system and the use of regular service user meetings. Records of service user meetings were inspected and covered areas including: choice of food/ meals, personal needs and the house rules. From discussions at service user meetings the home has just agreed and introduced a “resident of the month award”. This is for the service user that is deemed to have improved the most during the previous month. One aim of this scheme is to provide some positive reinforcement to help reduce potential conflicts between service users. The “resident of the month” prize was being presented when the inspector arrived at the home. The prize was some very nice clothing that the service user was pleased with. The scheme also includes a picture of the service user being displayed in the entrance hall of the home for a month. The home also undertakes formal service user and stakeholder surveys on a regular basis and these were sampled as part of the inspection. These contribute to the overall aims and objectives for the home. The provider organisation also undertakes its own quality monitoring visits and copies of the reports of these are sent to the inspector. A range of satisfactory health and safety documentation was inspected that included: a gas safety certificate, electrical installation certificate, portable appliance testing as well as records of fire drills and of servicing and testing of the home’s fire fighting equipment. The home had an up to date fire plan and fire risk assessment. The inspector was told that these documents had been reviewed in the light of revised fire precaution guidance that came into force in October 2006. As a result of this a gate had been placed in the fence to the rear garden to further assist evacuation in the event of a fire. A new lock has also been ordered for the rear entrance to the home as a result of this review. Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 25 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 X 4 X 5 X 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 X 26 X 27 3 28 X 29 X 30 3 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 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 26 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 Timescale for action 28/02/07 2. YA24 23(2) The registered persons must ensure that an identified service user’s medication is reviewed by their G.P. to ensure that the correct directions for administering the medication are recorded on the medication container, the MAR chart and the individual’s medication profile. The registered persons must 31/08/07 ensure that the lounge/ dining/ kitchen area are redecorated and new floor covering provided. 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 Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Roland Care Home (North Circular Road) DS0000010621.V313466.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!