Inspection on 11/08/05 for Ronak Home

This inspection was carried out on 11th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Ronak Home 14/01/09

Ronak Home 01/07/08

Ronak Home 17/07/07

Ronak Home 10/04/06

Ronak Home 14/04/05

Ronak Home 15/10/04

Ronak Home 10/05/04

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 Ronak 120 Aldermans Hill London N13 4P Lead Inspector Rebecca Bauers Unannounced 11 August 2005 @ 10.30 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Ronak Address 120 Aldermans Hill, London N13 4PT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8882 3586 Michael Crausaz for MHJ Crausaz Ltd Vacant Post (acting manager-Myra Sadique) PC Care Home only 10 beds Category(ies) of LD Learning Disability registration, with number of places Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 14 April 2005 and 20th May 2005 additional visit Brief Description of the Service: Ronak Home is operated by MHJ Crausaz Ltd. This company has two other homes locally. This home is registered for ten adults, aged between 18 and 65 years, who have a learning disability.The majority of current service users are non-verbal and a number have a diagnosis of autism. The home is a semi-detached three-storey house with a garden. There are ten single bedrooms, of which eight are en-suite. There are five vacancies in the home. The home is situated close to the facilities of Palmers Green and is opposite a large park. There are good public transport services locally. High staffing levels and some day services are provided by the company. The homes stated aims are to provide care and support to ten younger adults who have learning disabilities. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 11th of August as part of the annual inspection programme. In addition, to check up on requirements made following an additional visit made on the 20th May 2005 and following numerous anonymous complaints made throughout June and July 2005 with regard to changes in practice stipulated by the registered provider and operations manager. The inspection took seven hours to complete. The unannounced inspection involved a tour of Ronak, observation and interaction with three service users and discussion with four staff. No relatives visited the home on the day of the inspection. The new acting manager was present throughout the inspection. The registered provider and operations manager were not present. Records examined included staff files, service users files, medication records, complaints records and health and safety records. What the service does well: Service users benefit from knowing that their individual needs and aspirations are assessed. Family and friends contact is good and promoted by the home. Service users rights are respected and a good selection of healthy, culturally appropriate food is provided in the home, which the service users enjoy. Service users indicated using makaton that they liked the food provided. The health needs of service users are well met with evidence of multidisciplinary working. Personal care needs are carried out in preferred ways promoting respect and dignity. Staff are according to the homes recent quality assurance summary ‘kind and caring’. Service users benefit from clarity of staff roles and responsibilities. The inspector did observe positive interactions between service users and staff during the inspection, service users seemed generally relaxed Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 6 What has improved since the last inspection? Ten of the fifteen requirements made at the last announced inspection on the 14th of April had been met. Four of the five requirements made at the additional visit on the 20th of May had been met at this inspection. The staff files now contain the CRB checks. Half the staff team have almost completed NVQ level 2 or 3 in care. The remaining staff are ready to enrol to do NVQ level 2 or 3 in care to ensure a level of competence within the staff team. Regulation 26 visit reports are now held on file in the home. Service users have all either had an annual review or one is planned with the placing authority. Service users individual plans now contain detailed information with regard to their autistic support needs and behaviours relating to autism. Risk assessments had been updated. Authorisation records for the administration of medication by trained staff have been updated all staff had received medication training. The recommendations made following an O.T assessment for one service user had been progressed to meet the physical needs of the service user and to ensure staff safety when supporting her with personal care. Service users are now receiving their benefits via their own savings account. Maintenance issues had been addressed for the safety and comfort of the service users. Staff have been transferred from within the organisation to fill the vacancy that was being covered by agency staff to enable continuity in service delivery for the service users. Improved Communication across the organisation is now evident despite the recent influx of anonymous complaints to the Commission. The home has a designated driver to facilitate service users access to the community. Each service user has an individual activities plan. Service users communicate their preferences through the use of a pictorial communication board. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 7 What they could do better: Fourteen requirements were made at this inspection five requirements were amended and restated from the last two or three inspections. Nine new requirements were made at this inspection and three recommendations. The staff files are still incomplete and need two references; staff must not under any circumstances commence employment prior to the receipt of a CRB check. Staff files still do not contain a record of completed induction training. Staff must undertake some statutory training refresher courses. Regulation 26 visits must be carried out every month. Risk assessments need to be developed to promote independence and life skills for service users. Medication PRN guidelines still need to be in place and must be more specific to the individual to safeguard against over administration of a PRN. Medication administration sheets must be completed appropriately to safeguard service users. Recommendations are made for all staff to be given a copy of the organisations complaints and grievance procedures to ensure that all complaints are made through the correct channels of management. Maintenance issues are itemised in the relevant section of the report. These must be addressed for the safety and comfort of the service users. The registered person still has not recruited a manager to put forward to the CSCI to apply to become registered. This must be worked toward and achieved as a priority to promote clear direction and leadership within the home. The new acting manager must receive regular supervision and a deputy manager must be recruited temporarily to aid continuity in management and the consistency of care for service users. Long shift patterns should be reviewed to ensure the safety of staff and service users. The health and safety of service users must be protected by ensuring that the annual checks for emergency lighting and the fire system are carried out. The recommendation made by the LFEPA must be actioned. A recommendation is made for the language used in the incident reports to be reviewed. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 8 ADDITIONAL INSPECTION IN RESPONSE TO A COMPLAINT Name of establishment/a gency: Address of establishment/agency: Ronak Home 120 Alderman’s Hill Palmers Green London N13 4PT Telephone number: Name of establishment/agency representative present at the time of additional inspection: Name of Inspector: Date of additional inspection: Time of additional inspection: 0208 882 3586 Ms Myra Sadique – Deputy Manager Jane Ray and Georgia Chimbani 20 May 2005 15.00 Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 9 Details of what prompted the additional inspection: • (this should include the elements of the complaint described in broad terms e.g. complaint in relation to medication, staffing levels for care staff, cleanliness of premises etc) There is not enough food in the house and they regularly have to eat tuna as there is no meat available. The service user Marissa has to sleep on a mattress on the floor and when the social worker came they put a bed in her room and removed the bed after the social worker had left. They are constantly having agency staff working in the home who are new and these staff have no induction and are very disruptive for the residents as they do not know them. The residents are not given opportunities to go out and spend too much time at home. When they go out there is no money available to pay for activities. • • • She said that everything in the home is about saving money and they do not want to spend money on food and activities. Please provide details of each element of the complaint and the outcome of each element: Element of complaint 1. Quantity and variety of food offered to service users 2. Service user M sleeping on a mattress 3. Service user D.J sleeping on a mattress 4. Agency workers constantly working in the home and no induction for agency staff 5. Service users spend too much time at home and do not have many activities Ronak Outcome i.e. upheld, not upheld, unresolved Not upheld Unresolved Upheld Agency workers constantly working in the home - not upheld No induction for agency staff - upheld Upheld G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 10 Requirements arising from additional inspection (if any) 1. The registered person must replace the mattress currently used by the service user D.J with one appropriate to his needs. 2. The registered person must ensure that service user D.J is provided with a bed that has a sturdy frame that cannot be broken so that the service user does not sleep on the floor. 3. The registered person must ensure that an induction checklist is developed for agency members of staff. 4. The registered person must develop a programme of structured activities for service users who do not attend or when they are not at the day centre. 5. The registered person must ensure all areas of the home are maintaining a good standard of cleanliness and hygiene. Timescale for action 21 May 2005 Immediate requirement 30 June 2005 3 June 2005 30 June 2005 3 June 2005 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. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 11 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 12 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Prospective service users can feel assured that their individual aspirations and needs are assessed prior to admission. EVIDENCE: There have been no new admissions since the last inspection. The home conducts a thorough assessment of prospective service users. There is evidence of care manager assessments in service user files. Two service users have moved out from the home since the last inspection due to changing needs and one wishing to live with family. The new acting manager informed the inspector that she is currently assessing prospective service users for their suitability to move into the home. The home currently has five vacancies. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Service users assessed needs are being fully documented, changing needs have been reflected in the individual plans, service users are having annual reviews with other professionals. Service users are supported to take risks these are being satisfactorily reviewed although they do not promote independence. Service users are making decisions about their lives with assistance from staff. EVIDENCE: Good progress has been made with the restated requirement made at the last inspection for the service user individual plans to reflect the autistic needs of service users. They now specify the actual autistic needs exhibited and the type of consistent support that is needed from staff. This information has been included in the individual plans as a profile to ensure that a clear distinction is made between autistic needs and challenging behaviour needs. Service user individual plans are detailed and had been reviewed on a six monthly basis. Good progress had been made following a requirement for all service users to have multi-disciplinary annual review with the placing Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 14 authority. Three service users have had their reviews and two have been arranged for the12/8/05. Individual plans had been up-dated accordingly to specify support needs that had changed and new goals for service users. Pictorial communication boards are used by all service users to indicate their choices with regard to the daily activities they wish to participate in and the plan for the day. Risk assessments are now being reviewed more frequently to meet the high and changing needs of the service users. The risk assessments did not include daily living skills and how to promote service users independence; these must be developed to promote service users independence and daily living skills. For example cooking, making tea, cleaning rooms as per their activities plans. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,16,17 Service users do take appropriate planned activities; these are now being facilitated by a designated driver. Contact with family and friends are good. Service users rights are respected and a good selection of healthy, culturally appropriate food is provided in the home, which the service users enjoy. EVIDENCE: A requirement made during an additional visit following a complaint made anonymously to the Commission on the 20th of May 2005 for the registered person to develop a programme of structured activities for service users who do not attend or when they are not at the day centre had been fully progressed. Each service user had on file a programme of activities ranging from community trips, swimming, picnic’s in the park, cinema and the development of independent living skills in some cases. All service users are non-verbal and express themselves using makaton, gestures or they are supported to make decisions with regard to the plan for the day using their pictorial communication boards which has been developed with the speech and language therapist. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 16 A recommendation made at the last inspection for the registered person to employ a designated driver to support service users to access the community had been fully progressed. A new member of staff had been specifically employed to drive the homes vehicle. Four staff spoken to confirmed that service users go out most days for walks, shopping trips and day trips every two weeks. Recent day trips have included a visit to London Zoo and Canterbury. Evidence of day trips was seen in the petty cash records and the daily notes of the service users. The homes petty cash records evidenced that the organisation pays for the service users and staff meals whilst out on day trips. Service users were seen accessing the local community on the day of the inspection; some had attended a local daycentre others had decided not to carry out the planned activity. Service users have recently returned from a summer holiday in Devon. Service users are supported to have appropriate family contact. On the day of the inspection service users were observed being served a cooked lunch that corresponded with the menus and promoted a healthy balanced diet. Staff members informed the inspector that they no longer eat their meals with service users; they provide a supportive and supervisory role only. Staff said that they bring their own prepared meals into work and eat in a designated area of the home. The staff stated that they are currently storing their labelled food in the same fridge as the service users food and that there is not always enough room to store their food if the shopping has been done. Staff must be provided with a separate fridge for the storage of their own food stuffs to prevent cross contamination and to prevent any confusion with regard to whose food is whose. A requirement is made under the relevant section of this report to rectify this. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The management of medication has lapsed so that service users are not protected by the homes medication policy and procedure. There remains a need to develop the PRN guidelines to safeguard the service users fully. The emotional health needs of service users are well met with evidence of good multidisciplinary working. The physical needs of service users are generally being met. Personal support is offered in such a way to ensure service users privacy and dignity. EVIDENCE: Staff are not following the homes medication policies and procedures for the administration of medication. Two of the five medication administration sheets examined had gaps where staff had not signed to say if they had administered medication or a code had not been entered if the service user had refused to take medication. This is not protecting service users against medication administration errors or the good health of the service users. Progress had been made with regard to the requirement made for the staff signatures in the front of the medication file which stipulates who has been trained to administer medication to be updated since the recent medication training, had been updated. The requirement made at the last inspection for the PRN guidelines to be Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 18 developed to include the specific behaviours exhibited prior to the administration of the PRN to safeguard service users from over administration had not been fully progressed. One set of guidelines had been obtained but three sets of guidelines for other service users had not yet been obtained. The acting manager provided evidence that she had written to the necessary consultant psychiatrist for this information. Service users personal care needs and preferences are well documented in their individual plans. Service users have annual health checks and benefit from regular input from health professionals such as occupational therapists, psychologists and psychiatrists. Some progress had been made following the requirement made with regard to the home meeting the recommendations made for one service user who had an O.T assessment on the 23/12/04. The service user has visited several other placements that may be suitable to meet her needs although no definite decisions have been made yet with regard to an alternative placement. The home has arranged for all adaptations to be in place to meet the service users needs in the interim period whilst she remains in the home. There have been no accidents since the last inspection. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Adult protection procedures are good. Staff have a clearer understanding and knowledge to protect service users from abuse, neglect and self-harm. The Commission have received four anonymous complaints. The homes complaints and grievance procedure is still not being utilised by staff. The complaints procedure is accessible to service users and visitors, service users views are listened to and acted upon. Satisfactory records demonstrate that service users monies are now protected by the homes financial policy and procedure. EVIDENCE: Following an anonymous complaint made on the 20th of May 2005 an additional visit was carried out in the home. The outcome of this visit is summarised in the summary section of this report. Five requirements were made four have been met so one was restated concerning the need to get a bed frame for one service user. The Commission have received four anonymous complaints since the last inspection which concerned the practice of the new operations manager, staffing issues and changes to working conditions implemented by the new operations manager and registered provider. There were also concerns raised with regard to staff no longer being able to have a meal with service users, the use of agency staff, not being listened to by the registered provider, payment of activities and the recent news of possible redundancies. The Commission have taken all these anonymous complaints seriously and have met with the registered provider to discuss the issues raised. In some cases the registered Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 20 provider has investigated these complaints. In some cases the complaints have been outside of the Commissions remit as they concerned staffing terms and conditions of employment and were directed at the new operations manager. During this inspection four staff were spoken to and were informed of the general content of the anonymous complaints and were then questioned accordingly. Some staff were surprised that the anonymous complaints had been made to the Commission. The inspector identified that there had been changes to work practice in recent months and that some staff had adjusted to these changes more effectively than others. For example the changes to meal provision for staff and how service users are supported by staff, activities carried out by service users and the use of agency staff. Staff rotas showed that agency staff are not used excessively and that the same staff are used consistently when needed, in addition some staff have transferred from another home from within the organisation. The registered person has written to all staff with regard to the proposed redundancies and has met with the staff as a group for an information and consultative process to inform and to share ideas about how to try and prevent the redundancies. All staff spoken to stated quite clearly that they “felt worried about the impending redundancies.” The staff spoken to confirmed that they were aware of the homes complaints and grievance procedures and the suggestion box. They also stated that they felt able to use these procedures. None of the anonymous complaints however were made using the homes complaints and grievance procedure. This had been confirmed by the registered provider and operations manager during a meeting with the Commission on the 11/7/05 and in a letter dated 20/7/05. The homes complaints records showed that no complaints had been made to the acting manager since the last inspection and so none had been recorded. It is recommended that each member of staff be issued with a copy of the homes complaints and grievance policy and procedure so that there is clarity with regard to whom to make complaints to in the first instance. None of the staff interviewed wished to make any complaints to the inspector during the inspection. Service users said on their quality assurance questionnaires that they felt confident that complaints would be listened to, taken seriously and acted upon. A restated requirement made concerning the registered person providing clarity and evidence of how service users, receive, access, save and spend their own money had been progressed. The registered provider has provided evidence that all service users are now having their benefits paid directly into their savings accounts so that they can access their money through their own savings accounts instead of through a pooled account. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 Service users are benefiting from the recent investment in the replacement of furnishings and the re-decoration of some of their own bedrooms, which has created a more comfortable and safe environment. The home is generally clean and hygienic. Further maintenance work is needed to improve standards. EVIDENCE: The environmental conditions of the home have been improved since the last inspection all requirements had been addressed and rectified. Three of the bedrooms have been recently decorated and wooden floors had been fitted to replace carpets that had been identified as needing to be replaced. One bedroom that is currently occupied had been decorated to suit the service users own preferences making it bright and homely, as are the unoccupied bedrooms. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 22 Further maintenance issues are as follows: A strong bed frame must be purchased for one service user who currently sleeps on a mattress on the floor. The toilet seat in the first floor bathroom is chipped and needs replacing. One of the chairs in the lounge has broken and needs to be repaired. On entering the home the inspector noted a smell of urine in the hallway only, this needs to be eradicated. Other areas of the home were clean and hygienic. The staff do not always have enough space in the homes fridge to store their prepared meals. It is recommended that the registered provider should provide the staff with their own fridge whilst they continue to provide their own meals at work. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The staff records have improved although the homes recruitment policy and procedure is not being followed fully to protect the service users. Staff have received a good level of training to meet the needs of the service users, some refresher training is still needed. Staff are enrolling to undertake NVQ Level 2 in care to meet the needs of service users. Service users benefit from staff being clear about their roles and responsibilities and the sharing of tasks. Staff morale is low in the light of the imminent redundancies. The new acting manager is not receiving adequate 1 to1 supervision. EVIDENCE: Progress had been made with regard to a requirement made at the last inspection for staff to be enrolled to do NVQ level 2 or 3 in care. Two staff have completed NVQ level 2 five are currently doing NVQ Level 2 or 3 and aim to complete by September 2005. Seven staff are waiting to enrol to do NVQ level 2 or 3 and are waiting for funding to be agreed. Service users are still not fully protected by the homes recruitment policies and procedures. A requirement made for all staff to have two written references in place and for CRB checks to be on file had been partially complied with. The five staff files examined contained copies of CRB certificates, however only three of the files contained two references. This must be rectified; the Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 24 requirement is amended and restated. The requirement made at the last inspection for the support worker vacancy to be recruited to, to promote continuity in care had been progressed. Since the last inspection the vacancy has been filled by staff transferring from another home within the same organisation. The files were seen for these staff. It was evident from the file that one member of staff had commenced employment prior to the previous home receiving a CRB certificate this is not acceptable and must not occur again under any circumstances. No progress had been made following a requirement made for the completed staff induction files to be held on staff files. Three of the five files seen did not contain completed induction programmes. Induction is an essential part of care staff training and must be completed within six weeks of commencing employment to ensure that they are well equipped to understand the needs of the service users and to ensure that staff work within the organisations policies and procedures to safeguard service users. The four staff spoken to had recently undertaken training in medication administration, protection of vulnerable adults, infection control and epilepsy. In some cases staff needed refresher training in first aid, food hygiene and manual handling and lifting. This is required to safeguard service users and staff. Staff expressed their concerns with regard to the possible redundancies within the staff team and that; as a result morale was a little low. Staff had had a consultation meeting to discuss this with the registered provider and operations manager, this issue had been made reference to during a staff meeting on the 28/7/05 by the acting manager. All staff had received letters from the registered provider confirming the organisations position and the need for redundancies. Since the last inspection the acting manager and one of the deputies have both left the organisation. The second deputy is now acting up into the role of manager and will do so for a three-month trial period. The acting manager no longer has a deputy manager to work with or to share the workload and manage staff through the changing work practices that have recently been introduced. Constant monitoring and support to manage these changes are needed to ensure the continuity in care for service users and to ensure that staff issues are addressed in the first instance by a solid consistent management team. This should be rectified and is recommended. The acting manager has had one supervision since the last inspection in April, this is not sufficient 1 to1 support given the change in role and the changes occurring throughout the organisation. This must be rectified to ensure continuity and consistency in management. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 25 The rota was examined and found to reflect the staff members on duty for that shift. The use of agency staff is minimal and they are only used to cover sickness or annual leave in some cases. All agency staff are inducted prior to working in the home, staff spoken to confirmed this. The rota showed that the same agency staff are used to ensure consistency in care for service users. However the inspector noted that on some occasions permanent staff undertake 15 hour shifts this could prove detrimental to the service users and the rotas should be reviewed so that long shifts are eradicated. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,42 Monthly monitoring systems still need to be progressed. The new leadership and management of the home is showing some benefit for the service users and staff despite the anonymous complaints. The health, safety and welfare of service users is promoted with some areas needing attention to ensure that they are protected effectively. EVIDENCE: Staff made positive comments with regard to the new acting manager’s approachableness, but were mixed in their views with regard to the changes being made in the day-to-day practices that had been introduced in the last few months by the operations manager. Progress had been made with the restated requirement for the registered person to carry out unannounced monthly visits to the home, reports were available in the home however the last visit was carried out in June 2005. These must be carried out every month. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 27 The new acting manager last had a supervision from the newly appointed operations manager in April and has not had one since although management meetings are more frequent. This is a positive step in providing support and in the development of the service for the service users. The acting manager left her post on the 31/5/05. The restated requirement for a manager to be appointed and to apply to the CSCI to become registered has not been progressed and is a matter of urgency. Progress had been made since the last inspection for communication between the staff team, managers and director to be professional, open, clear, consistent to ensure the objectives of the home are being worked toward to promote the continuity of care for service users. Managers are having regular management meetings although supervision for the acting manager has been less frequent as mentioned previously. The home maintains all records for the health and safety of service users. Records were seen for fire drills, electrical checks, insurance cover and a detailed work place risk assessment. The recent inspection by the LFEPA on the 29/4/05 made several recommendations, these were for the fire risk assessment to have a detailed action plan, for the emergency lighting to be tested monthly and a record to be kept in a log book. These recommendations must be complied with to safeguard service users and staff. The annual checks for the emergency lighting system and fire system were over due and must be checked by an approved contractor to safeguard service users. The incident reports received by the Commission and those held on file in the home are not always written in appropriate language. For example one report talks of ‘ isolating’ a service user following an incident, however guidelines for managing challenging behaviour are worded more appropriately. The writing of reports must be reviewed to ensure that accurate information is recorded with regard to actions taken in line with guidelines to safeguard service users. Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score 2 3 3 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ronak Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 1 x x x 2 x G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 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 36 Regulation 26 Requirement Timescale for action 1/9/05 2. 34 19(1)(a) Schedule 2 3. 38 9(1)(2) 4. 20 13(2) The registered person must ensure that the unannounced monthly visits occur every month. This requirement is amended and restated from the last three inspections. Timescale for action was 10/12/04, 1/2/05 and 1/5/05. The registered person must 1/10/05 ensure that all staff have on file two written references. These must be available for inspection. This requirement is amended and restated from the last two inspections. Timescale for action was 31/5/05. The registered person must 1/10/05 ensure that the Care Home has a manager in post to manage the care home who must apply to the CSCI to become registered as the manager. This requirement is restated from the last two inspections. Timescales for action was 1/2/05 and 31/6/05 The registered person must 1/10/05 ensure that the PRN guidelines specify the specific challenging behaviour exhibited prior to the administration of the PRN. The Version 1.40 Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Page 30 5. 35 18(1) (c ) (i) 6. 9 13(4) 7. 20 13(2) 8. 24 23(1)(2) 9. 34 19(1)(a) Schedule 2 10. 35 18(1)( c) (i) 13(4)(5) 18(2) 11. 36 12. 42 23(4) individual plan must contain this information also. This requirement is restated from the last inspection. Timescale for action was 30/6/05. The registered person must ensure that completed induction training plans are held on all staff files. Timescale for action was 1/8/05. The registered person must ensure that service users have in place risk assessments to promote their independence and daily living skills. The registered person must ensure that the medication administration records are completed appropriately and that where service users refuse medication or miss medication this should be documented on the MAR sheet using the appropriate code. The registered person must ensure that the maintenance issues raised in the relevant section of the report are rectified. The registered person must ensure that under no circumstances a staff member commences employment prior to receiving an enhanced CRB certificate. The registered person must ensure that all staff receive refresher training in first aid, manual handling and lifting and food hygiene. The registered person must ensure that the acting manager receives regular supevision at least every two months. The registered person must ensure that the recommendations made by LFEPA during an inpsection on 31/10/05 31/10/05 1/9/05 1/9/05 1/9/05 1/11/05 1/9/05 1/10/05 Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 31 the 29/4/05 are complied with. 13. 42 23(4) (c ) The registered person must ensure that the emergency lighting and fire system is tested annually by an approved contractor. Certificates of inspection must be available for inspection. 15/9/05 14. 15. 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 22 Good Practice Recommendations It is recommended that the registered person issue each staff member with a copy of the organisations complaints and grievance policy and procedure. A record of this action should be recorded. It is recommended that the registered person review the rota to ensure that no member staff undertakes a fifteen hour shift. It is recommended that the registered person should recruit a deputy manager on a temporary basis whilst the permanent deputy is the acting manager. It is recommendaed that the registered person review the language used by staff when reporting incidents in the home to ensure that appropriate language is used and that the actual situation is reflected accurately. 2. 3. 4. 33 31 42 Ronak G59 S10634 Ronak V240565 11.08.05 Stage 00.doc Version 1.40 Page 32 Commission for Social Care Inspection 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. 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