Inspection on 26/10/05 for Rutland Gardens 79

This inspection was carried out on 26th October 2005.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rutland Gardens 79 27/05/05

Rutland Gardens 79 02/11/04

Rutland Gardens 79 25/05/04

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

CARE HOME ADULTS 18-65 Rutland Gardens 79 London N4 1JW Lead Inspector Peter Illes Unannounced Inspection 26th October 2005 11:30 Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 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 Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 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. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rutland Gardens 79 Address London N4 1JW 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 8800 0429 020 8800 0429 Mr Phivos Joannides Mr Phivos Joannides Care Home 3 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (3) of places Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Limited to 3 people of either gender who have a learning disability (LD) and who may also fall into the category of old age (LD E) Date of last inspection 27th May 2005 Brief Description of the Service: 79 Rutland Gardens is a care home registered to provide personal care for three adults with learning disabilities who may also be over the age of 65 years. The home is run by St Raphael’s Integrity Care Homes, a family owned and managed private company that operate a number of care homes for people with a learning disability in Haringey. The registered manager is also the registered provider. The home consists of a converted two storey terrace house with three single bedrooms. On the ground floor, there is a kitchen, dining room / lounge, a single bedroom with adjoining en-suite facilities and the homes laundry facilities. On the first floor, there are two other single bedrooms, a toilet, a bathroom/ toilet, and the manager’s office/sleeping in room. There is a pleasant paved area at the front of the building. The back garden is partly paved and accessible to service users. It contains a variety of fruit trees. The stated aims of the home include: to provide a high quality of care within a comfortable and homely environment; to enable service users to lead as independent a life as possible and to assist service users achieve their full potential. The home is situated in a residential area of Haringey and close to a large selection of multi cultural restaurants, shops and community facilities located along the busy Green Lanes. Wood Green Shopping Centre and Manor House are within walking distance. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took approximately four hours. The care worker on duty was present or available throughout. The registered manager and two other managers from the provider organisation attended the home to contribute to the inspection. One of these took an overview for the provider organisation regarding care issues and the other an overview regarding training. There were two service users accommodated at the home at the time of the inspection and one vacancy. The inspection included: discussion with the two service users, one of them of them independently, staff assisting with discussion with the other service user whose first language is Greek; discussion with two care staff and also a brief discussion with a service user who also visited independently from a nearby care home. Further information was obtained from a tour of the premises and a range of documentation kept at the home. What the service does well: Service users like the small-scale family type atmosphere at the home. One of the service user’s first language is Greek and the registered person and a number of staff also speak fluent Greek. This greatly enhances the service offered at the home to this service user. Service users at the home have experienced a range of health problems since the last inspection and the home has provided particularly sensitive care to those individuals during this period. The home involves service users as much as possible in deciding how the service is offered to them and has developed a range of ways of consulting with them. As a result of this service users receive a level of care, including personal care, which suits them as individuals. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&3 Prospective service users can be confident that their needs will be assessed prior to admission to the home to assist the home in meeting these needs. They can also be confident that their changing needs will continue to be reviewed once admitted to the home to enable these to continue to be appropriately addressed. EVIDENCE: No new service users have been admitted to the home for a number of years. There was satisfactory historical assessment information on the two service user files that were inspected. At the last inspection a requirement was made that a referral was made to an occupational therapist for the two service users that were accommodated at that time who were 85yrs and 87yrs. This was to further assist the home meet the service user’s current age related needs and also to assist plan for any possible future changes in their mobility or other areas of functioning in their daily lives. The inspector was pleased to see that this had been complied with and a report was seen from the occupational therapist following their visit to one of the two service users. The other service user in their eighties had been admitted to hospital since the last inspection and the placing local authority had apparently made a decision to move the service user to a care home with nursing. The registered manager was very upset about the way this had been handled and stated that the local authority concerned had not engaged in any communication with the home regarding this move. The placing authority Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 9 appeared to have failed to honour its contractual obligations to the home regarding this service user who had lived at the home since 1996. The service user’s belongings were still at the home and the placing authority had reportedly made no contact with the home to collect these. The registered manager was in the process of trying to resolve this issue with the placing authority at the time of the inspection. Another service user had been admitted to hospital for major surgery and had been discharged back to the home since the last inspection. This service user was spoken to and indicated that he was glad to be back and was happy at the home. A range of specialist medical assessment information was available to the home including a discharge summary from the hospital to assist the home meet that service users changing needs. The inspector was impressed with the way the home had dealt with this service user’s significantly changed and complex needs since the last inspection. One of the two service users accommodated at the time spoke Greek as their first language. Both the registered manager and a number of staff at the home speak Greek including the members of care staff who were on duty on the early and late shifts during the inspection. This linguistic ability of staff clearly continues to assist the Greek speaking service user to receive sensitive care that meets their needs. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6&9 Service users assessed and changing needs are generally well documented in their care plans to assist the home and relevant others meet these needs. Further clarity is required regarding the review process for one of these. Service users are also supported to take appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: Care plans were seen on the two service user files inspected. These were detailed with one showing evidence of substantial ongoing review and amendment over the previous six months. This was to give clear guidance to staff on how to assist meet that service users significant changing health needs that had occurred since the last inspection. The other service user’s care plan was generally satisfactory with amendments also recorded but these amendments were not dated or signed so that it was not possible to verify when the care plan was last reviewed and by whom. A requirement is made regarding this. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 11 Satisfactory individual and general risk assessments were seen as part of the inspection. There were general health and safety risk assessments including fire and COSHH. Individual risk assessments seen included those that related to identified risks such as handling food, kitchen equipment, unintentionally being locked in bathrooms and toilets and absconding/ going missing. Individual risk assessments contained evidence that service users had been involved in the process and had signed the individual assessments. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 12 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, 15 & 17 Service users enjoy appropriate activities including within the local community that contribute to enhancing their social lives. Contact with relatives and friends is maintained and encouraged in accordance with the service users wishes. Service users also enjoy healthful meals of their choice that also meet their cultural preferences. EVIDENCE: One service user has a five-day a week place at an external days service. The service user has not been able to access this over the past months due to their changing health needs referred to in the Choice of Home section of this report. The inspector was informed by one of the provider organisation managers that the day service staff kept in touch with the home to monitor progress. The service user was effectively convalescing at the time of the inspection and was keen to discuss with the inspector Christmas presents that he would like. He indicated that he was comfortable at the home and that he visited friends in another of the provider organisation’s homes and that they visited him at the home. The provider organisation had organised some day trips for service Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 13 users and service users from the home had participated in a day trip to Clacton since the last inspection. The second service user accommodated who is in her mid eighties continues to enjoy visiting friends in the other provider organisation’s homes and being visited by them. During the inspection a Greek speaking service user from another of the home’s called in to see the second service user for a chat and a cup of tea. The second service user was able to indicate to the inspector that her weekly routine met her needs. There was evidence that both service users have contact that they enjoy with others outside of the home. The inspector was informed that the relative of one of the service users continues to visit the home regularly and that the other has a relative in Greece that keeps in contact by telephone. The menu was seen to be satisfactory including a range of healthful meals. The inspector was informed that the service users often ask for something different from the menu and staff are normally able to accommodate this. A request book was seen that was also used in addition to the main menu and that included requests for specific Greek dishes. The diet for the service user who had been in hospital had been amended significantly following the surgery and evidence was seen of communication between the home and hospital regarding this. Service users spoken to stated that they enjoyed the food at the home. Food was in date and stored appropriately. The kitchen was clean and tidy. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 14 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 Service users receive appropriate personal support in accordance with their changing needs and their individual preferences. Their emotional and physical health needs are promoted and relevant specialist medical treatment is obtained when required. Further training for staff in the safe administration of medication is still needed to properly protect service users. EVIDENCE: There was evidence that both service users accommodated receive appropriate personal support to meet their needs. One service user continues to need significant personal support with regard to washing, toileting and dressing and these were recorded on the service user’s file with staff spoken to being aware of these. The other service user who is normally more independent regarding their personal care was in need of significantly more physical assistance whilst convalescing after their discharge from hospital. This was recorded in some detail on their revised care plan. The provider manager that takes an overview of personal care throughout the organisation’s homes was clear that she was ensuring that this was undertaken in a sensitive and appropriate way. The service user indicated to the inspector that he was comfortable with the additional personal support received at this time. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 15 There was evidence that both service users had access to their GP’s and other healthcare professionals as appropriate. Routine appointments included with a dentist and an optician in the current year. The inspector was pleased to see evidence of an occupational therapy assessment for one service user as indicated in the Choice of Home section of this report and required at the last inspection. There was also evidence of contact with a district nurse and a consultant for the same service user. Both service users were on medication at this time and the medication and medication administration record (MAR) charts were inspected for both and were found to be satisfactory. A requirement was made at the last inspection that all staff that administer medication should have up to date training on the safe administration of medication. The inspector was disappointed that this had not been fully complied with. Following discussion with the provider organisation manager that coordinates training for staff employed at the home this requirement is restated with a negotiated timescale that must be complied with. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 16 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 Service users and relatives are able to express their views and concerns and have these appropriately dealt with by the home. EVIDENCE: The home had an appropriate complaints policy and procedure that gave details of the Commission and also that any complaints made must be responded to within twenty-eight days. The inspector was informed that no complaints had been received at the home since the last inspection. One service user spoken independently indicated that he would feel able to raise concerns with staff should the need arise. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 17 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 & 30 Service users live in a home that is comfortable, well decorated and generally well maintained. The home was clean and tidy throughout creating a pleasant environment for both those that live and work at the home as well as for those that visit it. EVIDENCE: The home remains clean, comfortable and generally well maintained. The house is a converted domestic terraced property with two service user bedrooms on the first floor and one on the ground floor. Shared spaces that are also on the ground floor comprise: lounge/ dining room, kitchen and separate laundry facilities. A manager from the provider organisation informed the inspector that the home was considering some major refurbishment work at the home and possibly an extension at some stage in the future. She stated that CSCI would be kept informed if and when these became a firm proposal. The inspector was pleased to see that carpet protectors that had been identified at the last inspection as a potential trip hazard on the ground floor entrance hall had been removed. The inspector was also pleased to see that a broken ceramic soap dish attached over the bath in the first floor bath/ shower room had been dealt with as required at the last inspection. Identified fire Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 18 doors did not close and remain closed properly and a requirement is made regarding this in the Conduct and Management of the Home section of this report. The home remains clean and tidy throughout and free from unpleasant odours. The home had satisfactory laundry facilities and infection control procedures. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 19 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, 35 & 36 Service users are supported by a staff team that is well supervised, has regular training opportunities as well as access to qualification training. This assists staff members to develop their professional skills and to better address the needs of the service users. EVIDENCE: The home employs four care workers in addition to the registered manager. The inspector was informed that two of the care staff were currently undertaking the national vocational qualification (NVQ) level two in care as required by the national minimum standards. This was confirmed by one of the two care staff spoken to. The registered manager is aware that fifty percent of care staff need to be qualified to this level from the end of 2005. No new members of staff had been recruited to the home since the last inspection. There was evidence seen that the home provides an ongoing training programme for staff employed in the home. Evidence of training since the last inspection was seen for all the staff in fire safety, control of substances hazardous to health (COSHH) and challenging behaviour. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 20 The inspector was informed that all staff receive regular supervision. This was evidenced by documentation of both supervision sessions and an annual appraisal in one staff file sampled and by one care staff member spoken to. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 21 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 & 42 Service users benefit from the home being effectively run by a registered manager who is currently undertaking required qualification training. Health and safety remains a priority for the home although further maintenance work is needed to the home’s fire doors. EVIDENCE: The registered manager has five years experience managing the home and stated that he had a number of years management experience in catering management prior to that. He is also undertaking the registered managers award and anticipates completing this by mid 2006. This will meet the registered manager’s qualification requirements laid out in the national minimum standards. The home’s health and safety documentation was inspected at the last inspection and was satisfactory at that stage. It was confirmed at this inspection that the fire fighting equipment at the home was serviced in January 2005 and that the fire alarm had an annual service check on 7.10.05. During a Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 22 tour of the building it was noted that some identified fire doors throughout the home did not close and stay shut effectively when released and a requirement is made regarding this. No other health and safety issues were identified. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 23 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 3 X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 X X 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rutland Gardens 79 Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 2 X DS0000010786.V252200.R01.S.doc Version 5.0 Page 24 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 YA6 Regulation 15(2) Requirement Timescale for action 30/11/05 2 YA20 13(2) 3 YA42 23(4) The registered person must ensure that all the service user care plans are reviewed at least six monthly. Evidence of this must be recorded on the plan as well as any amendments made, the date of the review and the name of the reviewer. The registered person must 31/12/05 ensure that all staff that administer medication receive regular updated training in the safe administration of medication from a person competent to do so. (previous timescale of 30/6/05 not met). The registered persons must 30/11/05 ensure that all the fire doors close and remain shut effectively when released. Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 25 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 Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 26 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 Rutland Gardens 79 DS0000010786.V252200.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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