Inspection on 13/03/06 for Saltram Crescent, 91 & 99

This inspection was carried out on 13th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Saltram Crescent, 91 & 99 08/06/07

Saltram Crescent, 91 & 99 07/06/06

Saltram Crescent, 91 & 99 21/06/05

Saltram Crescent, 91 & 99 06/01/05

Saltram Crescent, 91 & 99 02/08/04

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

CARE HOME ADULTS 18-65 Saltram Crescent, 91 & 99 91 & 99 Saltram Crescent London W9 3JS Lead Inspector Sheila Lycholit Unannounced Inspection 13th March 2006 10:40 Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Saltram Crescent, 91 & 99 Address 91 & 99 Saltram Crescent London W9 3JS 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 8964 8154 020 8968 1983 Lookahead Housing & Care William Berkye Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia of places Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st June 2005 Brief Description of the Service: Saltram Crescent is a Registered Care Home that operates in two, three storey houses (No 91 and No 99). The service is registered to provide accommodation for 12 residents who have a mental disorder. Each home accommodates six residents and both houses are managed from number 91. The care is provided by Look Ahead Housing and Care Ltd. The homes are situated in the Queens Park area with good access to public transport and local services. Each service user has a single bedroom and both houses have a kitchen/diner, lounge, adequate bathroom space and attractive patio garden area to the back of the two houses. Currently No 99, where there is one vacancy, has only male service users. There are two female and four male service users at No 91. A prospective service user would need to be made aware of the high level of smoking in communal areas. In each house the bedrooms are on the first and second floors making the service unsuitable for anyone with a physical disability. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Monday 13th March 2006 from 10.40AM until 4.00PM. The Manager, who was on duty, made himself available throughout the visit. Ten of the service users were present at some time during the visit, while one service user was at the day service she attends on weekdays. In addition to the Manager, there were 2 staff on duty at all times. The Cook came on duty at 3PM. The Domestic Assistant was present in the morning. The Inspector spoke with 3 service users and 2 staff, as well as the Manager. The Manager had completed a pre-inspection questionnaire in January 2006. Comment cards were received from 8 service users and 2 GPs. What the service does well: 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. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 6 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 Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, and 5 There is a detailed statement of purpose and service user’s guide. Service users’ needs are fully assessed before moving to the home. Contracts are clearly written and are up to date. EVIDENCE: A comprehensive statement of purpose and service user’s guide are available. There are a number of leaflets produced by Look Ahead Housing, which are displayed in the hallways for service users, giving information about complaints, maintenance and the customer charter. The personal files of five service users were looked at. Copies of an assessment were available on each file. Up to date contracts, signed by the service user and Manager were also seen on each file. Steps are being taken to assess whether the service continues to meet the needs of the eldest service user. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Care/support plans have been drawn up with the active involvement of service users. Service users are supported to take part in a range of activities outside the home and where appropriate to move to more independent living. EVIDENCE: Support plans were seen on each of the 5 files looked at. They had been compiled with the service user and were regularly updated and reviewed. Records of monthly key working sessions were also on file, as well as daily notes. Notes of 6 monthly reviews with the Care Manager were available on some files, though staff commented that notes of reviews were not always forwarded to the home. Risk assessments are carried out in relation to the support plan but in some cases were insufficiently detailed. All risks need to be identified and risk management strategies agreed. Residents meetings take place every 2 weeks. Agendas of meetings are available but notes are not regularly taken. It is recommended that staff or residents note decisions and action agreed. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 9 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 and 17 Service users are supported to take part in a range of activities and to maintain links with friends and families. Routines are flexible, though staff encourage service users to have some structure to their day. Healthy eating is promoted by staff. EVIDENCE: Plans are in hand for two service users to move to more independent accommodation. In preparation for the move one service user is attending cookery sessions. Service users have a rota of household tasks, though the cleaning of communal areas is carried out by a domestic assistant. The written feedback from service users indicated that they would like to take part in more activities. Records show that the majority of service users attend activities outside the home and staff run art, bingo, craft sessions and a gardening group. Holidays and days out are also arranged. Discussion of activities is a standing item on the agenda of residents’ meetings. Service users’ files indicate that contact with families and friends is maintained wherever possible. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 10 Routines are flexible. All service users were up or in the process of getting up when the Inspector arrived. Staff support service users to keep appointments and to attend day services. The weekday evening meal is prepared by the Cook in the kitchen at No 99. Menus are varied and reflect the choices of service users. One service user is vegetarian for whom the Cook prepares a separate main dish. In discussion the Cook showed that she is aware of the needs of the service users with diabetes. The dietary needs of the service user who is Moslem should be discussed further with him to ensure that he is offered meals that are in keeping with his religious and cultural background. Service users who are at home at lunchtime normally have a sandwich, which staff assist them to prepare. Fruit was available for service users to help themselves. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 11 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): Service users receive individual support through the key working system. While the Manager has taken steps to improve the administration of medication, some problems remain, indicating a need for further staff training. EVIDENCE: Each service user has a key worker, with whom they meet regularly. Key working sessions are recorded and show that service users are encouraged to set themselves goals and objectives.None of the service users needs help with personal care, though a number need some encouragement or prompting regarding their appearance and personal hygiene. Staff, normally the key worker, accompany service users to health care and other appointments. Service users are registered with 4 local GPs, one of whom commented on the lack of knowledge of some staff regarding health care needs such as diabetes. The Manager said that he has been in touch with the Diabetes Dietician regarding training for staff, though no date has been arranged. If this training does not materialise, it is recommended that staff attend other training in diabetes management in the near future. The weight of one service user recorded by a member of staff was clearly inaccurate. The Manager undertook to raise the issue and to look into recording BMI rather than weight where there are concerns. Medication records in both houses were looked at. One service user was being given his medication earlier than the 13.00 hours noted on the MARS sheet Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 12 because he was getting up earlier. The exact time of giving medication should be noted. Where ‘as required’ medication is given, staff should record on the back of the MAR sheet the reasons for administering the medication. It is recommended that the Manager discuss with the Pharmacist whether staff should also record medication prescribed PRN when it is not given. Two service users are managing their own medication in preparation for moving to less supported accommodation. No risk assessments regarding handling their own medication were available. Where service users are selfmedicating a risk assessment must be carried out and the advice of the relevant Medical Practitioner sought. One service user who was present in the house had not been given her medication 2 hours later than the 13.00 hours noted on the MAR sheet. The CSCI was informed of an incident in January 2006 when medication was found to be missing. An investigation was carried out by the Manager but was inconclusive. Steps have been taken to prevent a reoccurrence. One newly appointed member of staff who was administering medication had not received training since she started in the home. Her medication training had taken place 2 years previously while working elsewhere as an agency member of staff. All staff handling medication must have up to date training and be assessed as competent. Regular refresher training should also be provided. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 13 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 and 23 A clear complaints policy and procedure is available and adult protection policies are in place. EVIDENCE: Copies of the complaints procedure are displayed in the hallway. Complaints and action taken are carefully recorded. There have been 4 complaints in the past 12 months. Two of the complaints concerned the behaviour of a service user who has since left the project. Look Ahead Housing has an adult protection policy and procedures. Copies of the local inter-agency policy and procedure are not available in the home. The absence of training records for staff mean that it is not possible to confirm that all staff have attended training in the protection of vulnerable adults. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30 The two houses provide comfortable accommodation that is decorated and furnished in a homely and domestic style. A good standard of cleanliness is maintained in the communal and kitchen areas. Ventilation is poor and needs to be improved in view of the high percentage of smokers among service users. EVIDENCE: Both houses are well maintained and are indistinguishable from others in the street. Each service user has a single bedroom, with a washbasin. Four service users showed the Inspector their rooms and confirmed that they had sufficient bedding and furniture. Both houses have small rear gardens that have a mixture of plants and hard surface areas. The gardening group keeps both gardens looking attractive. Sitting rooms are well furnished and the kitchen/dining areas were clean and tidy at this unannounced visit. The level of smoking among service users is high creating a very smoky atmosphere in communal areas. Staff report that the windows are difficult to open. The smell of smoke permeates all areas of the home and ways of improving the ventilation should be explored. The washing machine and dryer at No 99 are sited in the kitchen/diner. In view of the risk of cross infection both machines should be moved elsewhere. In the Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 15 meantime service users should be reminded to put washing straight into the machine and not place any items on the worktops or floor. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 16 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, 35 and 36 A consistent staff team has been maintained. The percentage of staff with qualifications in social care is low and the good access to training previously provided by Look Ahead Housing has not been maintained. Staff are well support by a system of regular staff meetings and supervision. EVIDENCE: The Manager calculates that 28.5 of staff have achieved a NVQ2 or above in social care. Two staff will start NVQ2 next month. Training records are not available for all staff. The Manager confirms that all staff have completed induction training. The Manager commented on the difficulty he has experienced in accessing relevant training for staff. Staff rotas allow for a minimum of 3 staff on duty at any time including weekends. Staff regularly work a 10AM to 11PM shift followed by a sleep-in. Although staff take a 2 hour break during the middle of the shift, it remains a long period to be on duty and should be kept under review. Rotas allow for handovers to take place and for the shift plan to be discussed. Records show that staff meetings take place regularly. Staff receive supervision from the Manager every two months. Supervision records for 2 staff were looked at. These were well recorded and up to date. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 17 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, 40, 41 and 42 The home is run by a Manager who is experienced in working with people with mental health problems. Attention is paid to health and safety issues, including a system of regular checks of the buildings. Records are generally in good order and are well maintained. EVIDENCE: The Manager is completing NVQ4/RMA and is experienced in working with people with long-term mental health problems. A system of seeking service users views both at residents’ meetings and through twice yearly questionnaires is in place, although the results of these surveys were not available in the home. Policies and procedures are available in the home and via Look Ahead Housing’s intranet. Service users’ files and other records seen were in good order and were up to date. Staff carry out regular checks of the building and take water temperatures and fridge and freezer temperatures. The recording of fridge temperatures Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 18 continues to be unsatisfactory as noted at the last inspection. Temperatures were recorded as much too high. The Manager and Cook confirmed that the fridges were operating satisfactorily. The Manager is purchasing new thermometers which staff should find easier to read. A fire risk assessment has been carried out. Fire drills take place every 2 months. The time of the drill and names of staff present should be recorded, along with other information such as the time taken to evacuate the building. The fire detection system and fire fighting equipment are regularly serviced. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 x 27 x 28 3 29 x 30 2 STAFFING Standard No Score 31 x 32 2 33 34 35 36 3 3 3 2 x LIFESTYLES Standard No Score 11 12 13 14 15 16 17 3 3 3 3 3 x 3 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000010872.V285362.R01.S.doc Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Saltram Crescent, 91 & 99 Score 3 3 2 x 3 x 3 3 3 2 x Version 5.1 Page 20 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 9 Regulation 13 Requirement Risk assessments should be comprehensive and include strategies for managing identified risks. Further steps to improve the recording and administration of medication should be taken, including staff training. Risk assessments, agreed with the Medical Practitioner, must be carried out for all service users who are assessed as being able to manage their own medication. All staff must receive training in adult protection and a copy of the local inter-agency policies and procedures should be available in the home. The ventilation in communal areas used by service users who smoke must be improved to reduce the risks to other service users and to staff. The washing machine and dryer located in the kitchen/diner at No 99 must be re-sited to prevent the risk of cross infection. Attention must be paid to the recording of accurate fridge and DS0000010872.V285362.R01.S.doc Timescale for action 31/05/06 2. 20 13 31/05/06 3. 23 18 31/05/06 4 24 13 31/05/06 4 30, 13 31/05/06 5 42 13 31/05/06 Saltram Crescent, 91 & 99 Version 5.1 Page 21 6 7 42 32, 35 23 18 freezer temperatures as required at the previous inspection. The time of fire drills and names of staff present must be noted. Steps should be taken to improve the level of relevant qualifications in the staff team and to implement the staff development and training plan. 31/05/06 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard 17 23 33 42 Good Practice Recommendations The wishes of the service user who is Moslem should be explored further with him to ensure that his religious and cultural needs regarding food are met. Copies of the local inter-agency adult protection policies and procedures should be available in the home. Staff rotas in particular the long shifts and split rest days should be kept under review. A pedal bin should be purchased for the main kitchen so that the Cook does not have to touch the lid. Saltram Crescent, 91 & 99 DS0000010872.V285362.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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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