Inspection on 21/06/05 for Saltram Crescent, 91 & 99

This inspection was carried out on 21st June 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Saltram Crescent, 91 & 99 08/06/07

Saltram Crescent, 91 & 99 07/06/06

Saltram Crescent, 91 & 99 13/03/06

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 99 Saltram Crescent London W9 3JS Lead Inspector Ffion Simmons Unannounced 21 June 2005 at 09.45 st 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. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Saltram Crescent Address 91 & 99 Saltram Crescent, London W9 3JS 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 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 (12) of places Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: NA Date of last inspection 6th January 2005 Brief Description of the Service: Saltram Crescent is a Registered Care Home run in two, three storey houses (houses 91 and 99). The homes are registered to provide accommodation for 12 residents who have 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 have their own single bedrooms and both houses have kitchen/dinner, lounge, adequate bathroom space and attractive patio/garden area to the back of the two houses. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over one day in June between 09.45 and 16.45. As part of the inspection, the inspector spoke to the service users, staff and the Manager. Various records and documentation was also checked including care records and medication records. The inspector made four requirements, three of which were immediate requirements. What the service does well: What has improved since the last inspection? What they could do better: Consideration should be given for developing a consistent plan for the future for one of the service users whose physical needs are increasing. The Manager needs to ensure that there are adequate and safe number of staff on duty at all times during the day. Medication records need to be improved. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 6 Action must be taken when it is identified that fridge temperatures fall outside the safe temperature for storing food. Steps must be taken to ensure that staff are able to identify what the safe temperatures are for storing food. 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 G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 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 standard(s) 1,2 & 3 Service users and prospective service users have sufficient information for making a decision about where they would like to live. Service users’ needs are fully assessed before moving into the home, which ensures that the placement is appropriate for meeting their needs. EVIDENCE: The home’s statement of purpose and service user’s guide is available and includes a good level of information including the services provided, relevant Look Ahead policies and details about the accommodation itself. The guide contained details of how to contact local services and healthcare authorities and contain the details of the CSCI regional head office have been included since the last inspection. Informative leaflets prepared by Look Ahead, provide information on the maintenance department, customer charter, harassment including racial harassment and complaints. These were found to be accessible to service users in the hallways. The personal files of three service users were checked. Each service user had an assessment prior to them moving into the home to ensure that their needs are known prior to moving in. The needs of the current service users are being met at the home. The needs of one service user, whose physical health has deteriorated is currently being assessed in view of establishing if the home is the most appropriate placement. The Manager must keep the Commission informed of the outcome of the assessments and the future plans. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 9 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) 6,7,8,9, The quality of the care plans are good and contain evidence that service users are involved in the care planning process and are enabled to make their own decisions about their lives. EVIDENCE: The files of three service users were checked and each has an Individual Service Agreement on file outlining their needs. The plans are detailed and long and short-term goals are set. The plans are regularly updated and daily notes are maintained outlining the activities of the day. Risk assessments have been completed and relate to the needs identified within their care plans. Service users spoken with said that they felt that they were able to make their own decisions and that staff help them with any information when they need it. Service users were also aware of who their key worker was and confirmed that they had regular sessions which they felt was useful. There was clear evidence of residents’ meetings taking place where service users were able to express their views about aspect of the running of the home including activities and outings. Service users spoke about the daily chores rota, which was on display in the kitchen and explained that they are given certain household chores. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 10 One service user confirmed that on the whole this worked well but sometimes they required prompting by staff. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 11 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, 16 &17 Staff offer good support to service users to access employment, education and social opportunities. Routines are flexible, providing service users with the freedom to make their own decisions about their lives and their daily activities. EVIDENCE: Staff confirmed that one service user currently has a job and another has shown interest in enrolling on a college course. . Another service user said that they are not currently working but that staff would support them in finding a job or to enrol on a course should they be interested in doing so. Evidence of this was also available on individual files. Service users spoke about their visit from family members and another service user about their involvement at the day centre. There is a staff member responsible for arranging activities for service users and some of the in-house activities include bingo, gardening club, pottery and cooking classes. Each lounge has a TV and music system. Service users talked about a recent BBQ that was held at the home and there are other leisure activities currently being organised such as a picnic in the park and a dance within the local community. A service user expressed that they felt Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 12 relaxed in the home and that they have their freedom and that they could please themselves in terms of getting up and going to bed. Mealtimes also appeared relaxed and flexible. The home employs a cook who caters for all residents including those on special diets and/or are vegetarian. Staff confirmed that there are two service users who are able to cook with staff support and are encouraged to do so. Service user’s satisfaction with the food is assessed through ongoing satisfaction surveys and on the whole the service users were satisfied with the meals on offer. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 13 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 & 21 There is a key working system in place, which ensures that service users receive continuity of care and support for meeting their personal care needs, emotional and health needs. Although medication policies are available for staff reference, the Manager must ensure that a clear record is maintained of all medications given. This is to ensure the safe administration of medication. EVIDENCE: Service users are mainly self-caring with their personal care needs but benefit from some prompting by staff. Each service user has a key worker to ensure consistency and continuity of support. During the inspection, two service users were being supported by staff to attend appointments with medical practitioners. Service users have access to CPN, DN and other members of the multi-disciplinary team. Another service user talked about being supported to have their blood tested regularly and confirmed that an optician had visited the home. Service users’ wishes regarding death and dying has now been noted as far as possible within the care plans. The home is situated over three floors and although Saltram Crescent is described as a home for life, the stairs in the home makes it unsuitable for service users with a physical disability. The medication records for both 91 & 99 were checked and some gaps were evident within these. There is an immediate need to ensure that the quality of Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 14 the medication records is improved. The medication policies were available for staff and the medication was securely stored. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 15 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) 23 Policies are in place and staff have received training for protecting vulnerable adults from abuse. EVIDENCE: Staff confirmed that they have had training in the protection of vulnerable adults and policies are available for responding to suspicion or evidence of abuse or neglect. The home holds money for safekeeping for six service users. Each service user has their individual record books and any money put in or taken out is recorded and a signature is obtained by the service user. The inspector checked the money against the records books and found the balances to be correct. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 16 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, 28, 30 The standard of environment is good and it has been enhanced since the last inspection to provide service users with a homely and comfortable home. The accommodation is well located to enable service users to take part in the local community and have access to transport links. EVIDENCE: Both house number 91 and 99 are considered suitable for their purpose are well located and close to public transport and local amenities. Each service user has a single bedroom and has the use of a shared kitchen/dinner, lounge and bathroom. There is an attractive patio/garden area to the back of both houses and the service users looked to be enjoying this space during the inspection. New carpets have been fitted to two bedrooms in house number 91 as per the requirements of the last inspection report. New good quality furniture have been provided for the lounges in 91 & 99, which have enhanced the environment. The home was clean and hygienic during the course of the inspection. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 17 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) 33, 35, 36 The staff team understand the needs of the service users and work hard at meeting these needs. The staffing levels during parts of the inspection day were not safe and were not adequate for the needs of the service users. This impacts on the ability of the staff on duty to maintain the safety of service users and to deal with any potential emergencies. EVIDENCE: When the inspector arrived at the home there was only one project support worker on shift to 12 service users. Another project support worker was supporting a service user at the GP surgery, another project support worker had called in sick and the manager was at head office. Later, the staffing levels came back to safe levels when the Manager returned to the project, the support worker returned to the project and an agency member of staff started their shift. Later on in the shift, the levels reduced again to one support staff and one agency member of staff on duty. At 3pm the support staff on duty left the project to accompany a service user to the hospital, which left only one agency member of staff to all 12 service users. An immediate requirement was issued to ensure that arrangements are made to ensure safe and adequate staffing levels at all times. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 18 Staff spoken with during the inspection felt that there are good training opportunities available. The inspector was unable to view staff training records and personnel files including supervision notes as they were locked away. The staff however felt well supported by the Manager and felt that the level of care provided to service users was very good. The staff member also commented positively about the team, and felt that staff all work well together. Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 19 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) 37 & 42 Health and safety checks are carried out regularly by staff. The fridge temperatures were found to be above the normal temperatures for storing food on a number of occasions without intervention. As a result, staff failed to promote the health and safety of service users in this area and must ensure that any abnormalities are immediately identified and acted upon. EVIDENCE: Look Ahead have not employed a deputy manager as per the recommendation of the last inspection report. Arrangements are however in place for recruiting one extra project support worker. There are two staff members responsible for the health and safety in the home. The health and safety records were checked and the inspector found that all necessary checks had been carried out. These included regular water temperature checks, weekly fire alarm, panel and emergency lighting tests. Quarterly fire drills are performed and the fire equipment tested. The inspector noted however that although daily fridge and freezer temperatures had been recorded, the temperatures were found to be above safe limits for storing food on a number of occasions. The inspector Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 20 could not see what action had been taken to rectify this. An immediate requirement was made to ensure that fridge temperatures are kept at safe temperatures for storing food and that arrangements are made when the temperatures are identified as being above normal levels. Copies of the electricity certificates for both 91 & 99 have been forwarded to the Commission as per the requirements of the last inspection report. Copies of the home’s insurance certificate was also seen Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 21 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 3 3 2 x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x 3 x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Saltram Crescent Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 2 x G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 22 no 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 3 Regulation 14 [1] [2] 40 Requirement The Manager must keep the Commission informed of the outcome of the assessments and the future plans for the service users whose physical needs have increased. Medication records must be improved without delay. The manager must ensure that staffing levels are adequate at all times. The Manager must ensure that fridge temperatures are kept at safe temperatures and that arrangements are made when the temperatures are above normal levels. Timescale for action 01 August 2005 2. 3. 4. 20 34 42 13 [2] 18 [1] [2] 13 [4] (c) 24 June 2005 24 June 2005 24 June 2005 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 Good Practice Recommendations Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 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. Extracts may not be used or reproduced without the express permission of CSCI Saltram Crescent G09-G60 S10872 SALTRAM CRESCENT UIV23447 210605 STAGE 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!