Inspection on 11/11/08 for Shalom Home

This inspection was carried out on 11th November 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 30 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shalom Home 09/04/09

Shalom Home 16/05/08

Shalom Home 12/10/07

Shalom Home 05/04/06

Shalom Home 22/11/05

Shalom Home 27/07/05

Shalom Home 04/01/05

Shalom Home 02/08/04

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shalom Home Shalom Home 143 Caistor Park Road Stratford London E15 3PR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Lea Alexander     Date: 1 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Shalom Home 143 Caistor Park Road Shalom Home Stratford London E15 3PR 02084719533 02084719533 b.fadojutimi@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mr Bodi Fadojutimi Type of registration: Number of places registered: Mr Bodi Fadojutimi care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 3 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home Shalom Home is a small care provider for 3 adults with a history of mental illness. It was registered in July 1999 and the registered provider is also the registered manager. The premises are located in a terraced house on a residential street in Stratford. The accommodation comprises of a communal lounge and attached kitchen diner, bathroom with wc and garden. There is a staff office/sleep in room and two service user bedrooms located on the first floor, and a third service users bedroom located on Care Homes for Adults (18-65 years) Page 4 of 35 Over 65 0 3 Brief description of the care home the ground floor. There is a garden to the rear of the property and a large park nearby. The home has easy access to transport links and community facilities. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by two inspectors over the course of two visits to the home. The lead inspector had visited the home on several occasions previously. This was an unannounced inspection focusing on key standards and the homes progress with requirements made at earlier inspections. During the course of the inspection we met with the care worker on duty and spoke with two residents living at the home. We also looked at a range of records relating to the running of the home including staff personnel records and residents personal files. Care Homes for Adults (18-65 years) Page 6 of 35 What the care home does well: What has improved since the last inspection? What they could do better: Several requirements are restated as a result of this inspection. These include developing comprehensive care plans for people who use the service and providing advocacy and support services to residents making major life decisions. Requirements relating to the homes risk assessment practises are also restated along with requirements for the home to record and investigate all complaints, and the appropriate application of safeguarding procedures with regard to one residents finances. Requirements relating to some maintenance issues are also restated, as is the requirement for the home to evidence that all staff have an awareness of basic mental health issues and their impact upon residents. As a result of this inspection several new requirements are made. These include the need for assistance with personal finances to be clearly identified in care plans along with the nature of the assistance required and the reason why it is needed. The home must also make available for inspection records of payments received from privately funded residents. A record of all meals actually provided to residents must be maintained, and individual plans should sensitively address areas of personal care so as to promote dignity and respect. Where a deterioration in residents physical health is noted, an appropriate care plan must be developed and implemented to address these needs. All self medication must be clearly identified in the care plan and be subject to regular risk assessments. All medicines must be securely stored at all times. The homes complaints log must be regularly reviewed to establish any trends in the nature of complaints received and to identify any exacerbating factors in nature of complaints received. The home must investigate and evidence the whereabouts of a substantial amount of money belonging to one resident. Some repairs and maintenance work is required within the home. Some improvements in hygiene in the kitchen and dining areas are also required. The home must maintain accurate health and safety records and ensure that cleaning materials are securely stored. Care Homes for Adults (18-65 years) Page 7 of 35 The home must ensure that the staffing roster accurately reflects the situation in the home, and that sufficient staff are on duty at all times to ensure that residents needs are met and that the administrative and day to day running of the the home are undertaken. The home must evidence that two references, Criminal Records Bureau (CRB) check and proofs of identity are obtained for all staff prior to the their commencing duties. All staff should receive an annual appraisal. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is provided to potential residents and their needs are assessed. Evidence: Previous inspections have evidenced that the home has produced a statement of purpose that reflects the service provided. There have been no new admissions to the home since the last inspection. Previous inspections have evidenced that the home assesses potential residents prior to their moving in. Documentation found on the personal files of people who use the service evidenced that residents needs have been reassessed since the last inspection in May 2008. Care Homes for Adults (18-65 years) Page 10 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are basic and do not address all areas of need. The home does not properly assess or manage identified risks. The home does not maintain adequate records relating to residents finances. Evidence: We looked at the individual plans the home had developed for each of its residents. Whilst some personal, social and health care needs had been addressed by these plans, there were notable gaps. For example, one resident had no plan to address their mental health needs and their was no information about their diagnosis, presentation or triggers and indicators to periods of mental ill health. For a second resident a plan addressing their diabetes did not include information on how their insulin was administered and what kind of support the resident needed in administering this medication. Other entries in the personal file, direct observation of the resident and discussion with them evidenced difficulties in mobilizing, and the use of some aids. There was however no plan on file addressing their mobility needs inside or outside of Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: the home. For the third resident entries in their personal file evidenced that they were self medicating during frequent visits to their relative. However their was no care plan addressing the residents ability to self medicate. Sampling of the available records evidenced that staff complete entries for each plan on a daily basis, and that this information forms the basis of a six month review conducted by the homes manager. Some of the information recorded was very brief. For example one resident has recently been accepted by a befriending service. Whilst their initial visit was recorded, it did not include their name, the length of their visit, the frequency of future visits or their contact details. Some care plans were signed by the residents. Sampling of the available records and discussion with two people who use the service did not evidence regular 1:1s with care workers or the homes manager to review progress, needs or plans. People who use the service each have their own bank accounts and manage their own finances. Two residents have decided to keep small amounts of cash in the homes office. This is kept in individual locked boxes and a financial transaction sheet is completed with the date and amount of each transaction. This is signed by the worker on duty and the resident. One resident had been receiving independent financial advocacy services. However, it was not clear from available records, discussion with the staff member on duty or the resident whether this support was ongoing or had concluded. Recorded discussion with this residents social worker, entries in their care plan and discussion with the person using the service identified a need for support in managing their finances. However information in their personal file did not detail how this would be provided. An entry in the care plan did state that staff would check their post on a daily basis. Sampling of records, discussion with the resident and care worker on duty did not evidence that this occurs each day. We looked at the minutes of meetings held with residents. Since the previous inspection a meeting has been held with residents on a monthly basis. We were pleased to note that during the meetings residents commented on improvements on the menus and food provided within the home. We did note that the agenda for meetings is rather limited, focusing predominantly on menus and complaints. There was only one occasion when other matters relating to the day to day running of the home were discussed, and this related to the homes smoking policy. Since the last inspection the home has introduced a new risk assessment tool. This is a generic tool that addresses areas of behavior such as aggression, violence and self care. It had been completed for each resident, regardless of whether their assessment of need or care plans had identified potential risks in each area. We were concerned to note however that a document headed family review identified an incident (without Care Homes for Adults (18-65 years) Page 12 of 35 Evidence: dates) when the resident allegedly stabbed a person in a shop. A knife attack assessment completed by the home home in July 2008 makes no mention of this incident. Potential risks that relate to specific needs identified in individual care plans were not subject to risk assessment or management strategies. This includes one resident administering their insulin, and another self administering their oral medication whilst on leave to a family member. Care Homes for Adults (18-65 years) Page 13 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are involved in daytime activities of their choice and remain in contact with their families. There has been some improvement in the meals provided, however the home needs to continue to develop the provision of culturally appropriate meals for residents. Evidence: Since the last inspection one resident who had expressed an interest in additional activities has been taken to a snooker activity session on three occasions. They have also been referred to a computer group but have not yet started attendance. This resident and a second resident continue to be visit the local supermarket with staff one afternoon each week. Whilst the staff member carries out the weekly shop the residents have lunch in the attached cafe. In addition these two residents also visit local fast food outlets with a staff member each Friday lunchtime. Both residents have Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: telephone contact with their family members. A third resident spends much of their time away from the home staying with a family member. We have previously been told that this resident is able to access local community services such as shops and transport independently and that they had declined day services. Both the residents we spoke to were happy with the frequency and nature of the activities they were involved in. People who use the service told us that they choose when to be alone or in company or when to join in an activity. Two of the homes residents are diabetic and the third has specific dietary requirements according to their cultural and religious beliefs. Since the last inspection an additional take away is provided one night per week to ensure that an Asian meal is provided for one resident. However, there were no clear records of what takeaway meal had been provided, and discussion with people who use the service suggested that Chinese takeaways rather than a Indian or Pakistani take away had been provided. We asked to see the record of meals provided by the home. We were shown a weekly meal planner, but were told that there was no record of the actual meals provided to residents. Both the residents we spoke to commented that the variety of meals on offer had improved since the last inspection. Care Homes for Adults (18-65 years) Page 15 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home encourages people to use the service to be independent in their personal care and to attend regular health care appointments. However, two residents are self medicating and this is not comprehensively addressed in their care plans or been subject to appropriate risk assessment and management strategies. Evidence: Sampling of individual plans and discussion with two people who use the service and the care worker on duty evidenced that residents carry out their personal care independently, but require prompts and reminders from care staff. We did find care plans on two residents files headed inappropriate toilet behavior. These related to incidents of poor toilet hygiene, but it was unclear from the plan what the contributing factors to soiling the toilet were. We found the tone of the plans to be insensitive toward residents. We sampled the information relating to health care appointments for two people who use the service. Information about the date and nature of health care appointments was recorded in the personal file of each resident. Recent health care appointments Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: included the district nurse, GP, dentist and optician. For one resident there were mentions throughout their personal file of recent poor health including poor eyesight and eye problems. One care plan that is headed to suggest it refers to cleaning the residents room makes several mentions of recent deteriorations in health. However, there was no care plan addressing this deterioration or evidence that the resident had been supported to obtain appropriate health care. Previous inspections have evidenced that the home has a medication policy. Discussion with the care worker on duty and one resident evidenced that they are currently self medicating their insulin on a daily basis. This information was not reflected in their care plan and a self medication risk assessment had not been completed. The records and care plans for a second resident evidenced that the majority of their week is spent staying with a relative and that during these periods they are self medicating. Again, a risk assessment for this activity had not been completed. We sampled the available medication for two residents and compared this to the Medication Administration Record (MAR). The two were found to correspond. The MAR sheets were generally in good order and were accurately completed. Medications are stored in a locked cupboard in the homes office, however we found that a completed dossett cassette that contained some missed medications was left on top of the refrigerator in the homes office. Care Homes for Adults (18-65 years) Page 17 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has made some improvements to the way complaints are recorded, however it was not evidenced that all complaints are recorded or responded to. Additional safeguarding training has been provided to some staff, but there continue to be concerns regarding the financial protection of one resident. Evidence: At an earlier inspection in May 2008 we found that one resident had made repeated complaints at residents meetings regarding noise levels from another residents room. At that time we required the home to investigate the complaint and to feedback the outcome to the resident and ourselves. During this inspection we noted that the complaint had been logged and some action taken, but that we had not been kept informed. Discussion with the person who uses the service and sampling of the residents meeting minutes identified that high levels of noise continued to be an issue for this resident, but that despite continued complaints in this area expressed at residents meetings, no further complaints were logged and no subsequent action taken. We discussed this with the care worker on duty who told us that even when the other resident was not at home they complained of noise coming from their room, and that in their view the resident making the complaint could be experiencing auditory hallucinations. We were concerned to note that this information was not reflected in Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: their care plan, in the investigations that had taken place or considered as part of the investigation outcome. Previous inspections have evidenced that the home has developed a complaints policy that complies with National Minimum Standards. The residents we spoke to at this inspection told us they knew how to make a complaint, although the resident who has frequently complained about noise levels told us that they felt frustrated that their complaints were not being satisfactorily dealt with. We looked at the training records for two staff members. These evidenced that one had completed additional safeguarding training since the last inspection in May 2008. Previous inspections have evidenced that the home has developed safeguarding policies and procedures. The staff member we spoke to on our second visit demonstrated an awareness of the different types of abuse vulnerable people might experience and their responsibilities should they have any safeguarding concerns. At the last inspection in May 2008 we were concerned that allegations of theft made by one resident had not been properly recorded or investigated. At this inspection we found records of the investigation subsequently undertaken by the home. These concluded that the residents memory loss was the likeliest cause of confusion over missing/spent monies and that no theft had occurred. As a result of the investigation it was agreed that monies they kept within the home for daily expenses would be retained in a locked box in the staff office with the staff member on duty and the resident signing for each transaction. We spoke to the resident concerned who told us that they were happy with this arrangement and would in fact welcome more assistance in managing their finances. We looked on this residents personal file and found a record of a meeting between them, the home manager and the allocated social worker in June 2008. This evidenced agreement at that time that the resident would welcome assistance in managing their finances. We spoke to the resident, to the staff member on duty and looked through available paperwork. It was not clear that such support had been further discussed with the resident or progressed. A financial advocate had been involved with this resident some months previously, despite further discussions with the resident and the staff member on duty and sampling of available records we were unable to establish whether they continued to be involved or whether their involvement had concluded. This residents care plan had been updated since the last inspection to state that staff at the home would check this residents mail daily to ensure that all correspondence relating to finances was appropriately addressed. Again, sampling of available records, discussion with the resident and the staff member on duty did not evidence that this occurred on a daily basis. Whilst we were looking through the homes complaints folder we noted that since the Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: last inspection this same resident had made an allegation that two withdrawals of of 10,000 pounds and 5,000 pounds had been made from their account. Recording stated that the resident later said that they subsequently remembered withdrawing the money to pay their fees at the home and at another time that they had withdrawn the money to pay for other expenditures. We were very concerned to note that the resident was making major life decisions with regards to their finances without any records to evidence the decision making process or any evidence of them being supported to make informed decisions. We were also concerned at the lack of clarity as to what the 15,000 pounds had in fact been spent on. During the period when the resident alleged that the money had been stolen from their account we noted that the home had not supported the resident to report the loss to the police. Similarly there was no evidence of local Social Services or the Commission for Social Care Inspection being notified. Care Homes for Adults (18-65 years) Page 20 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of shared and private spaces. Residents have their own bedrooms, and some repairs and maintenance issues identified at the last inspection have been completed. Evidence: The home is situated in a Victorian terraced property in a quiet residential location close to public transport links and the nearby shopping centres at Stratford and Upton Park. There is also easy access to the nearby West Ham Park. Entrance to the home is via a small porch that leads onto a hallway. A small lounge leads off this hallway and this has a range of seating, a satellite TV and a stereo. The lounge leads onto a kitchen with dining area. There are a range of fitted units and appropriate appliances. From the dining area there are patio doors to a paved rear garden. From the kitchen there is a small hallway that leads onto the bathroom. This has a WC, hand basin and bath tub with shower over. One residents bedroom is also located on the ground floor. Access to the first floor is via a staircase and two residents bedrooms and a staff office are located on this level. Some maintenance and hygiene issues were identified as a Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: result of this inspection, and these are identified in the requirements section of this report. The home was free from offensive odours. Care Homes for Adults (18-65 years) Page 22 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally happy with the care they receive. Staff are supported to undertake NVQ level qualifications and receive regular supervision. However, some staff do not have basic mental health awareness and the homes recruitment practice puts people who use the service at risk. Evidence: We looked at the homes staffing rota, a single care worker is rostered on duty for each day and sleeping night shift. On our first visit the staffing situation within the home reflected what was recorded on the rota, however, on the second day we attended we observed that the day shift staff were one and half hours late coming on duty. The night staff on duty told us that they had not been notified that the staff would be late coming on duty in advance. The night staff were able to stay on duty within the home until the day staff arrived. We noted that since the last inspection the home had updated its roster to include the timings of each shift as well as the name of the person on duty. We also noted that the Manager was rostered as being on duty each Monday and Wednesday. However, on these dates no care staff were rostered as being in attendance with the manager. Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: Over half the homes care staff have successfully completed NVQ level 2 or above studies, and the other remaining care workers are currently studying for these awards. We looked at the available personnel documentation for two care workers. For one it was evidenced that two satisfactory references, proofs of identity and a Criminal Records Bureau (CRB) check had been obtained. For a second care worker these documents were not available. One of the staff sampled was evidenced as having received an appraisal in November 2008. One staff member was evidenced as having already received in excess of six supervisions in the year, and the other was on target to receive six supervisions over the course of the year. At an earlier inspection in May 2008 the staff member we spoke with had no formal training or experience in mental health, and during our discussions with them we noted that their understanding of mental health issues and their impact on residents was very limited. We required the home to provide basic mental health training. Neither this member of staff or the manager were on duty on the days that we visited the home so we were not able to discuss with them what mental health awareness training had been planned or provided. We did however look at the training records and supervision notes for this staff member and could not evidence basic mental health training being provided. Care Homes for Adults (18-65 years) Page 24 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager is suitably qualified. The home needs to improve some of its health and safety and food hygiene practices. Evidence: At an earlier inspection in May 2008 the manager told us that they had completed their NVQ level 4 studies and were waiting to receive their certificate. At this inspection the home was evidenced as having obtained the views of people who use the service via a survey in May 2008. We looked at a range of health and safety records maintained by the home. These evidenced that appropriate accident reports are maintained. We also looked at the homes fire alarm testing records and found that weekly fire alarm call point tests are carried out. We looked at the homes record of fridge and freezer temperatures, whilst these are recorded daily we noted that the same temperature is always recorded without any variation, which led us to question the reliability of the record. We also Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: noticed the same with the homes record of water temperatures which are also recorded with exactly the same temperature over an extended period. We checked the contents of the homes fridge and freezer. One started processed food item had been incorrectly date labeled to show that it had been opened some days into the future. Some food items in the freezer were not labeled with their contents or the date they were frozen. No chopping boards were in evidence in the kitchen. The cupboard containing the homes cleaning materials and other potentially hazardous household products had not been locked. We asked to see the homes most recent London Fire and Emergency Planning Authority (LFEPA) inspection report, but this could not be located by the staff on duty. One resident is responsible for paying their own fees to stay at the home. We asked to see records maintained by the home of payments received from this resident, but they were not available. We asked the resident concerned whether they had received receipts for the payments they had made to the home, but they could not remember. Care Homes for Adults (18-65 years) Page 26 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 7 16 & 20 The home must ensure that appropriate advocacy services are provided to people who use the service. The home must seek independent financial advice from appropriate sources for the resident who is liable to pay their own contributions Where people who use the service are supported to make major life decisions detailed records must be maintained. 30/11/2008 2 9 13 The home must ensure that identified risks are appropriately assessed and subject to a management strategy. 30/11/2008 3 35 18 The home must ensure that 30/11/2008 all staffs demonstrate a basic understanding of mental health issues. Care Homes for Adults (18-65 years) Page 27 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 14 The home must ensure that 30/01/2009 individual plans appropriately detail the health, social and personal needs of people who use the service. To promote the safety and well being of people who use the service. 2 6 15 The home must evidence that plans are drawn up and reviewed with the involvement of the resident. To promote the well being of people who use the service. 30/01/2009 3 7 16 Where appropriate residents must be supported to manage their finances. The nature of this support and the reasons it is required must be documented and reviewed. For the safety and well being of people who use the service. 31/12/2008 Care Homes for Adults (18-65 years) Page 28 of 35 4 17 16 The home must maintain a record of the meals actually provided to people who use the service. To promote the well being of people who use the service. 31/12/2008 5 18 12 Sensitive support must be offered to people who use the service to promote their dignity and respect. To promote the safety and well being of people who use the service. 31/12/2008 6 19 12 The home must ensure that 31/12/2008 the health care needs of people who use the service are assessed and procedures put in place to address them. To promote the safety and well being of people who use the service. 7 20 13 Self medication by residents 31/12/2008 must be clearly identified in support plans and be subject to a risk assessment that is regularly reviewed. To promote the safety and well being of people who use the service. 8 20 13 All medications, including those awaiting disposal, must be securely stored. To promote the safety and well being of people who use the service. 31/12/2008 9 22 22 The home must ensure that each complaint it receives is 30/12/2008 Care Homes for Adults (18-65 years) Page 29 of 35 recorded along with the details of the investigation undertaken, the action and outcome. To promote the safety and well being of people who use the service. 10 22 22 The home must ensure that complaints are regularly reviewed and any trends or contributing factors identified. To promote the safety and well being of people who use the service. 11 23 13 The home must ensure that 30/12/2008 robust procedures are in place to safeguard people who use the service, and that allegations are investigated in accordance with the homes safeguarding policy. To promote the safety and well being of people who use the service. 12 23 16 The home must fully 30/12/2008 investigate and evidence the whereabouts of 15,000 pounds of one residents monies that are not appropriately accounted. To promote the safety and well being of people who use the service. 13 24 13 A plug must be fitted to the bathroom sink 30/12/2008 30/01/2009 Care Homes for Adults (18-65 years) Page 30 of 35 To ensure that people who use the service benefit from a comfortable and well maintained environment. 14 24 13 The toilet seat must be properly secured. To promote the safety of people who use the service. 15 24 13 The ripped net curtains to the rear patio door must be replaced. To ensure that people who use the service benefit from a comfortable and well maintained environment. 16 24 13 The broken patio door lock must be replaced. To ensure the safety of people using the service. 17 24 13 The broken front door glass must be replaced. To ensure that people who use the service benefit from a comfortable and well maintained environment. 18 24 13 Items of broken furniture stored in the rear garden must be appropriately disposed of. To ensure that people who use the service benefit from a comfortable and well maintained environment. 19 24 23 Items of furniture must not be stored on landings or in stairwells. 30/12/2008 30/12/2008 30/12/2008 30/12/2008 30/12/2008 30/12/2008 Care Homes for Adults (18-65 years) Page 31 of 35 To ensure that people who use the service benefit from a comfortable and well maintained environment. 20 24 13 A programme of maintenance and repair must be undertaken for the homes tired decor. To ensure that people who use the service benefit from a comfortable and well maintained environment. 21 30 13 The soiled bread bin and place mats must be replaced. To promote the safety and well being of people who use the service. 22 33 18 Staff must be employed in 30/12/2008 sufficient numbers to ensure uninterrupted work with residents in addition to the administration and day to day running of the home. To promote the safety and well being of people who use the service. 23 33 18 The staffing roster must accurately reflect the situation within the home. To ensure the safety and well being of people who use the service. 24 42 16 In accordance with good 30/12/2008 food hygiene practise, the home must provide a range of coloured chopping boards. 30/12/2008 30/12/2008 24/02/2009 Care Homes for Adults (18-65 years) Page 32 of 35 To ensure the safety of people who use the service. 25 42 13 Potentially hazardous 30/12/2008 household materials and cleaning substances must be securely stored. To ensure the safety of people who use the service. 26 42 23 The home must forward a copy of its most recent LFEPA inspection report to the Commission for Social Care Inspection. To ensure the safety of people who use the service. 27 42 16 Started, processed foods must be accurately date labeled. To promote the safety of people who use the service. 28 42 16 All frozen food stuffs must labelled with the contents and its date of freezing To promote the safety of people who use the service. 29 42 16 The home mus maintain accurate records of fridge and freezer temperatures. To ensure the safety of people who use the service. 30 43 25 The home must have available for inspection records of payments received from residents for the cost of their care and accommodation. 30/12/2008 30/12/2008 30/12/2008 30/12/2008 30/12/2008 Care Homes for Adults (18-65 years) Page 33 of 35 To ensure the safety and wellbeing of people who use the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 8 17 36 The home should consult people who use the service on all aspects of daily life within the home. The home must ensure that a range of meals that address residents cultural needs are provided. All staff should receive an annual appraisal. Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 35 of 35 - 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!