Inspection on 21/03/06 for Sharon House

This inspection was carried out on 21st March 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sharon House 08/11/07

Sharon House 05/02/07

Sharon House 16/10/06

Sharon House 12/09/05

Sharon House 14/12/04

Sharon House 21/06/04

Similar services:

Cowden Road, 52 - 54

Norbury Crescent (30)

Chatsworth Care - Tudor Lodge

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

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

CARE HOME ADULTS 18-65 Sharon House 24 Sharon Road Enfield Middlesex EN3 5DQ Lead Inspector Jane Ray Unannounced Inspection 11:30 21st March 2006 Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sharon House Address 24 Sharon Road Enfield Middlesex EN3 5DQ 020 8804 5739 020 8804 5739 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) Mr Chandra Jootun Mr Chandra Jootun Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the registering authority at such times as either of the specified service users vacates the home. 12th September 2005 Date of last inspection Brief Description of the Service: Sharon House is situated in a quiet residential road in Enfield a short walk from Brimsdown train station. Residents can access local shops and can reach Enfield Town by bus or train. The home is registered for five adults aged between 18 and 65 years who have a learning disability. There is also a condition allowing the home to continue to care for two people who are now over the age of 65. The home is owned and managed by Mr Chandra Jootun. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 21 March 2006 and was unannounced. The inspector was able to spend time meeting all the service users. The manager and two care staff were working and assisted throughout the inspection. The inspector looked around the building and also inspected relevant records. What the service does well: What has improved since the last inspection? What they could do better: The requirement for the home to complete a fire safety risk assessment and prepare an adult protection policy was restated. In addition a number of other areas for improvement were identified. These included ensuring the service users have regular monthly meetings, providing a medication cupboard large enough to store the medication, ensuring staff have copies of their ID and a CRB arranged by Sharon House in their staff records, ensuring staff have regular supervision, providing comprehensive behavioural guidelines for two of the service users, keeping detailed records of outcomes of service user healthcare appointments, ensuring care plans are regularly reviewed and reflect actions agreed at the previous care plan review meeting, ensuring staff Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 6 appropriately defuse a situation where service users become agitated, providing service users with a key to their room, having guidelines in place for PRN medication, providing a means of keeping a door open whilst not compromising fire safety, ensuring the portable electrical appliances have been serviced, ensuring the staff health and safety training is up to date and updating the annual quality assurance survey. A recommendation was also made that service users are supported to enjoy a wider range of leisure activities and to further develop their independent living skills. The inspector was disappointed that so many requirements have been made as the manager has the skills and experience to understand what needs to take place to ensure a professional service, meeting the needs of the service users but had failed to implement areas of work on an ongoing basis. 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. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 The service users have their needs assessed as part of the process of moving to the home and this includes obtaining information from the care professionals who know them well. EVIDENCE: The assessment information was inspected for the one service user who has moved to the service in the last 18 months. His records included an assessment provided by his care manager. The home also had completed an assessment and this record was available in his case notes. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 the following standard(s): 6,7,8 and 9 The service users have complex needs and the approach taken to support them is not clearly documented in their case notes and this raises concerns about the appropriateness and consistency of the staff input. EVIDENCE: The care plans were inspected for three service users. For two of the service users their care plans had not been reviewed in the previous six months. It was not clear from the care plans what the service users goals were and how they were progressing to meet those goals. One of the service users had a record of a review meeting with their care manager in the last few months. This had a number of agreed actions that needed to take place. These had not been incorporated into the care plans and it was not possible to see what progress had taken place. The inspector spoke to the manager about one of the service users. He used to smoke excessively and now is given three cigarettes in the morning and two in the evening. There is no record of this restriction being agreed and this decision being incorporated into his care plan or risk assessments although the inspector recognises that the outcome is positive from a healthy living Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 10 perspective. The manager also explained that when the service user becomes agitated the staff say that they will withhold his cigarettes. The manager explained that this threat is never carried out. During the inspection the service user was observed asking staff if he will receive his cigarettes later in the day. The behaviour management approach had not been recorded although a letter from the psychiatrist in the service users file mentioned the use of sanctions. It is required that the home meets with the appropriate care professionals to prepare behavioural guidelines for this service user and which everyone agrees are appropriate. The inspector observed the service users having lunch and saw that one was reluctant to eat. The manager explained that this service user may say they are going to be sick when eating and has to be supported in this area and that their weight has remained stable. The care plan when inspected had no specific guidance available on how this service user should be supported with eating. It is required that the appropriate care professionals are contacted and care plans and risk assessments introduced. The service users were observed making decisions in the home. This included choosing where they wanted to sit and whether they wanted to go out in the local area. The record of service user meetings could not be located during the inspection but the manager said that meetings had not been taking place regularly. These meetings need to take place regularly as a means of consulting the service users about the daily running of the home. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 the following standard(s): 11,13,16 and 17 Service users are supported to develop their living skills and to access community based activities but there is scope for this to be developed further. The food available in the home is nutritious and enjoyed by the service users. EVIDENCE: The service users were observed helping with a few domestic activities during the inspection including bringing in the shopping and clearing the table after lunch. One service user said that the staff clean his bedroom for him. The inspector recommends that the manager reviews the use of independent living skills with each service user to see if there is scope for them working towards developing further skills. During the inspection one of the service users was out with the manager doing the food shopping. Another service user was going to the local newsagent with a member of staff. The manager explained that none of the service users were attending college and the one service user who has a part time day centre placement is not attending at present due to healthcare issues. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 12 The staff talked about the activities that take place in the house including art and cookery. One service user said he enjoyed his trips to the library and two others said they enjoy going to the local shops. The inspector noted that the service users do have specific interests such as trains and dogs. It is recommended that the leisure activities are made more varied and incorporate individual areas of interest. The service users when spoken to said that staff knock on their doors when entering their bedrooms. One service user said he would like to have a key for his bedroom and had requested one in the past. Service users also said they open their own mail. The staff were observed talking to the service users and treating them in a respectful manner throughout the inspection. During the inspection the lunch was served. This was a healthy and nutritious meal and with the exception of one service user all the others enjoyed their meal. One resident said he really liked the meals and that since coming to the home he has started to “eat my greens” and his diet is now much more healthy in line with his health care needs. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 the following standard(s): 19 and 20 The service users ongoing healthcare needs are being met but one service users specific healthcare issues had not been adequately explored with the healthcare professionals. The medication is administered safely but a new medication cupboard needs to be provided. EVIDENCE: The healthcare records were inspected for three service users. Each service user had an individual record of the healthcare appointments they had attended. All the primary healthcare checks were up to date. The service users all had a record of their weight each month and one service user who needed to loose weight had been supported to do so. There were also records of service users being supported to attend hospital outpatient appointments as necessary. One service user had suffered a possible stroke in the last couple of months. He was undergoing a number of tests. The manager was very unclear about what was happening, the purpose of the tests and whether the home should be doing anything specifically to assist the service user. The records of appointments were very minimal and the manager was not sure when the next appointment would be. It is required that the manager speaks to either the GP or consultant to find out what is happening and what the home should be doing as part of this process. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 14 The medication and administration records were both satisfactory with adequate records of when the medication is delivered to the home or returned to the pharmacist to provide an audit trail. One service user has PRN medication as part of the behaviour management process and there are no guidelines in place for when this medication should be administered. The medication cupboard is too small for the dossette boxes and the medication is locked in a filing cabinet. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 the following standard(s): 23 The staff have received training on adult protection issues but the home needs to provide a procedure for use in the home that reflects the adult protection guidelines in the local area. The staff need ongoing training on how to diffuse a situation where a service user becomes agitated. EVIDENCE: The staff training records were inspected and these showed that the staff had received training on adult protection issues. The inspector also interviewed one of the care staff and she was able to discuss the different types of abuse and what action they would take if they thought abuse was taking place. The manager was not able to show the inspector the homes own abuse policy. This needs to provide guidance on what to do if abuse is suspected and to reflect the local guidance produced by Enfield Social Services. During the inspection one of the service users became agitated and starting shouting at the staff and other service users. A member of staff spoke to the service user and it was noted that whilst what she said was very appropriate the tone of her voice was very loud. The inspector spoke to the staff member afterwards and she had not been aware that she had spoken very loudly. The staff training records showed that some staff have not received training on supporting service users who have challenging behaviour and this is a training need for the staff working in the service. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 the following standard(s): 24,25 and 30 The home is comfortable and clean for the people who live there and the building is being maintained on an ongoing basis. EVIDENCE: The inspector looked at all the rooms. The home was clean throughout and the hall and bedrooms were in the process of being decorated. The furniture throughout the home was of a satisfactory standard. Service users had personalised their bedrooms with their own items. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 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 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): 33,34,35 and 36 The residents of the home are supported by a stable staff team who receive ongoing training but also need regular supervision. EVIDENCE: The inspector viewed the staff rota. During the day there are a minimum of two staff on duty and at night there is one waking member of staff. The staff team remains very stable and the manager explained that there had been no turnover since the previous inspection. Seven staff files were inspected. All the staff had a record of a police check but two staff had a CRB disclosure from another care provider and one had an old style police check. All the staff need to have a CRB disclosure through Sharon House even where they have been in post for several years. Most of the staff did not have a copy of their ID in the staff records. Four staff supervision records were inspected and they had no record of a supervision session since June 2005. Their appraisal record was also inspected and they have not had an appraisal for 12 months. The staff files contained a record of the training the staff had received. There is evidence that training has been ongoing but as some staff have been in post for several years some of the training may need to be updated. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 18 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): 39 and 42 There is further action to take in order to ensure the health and safety of the service users including some fire safety work and staff training. The annual quality assurance exercise needs to take place to ensure the development of the home to maintain the quality of the service for the service users. EVIDENCE: The record of weekly fire alarm checks and quarterly fire drills were inspected and were satisfactory. The fire safety risk assessment has not been completed and the requirement to do this work is restated from the previous inspection. The certificates were inspected to see if equipment in the home has been serviced and maintained. The electrical installations, fire alarm, gas system and fire appliances had all been serviced. The portable electrical appliances had not been serviced. The staff training records were inspected to ensure staff had received the necessary health and safety training. Whilst staff had received training on fire Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 19 safety, moving and handling, first aid and food hygiene this mostly was dated back to 2003 and so is now out of date. The quality assurance questionnaires were inspected and were completed over a year ago. The manager when asked said that the quality assurance exercise needs to be repeated. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 Score x 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 2 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 LIFESTYLES Standard No Score 11 3 12 x 13 3 14 x 15 x 16 2 17 Standard No 31 32 33 34 35 36 Score x x 3 1 3 1 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sharon House Score x 2 1 x Standard No 37 38 39 40 41 42 43 Score x x 2 x x 1 x DS0000010653.V265803.R01.S.doc Version 5.0 Page 21 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 YA6 Regulation 15(2) Requirement The registered person must ensure that all the care plans are reviewed and updated every six months. The registered person must ensure that the actions agreed at the service users review meeting are incorporated into the care plans. The registered person must ensure that the service user who has his cigarette use restricted has clear behavioural guidelines agreed with the other care professionals involved in the service users care. The registered person must ensure that the service user who is reluctant to eat has clear guidelines for supporting her to eat, agreed with the other care professionals involved in the service users care. The registered person must ensure that the service users are supported to have regular meetings and contribute to the running of the home. The registered person must ensure that any of the service DS0000010653.V265803.R01.S.doc Timescale for action 30/04/06 2 YA6 15(1) 30/04/06 3 YA6 13(6) 30/04/06 4 YA6 12(1) 30/04/06 5 YA8 12(2) 30/04/06 6 YA16 12(4) 15/04/06 Sharon House Version 5.0 Page 22 7 YA19 12(1) 8 YA20 13(2) 9 YA20 13(2) 10 YA23 13(6) 11 YA23 13(6) 12 YA34 19(1)-(5) 13 YA34 19(1)-(5) users who would like a key for their bedroom are given a key. The registered person must ensure that for the service user who has healthcare issues there is a clear record of what action is being taken by the healthcare professionals. The service users care plan and risk assessments must include what the home needs to provide for the service user to meet his healthcare needs. The registered person must ensure that written guidelines are in place for the service user who has PRN medication to help control his behaviour. The registered person must provide a medication cupboard that is the correct size to hold the medication. The registered person must prepare an adult protection procedure, which sets out the steps to be taken by staff and management in relation to adult protection issues. This requirement is restated (previous timescale of 31/10/05 not met) The registered person must ensure the staff have all been trained on how to positively support the service users who have challenging behaviours. This training must include how to diffuse a potentially aggressive situation. The registered person must ensure that all the staff have a CRB disclosure provided by Sharon House. The registered person must ensure that all the staff have a copy of their ID in their staff files. 30/04/06 30/04/06 31/05/06 30/04/06 30/06/06 30/06/06 30/04/06 Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 23 14 15 16 YA36 YA36 YA39 18(2) 18(2) 24(1)-(3) 17 YA42 23(4) 18 YA42 13(4) 19 YA42 18(1)(c) The registered person must ensure that all the staff have regular supervision. The registered person must ensure that all the staff have an annual appraisal. The registered person must undertake a quality assurance exercise seeking the views of the service users, relatives and other care professionals and once the views have been received this must be collated into an action plan. The registered person must prepare a fire safety risk assessment. This requirement is restated (previous timescale of 31/10/05 not met) The registered person must ensure that the portable electrical appliances are checked and a certificate is available to confirm this work has taken place. The registered person must ensure that all the staff have up to date health and safety training including fire safety, food hygiene and first aid. 30/04/06 30/04/06 31/07/06 30/04/06 30/04/06 31/07/06 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 Refer to Standard YA11 YA13 Good Practice Recommendations The registered person should explore if it is possible for the service users to further develop their independent living skills. The registered person should support the service users to enjoy more varied activities based on their individual interests. Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sharon House DS0000010653.V265803.R01.S.doc Version 5.0 Page 25 - 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. 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