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Inspection on 25/10/05 for Shrewsbury Road (267)

Also see our care home review for Shrewsbury Road (267) for more information

This inspection was carried out on 25th October 2005.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users have been resident on a long- term basis and were observed to be settled and happy and inform that they are supported and respected by staff. Service users` independence and personal development are promoted through participation in appropriate daily living activities in the home and in day, social and leisure opportunities in the community. Staff are familiar with service users` needs and are supported by the Manager to undertake their duties.

What has improved since the last inspection?

In the absence of discussion with the Manager, the inspector made no observations of any changes in the way the home operates or in its use of documentation in the home. The service users remain satisfied with the level of care they receive at the home.

What the care home could do better:

There are a total of 13 requirements, including 7 new requirements, which are not satisfactory for a small well established home with long standing service users. 2 of the inspected outstanding requirements are restated following noncompliance from the last inspection with timescales set at 30/01/05. These concern the need for care plans to be signed by service users and the need for a water safety certificate. A broad range of requirements are given, including the need to improve the quality of care plans; the administration of medication and for accounting and recording procedures to improve concerning service users` personal allowances. The Registered Manager must ensure that National Minimum Standards are met, that documentation required by regulation are kept and that requirements are achieved within timescales specified in this report.

CARE HOME ADULTS 18-65 Shrewsbury Road (267) 267 Shrewsbury Road 267 Shrewsbury Road East Ham London E6 Lead Inspector Nurcan Culleton Unannounced Inspection 25th October 2005 10:00 Shrewsbury Road (267) DS0000022850.V261309.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 Shrewsbury Road (267) DS0000022850.V261309.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. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Shrewsbury Road (267) Address 267 Shrewsbury Road 267 Shrewsbury Road East Ham London E6 020 8586 7781 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) Sahara Homes (UK) Limited Ms Lorraine White Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate one named service user over the age of 65. Date of last inspection 20th December 2004 Brief Description of the Service: 267 Shrewsbury Rd is a residential home run by Sahara Homes (UK) Limited providing long term support and 24 hour care for people with learning disabilities. The home is a large terraced house situated in a residential street in Forest Gate. It is within close proximity to East Ham and Green Street shopping areas and served by a range of bus routes, Upton Park and East Ham underground stations. There is off-street and on-street parking available. Each service user has their own single bedroom. There is a kitchen/dining room, bathroom and shower room and a paved garden. The home states that its purpose is to “support, encourage and enable each resident to realise their full capacity in choice, dignity, respect, privacy, independence, civil rights and individuality”. The Registered Manager is also the proprietor of the home. The home is also managed by a second manager in the home. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 26th October 2005. The inspector was assisted by a care worker throughout the inspection. The Manager was called away to respond to a personal matter therefore could not be present. The home is occupied by all 4 service users who have been long term residents in the home. At the time of the inspection, 3 of the service users were at the home and 1 service user was visiting her parents. The inspector spoke with all 3 service users and interviewed the staff member on duty. The inspection also involved a tour of the premises and inspection of service user files and other documents and records as required by regulation. There are a total of 6 restated requirements following this inspection, 4 of which could not be inspected and must be examined at the next inspection. What the service does well: What has improved since the last inspection? What they could do better: There are a total of 13 requirements, including 7 new requirements, which are not satisfactory for a small well established home with long standing service users. 2 of the inspected outstanding requirements are restated following noncompliance from the last inspection with timescales set at 30/01/05. These concern the need for care plans to be signed by service users and the need for a water safety certificate. A broad range of requirements are given, including the need to improve the quality of care plans; the administration of medication and for accounting and recording procedures to improve concerning service users’ personal allowances. The Registered Manager must ensure that National Minimum Standards are met, that documentation required by regulation are kept and that requirements are achieved within timescales specified in this report. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 6 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. Shrewsbury Road (267) DS0000022850.V261309.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 Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 Service users’ needs are assessed prior to their admission. Prospective service users have the opportunity to visit the home. EVIDENCE: Service users’ files were examined. Social work assessments seen in files evidence that service users’ needs are assessed prior to their admission and care plans are developed by the home according to their assessed needs. One service user told the inspector that she had visited the home prior to her admission. The Statement of Purpose and Service Users’ Guide were not inspected during this inspection. A requirement was made at the last inspection for the Service Users’ Guide to be updated to include all the items listed in regulation 5. This must be examined at the next inspection. The service users’ contracts, where a further requirement was given at the last inspection, must also be examined at the next inspection. Shrewsbury Road (267) DS0000022850.V261309.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, 9, 10 Service users are supported to take risks to maintain their independent lifestyle. Service users’ assessed needs are not fully reflected in their care plans. Consultation with service users regarding their care plans must be evidenced. Statutory reviews must be maintained. EVIDENCE: Four of the service users’ files were examined. Each file contained comprehensive care plans identifying a range of assessed need areas, goals aimed at and actions required to meet assessed needs. Records and risk assessments examined evidenced that service users are supported to take appropriate risks. There was evidence of consultation with service users in multiple activities concerning their lives, however not in the case of their care plans, which were not signed by service users (or their representatives/advocates) or by their key workers completing their plans. This was a requirement from the previous inspection in Dec 2005 and is restated. Needs identified through risk assessments and monthly reviews were not integrated to reflect assessed needs in the care plans. For example, Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 10 the inspector identified through case tracking, the care needs of one service user observed in two separate review notes, identifying, for example, a pattern of behaviour of throwing clothes away, cutting T Shirts, (recorded 01/09/05) and habitual behaviour, including at night time, of sorting out clothes (recorded 01/08/05) was not integrated into the individual care plan. Similarly, a risk assessment identifying a risk to another service user boarding public transport and a further risk to staff and service users of physical and verbal aggression whilst out in public places by this service user was not translated into their care plan. All service users needs identified through the use of risk assessments and other assessment tools, including reviews, must be incorporated into the service users’ care plan. Statutory reviews involving the service users’ carers/representatives/advocates and professionals involved in their care are required for some of the service users. Shrewsbury Road (267) DS0000022850.V261309.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, 12, 13, 14, 15, 16, 17 Service users continue to be supported to engage in daily living activities to promote their personal development. There are appropriate social and leisure opportunities. Service users enjoy a health diet. EVIDENCE: Through interviews with the care worker, service users and examination of service users’ files, the inspector was satisfied that service users are given every opportunity for personal development, including the development of independent living skills. At the time of the inspection, one service user was preparing her own breakfast. Another service user gave the inspector a tour of the home. A weekly activities chart showed service users on a rota to assist with group domestic chores. One service user spoke to the inspector about doing her own ironing and offered to make tea. Service users are responsible for cleaning their rooms, doing their own laundry and with assisting in the planning and preparation of food (menu observed to be varied and nutritious), all according to their individual plans. Service users are engaged in a variety of day and leisure activities during the week, including the Gateway Club for people with learning disabilities, day trips in a shared mini bus, other social activities within the community such as having pub lunches and bowling. There are also a range of activities within the home supported by staff. Personal friendships and family contact are encouraged and a minister visits the home. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users are encouraged to maintain their independence and are encouraged and supported by staff when needed. Service users are encouraged to administer their own medication. However some requirements are given concerning medication procedures. EVIDENCE: The inspector observed that the staff member was sensitive to service users’ needs. For example, one service user chooses to maintain her own personal care in the mornings and to take her time, which was respected by her as part of the ethos of the home. Other service users are also encouraged to be independent with personal care and are prompted with some personal care activities as required by the individual service user. Correspondence from multi-disciplinary professionals were seen in files related to the physical and mental health well-being of service users. Medication records seen were checked and deemed to be accurate at the time of inspection. One service user is assisted to self-administer medication. Staff have received medication training, however this did not cover the administration of insulin. The District Nurse who assumes responsibility for delegating this task to the non-nurse carer must provide written confirmation of the ability of the carer(s) to assist with this task. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 13 In addition, the MAR sheet was potentially confusing with two lines of dates at the top of the MAR sheet – one pre-recorded and one written by staff. This could lead to mistakes in the future. The Registered Manager must ensure a clear system of dates at the top of the MAR sheet (the line of dates not in use could be crossed out or further consultation with the pharmacist may be required on the use of the recording tool and how to provide a safe and clear system of recording). Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users feel valued, well cared for and their views listened to. Service users are satisfied with life in the home. Service users benefit from staff who are informed about how to protect them from abuse. EVIDENCE: The complaints book was examined. There were no recorded complaints since the last inspection. The lack of complaints are reflected in the views expressed by service users interviewed who informed that they were happy in the home, particularly with the staff and had no complaints about the home. The care worker confirmed that staff had received training on Adult Protection recently from their area manager. The complaints policy and adult protection policy must be examined at the next inspection. Two service users’ personal allowance records were examined. Whilst the balance of one account was correct, at the time of inspection, the balance of the other account was incorrect. The written balance totalled £296.45 whereas the personal allowance counted was £292.96. The inspector observed a record in the personal allowance book by a member of staff indicating where a mistake had been made earlier on. The Registered Manager must ensure a robust procedure for managing the personal allowance of all service users and to ensure accurate records are kept. In addition, service users signatures were not always available following receipt of their personal allowance. Evidence of the receipt of personal allowance by service users must be maintained. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 15 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, 26, 27, 28, 29, 30 The home is suitable to meet service users needs and is in keeping with National Minimum Standards to provide a homely, comfortable and safe environment. Requirements are given to ensure that furniture is maintained to good quality and to ensure safe storage of personal items. EVIDENCE: Service users live in a comfortable, homely and safe environment, which is suitable to meet their needs. Bedrooms contained personal effects to suit individual tastes. Shared rooms such as the kitchen/diner, lounge, the first floor bathroom and ground floor shower room are bright, clean and tidy. Requirements are given for a broken chest of drawers to be fixed in one service users’ room and for the chest of drawers with a handle missing to be repaired or replaced in another service users’ room. Also, service users must have lockable storage space to safely store personal products (such as razor blades and toiletries) which were observed to be openly displayed in one service users’ room. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 36 Staff are clear about their roles and responsibilities and service users benefit from staff who receive supervision to support them in their task. EVIDENCE: The inspector had no access to staff files and relied on the information given by the staff member on duty on the day of inspection. The care worker had an intimate knowledge of service users’ needs. She presented as being competent with care practices and procedures within the home and to have a good relationship with service users. The care worker was responsive to service users’ needs who sought support from her throughout the inspection, attending to their personal care and responding and taking appropriate action when called. It was evident that the care worker was clear about her role and the responsibilities of her task. The care worker informed that she regularly received supervision to assist her. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 17 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38, 41, 42 Service users benefit from staff who receive good support and supervision to enable them to conduct their duties safely and informatively. A water safety certificate is still required. EVIDENCE: The care worker interviewed informed that the Manager is very open, approachable and supportive. She divides her time with another of the registered homes but is available in person or on the telephone on a daily basis. There are some issues with records kept in the home, particularly concerning care plans and associated assessments and other records, which have been outlined in this report and for which requirements have been made. Valid health and safety certificates were seen for gas and electricity but a water safety certificate was not available. This requirement is restated following a requirement given at the last inspection. A requirement given at the last inspection concerning the need for a business plan must be examined at the next inspection. Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 Score 3 1 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 1 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 16 17 Standard No 31 32 33 34 35 36 Score 3 x x x x 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shrewsbury Road (267) Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 1 1 1 DS0000022850.V261309.R01.S.doc Version 5.0 Page 19 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 YA1 Regulation 5 Requirement The Registered Manager must ensure that the Service Users’ Guide must be updated to include all items listed in Regulation 5. This requirement is restated with a new timescale for compliance. The service users’ contract must be updated to include all items stated in Standard 5. This requirement is restated with a new timescale for compliance. The Registered Manager must ensure that care plans are signed by the service users or their representatives/advocates. (Timescale of 30/01/05 not met). 4 YA6 12, 13(2) (c) All service users needs identified 05/01/06 through the use of assessment tools such as risk assessments must be reflected in service users’ care plans. The Registered Manager must 05/01/06 ensure that statutory reviews are given for all service users. DS0000022850.V261309.R01.S.doc Version 5.0 Page 20 Timescale for action 05/01/06 2 YA5 5 (1)(c) 05/01/06 3 YA6 12 (1)(a) 05/01/06 5 YA6 14 (2)(a)(b) Shrewsbury Road (267) 6 YA20 13 (2) 7 YA20 13 (2) 8 YA23 17 (2), Schedule 4 The Registered Manager must 05/01/06 ensure that the District Nurse, who assumes responsibility for delegating the administration (or assistance) of medication through specialist techniques to the non-nurse carer, provides written confirmation of the ability of the carer(s) to assist with this task. The Registered Manager must 05/01/06 ensure that there is a clear system of recording of the administration of medicines in the home in order to minimise the potential for errors. The Registered Manager must 05/01/06 ensure: (1) A robust procedure for managing the personal allowance of all service users and to ensure accurate records are kept. Evidence is available for the receipt of personal allowance by all service users. 05/01/06 (2) 9 YA24 16 (2)(c) The Registered Manager must ensure repairs or replacements of the following: (1) A broken chest of drawers to be fixed in one service users’ room. (2) The missing handle of the chest of drawers in another service users’ room. 10 YA26 13 4(c) The Registered Manager must ensure that all service users have lockable storage space to safely store personal products DS0000022850.V261309.R01.S.doc 05/01/06 Shrewsbury Road (267) Version 5.0 Page 21 (such as razor blades and toiletries) in one service users’ rooms. 11 YA35 18 (1) The Registered Manager must ensure that a staff training and development plan is produced. This requirement is restated with a new timescale for compliance. The Registered Manager must have a water safety certificate. (Timescale of 30/01/05 not met) The Registered Manager must ensure the availability of a Business Plan. This timescale is restated with a new timescale for compliance. 05/01/06 12 YA42 37 05/01/06 13 YA43 25 05/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Shrewsbury Road (267) DS0000022850.V261309.R01.S.doc Version 5.0 Page 23 - 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!