Inspection on 30/01/06 for Shrewsbury Road (267)

This inspection was carried out on 30th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shrewsbury Road (267) 29/01/09

Shrewsbury Road (267) 23/01/08

Shrewsbury Road (267) 07/03/07

Shrewsbury Road (267) 25/10/05

Shrewsbury Road (267) 20/12/04

Shrewsbury Road (267) 12/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Shrewsbury Road (267) 267 Shrewsbury Road 267 Shrewsbury Road East Ham London E6 Lead Inspector Nurcan Culleton Unannounced Inspection 30/01/06 and 22/02/06 09:45 Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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 Sharon Kaur Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate one named service user over the age of 65. Date of last inspection 25th October 2005 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 four 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 a single bedroom with hand-basin. 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. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 2 days on 30/01/06 and 22/02/06. The Registered Manager was not present, however the inspector was assisted by a manager of another Sahara home and by the Senior Support Worker. At the time of inspection, three of the service users were in the home, assisted by the Senior Support Worker on duty. One service user was at a day centre. The inspector spoke with two of the service users; toured the premises; examined all four service user files; staff files and a range of records and documentation to ensure that the home meets standards. The inspector reviewed 13 requirements given at the last inspection to assess compliance. What the service does well: What has improved since the last inspection? What they could do better: Two restated requirements are given concerning: the need to ensure care plans outline all assessed service users’ needs and actions to meet those needs and for medication recording practises to improve. A further five requirements are given at this inspection. These are for risk assessments to improve; for signed statements from service users concerning their wishes regarding illness, ageing and death; staffing records to be kept up to date including staff training and for a system to monitor, review and improve the service. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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.V275517.R01.S.doc Version 5.1 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.V275517.R01.S.doc Version 5.1 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): 1, 3, 5 The home demonstrates its capacity to meet assessed service users’ needs. Information for service users concerning the home’s services and facilities has improved. Each service user has been made aware of the home’s terms and conditions. EVIDENCE: The inspector reviewed a requirement to revise the Service Users’ Guide. The Service Users’ Guide now contains all required information and is available in all service users’ files. The Statement of Purpose was reviewed and was also satisfactory. Social work assessments prior to service users’ admissions were seen in files at the last inspection. A previous requirement to update service users’ contracts was met as the inspector examined contracts containing all information required by regulation in each service users’ file, each were signed by the service user or their representative. One service user confirmed to the inspector at the last inspection that they had visited the home prior to their admission. The inspector was confident that the home showed its capacity to meet assessed needs through records kept in service users’ files, the knowledge, skills and commitment shown by staff and in the ongoing development of service users in the home. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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, 9 Service users are supported to take risks as part of an independent lifestyle. Care plans have generally improved however care plans and risk assessment documents still require more work to improve further. Care plans must still comprehensively include all needs and actions identified in other assessments. There must also be an improved system of risk assessment for an effective assessment of risk presented to service users. EVIDENCE: The inspector reviewed requirements given at the last inspection to have all care plans signed by service users and or their representatives as well as the need to improve care plans to include all needs identified through other assessments such as the risk assessment. Four service users’ care plans and risk assessments were examined. Care plans contained details of a broad range of needs including: personal care; mental and physical health; behavioural traits; cultural/spiritual; educational/leisure; financial; social/family contacts. Care plans were detailed and all were signed by the service users or their representatives. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 10 However despite a general improvement in the quality of care plans, the home still needs to ensure that needs and actions specified in risk assessments to meet identified needs are also specified in the service user care plans. For example, in one risk assessment for one service user, the risks identified were associated with the service user visiting friends however her needs in respect of this were not clearly outlined in her care plan, including her need for an escort when travelling. In addition, the Senior Support Worker informed that the format of risk assessments had changed to combine with care plans. Care plans examined now have added ‘Risk Category’ in a column at the end with space for freehand text at the bottom of the care plans detailing actions required to minimise risks. The inspector acknowledges the home’s attempt to integrate risk assessments with care plans. However, this method is inadequate compared with the old method of risk assessment used by the home. The inspector noted, for example, in one service users’ care plan a need identified that they could exhibit intolerance towards other people, with the associated risk category being ‘medium’. However it failed to identify what the medium risk actually was. The inadequacy of this method is therefore based on a failure to have a proper system of risk assessment and it fails to identify actual risks, despite the risk classifications of low, medium and high. This format could also encourage a lack of consistency among staff in completing assessments in terms of how risks are identified without a formal system of risk assessment. In addition the inspector observed two separate risk assessments in current usage for two service users. A requirement is given for the system of risk assessments to improve. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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, 14, 15 Service users continue to be supported to engage in daily living activities to promote their personal development. Service users benefit from engaging in a range of appropriate social and leisure opportunities inside and outside of the home. Family and personal contacts are encouraged. EVIDENCE: Service users’ care plans and files evidenced that service users’ individual needs are considered and responded to and their mental, physical and emotional needs are met. Service users’ independence and personal development are promoted through their participation in a variety of day and leisure activities in and outside of the home, 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. Personal friendships and family contact are encouraged and a minister visits the home. One 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 another Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 12 offered to make tea. Service users are responsible with support 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. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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, 20, 21 Service users’ physical, mental and emotional health needs are met. Medication administration is satisfactory however the recording of medication administration must improve. EVIDENCE: Correspondence from multi-disciplinary professionals was seen in files related to the physical and mental health of service users. Reviews have recently been held or are in the process of being arranged for each service user together with family members and other health professionals. Medication records were examined and some gaps were noted in the MAR sheets where staff should have recorded coded entries concerning the administration of medication to service users. One service user is assisted to self-administer medication. Staff have received medication training and in the case of one service user are given guidance on the administration of insulin from the diabetic clinic, District Nurse and G.P. A requirement is also given to obtain signed statements from each service user concerning their views and arrangements in the events of ageing, illness or death as they were not available in files. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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: 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. A satisfactory complaints policy and procedure was available in the home and also available in pictorial form for service users. The Senior Support Worker confirmed that staff had received training on Adult Protection recently from their area manager. A satisfactory policy on Adult Protection was available in the home. Service users’ personal allowance records were checked and were deemed to be correct at the time of inspection. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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. Previous requirements concerning service users’ furniture and storage space was met. EVIDENCE: Service users live in a comfortable, clean, 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 concerning the need to repair some service users’ furniture and to find suitable storage space for personal items were met. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Staff are clear about their roles and responsibilities and service users benefit from staff who receive supervision to support them in their task. Requirements are given to improve staff records kept in the home. EVIDENCE: There are five permanent members of staff employed, three of whom work part-time. The inspector viewed the rota and was satisfied that there is always a member of staff available to supervise the service users. The inspector reviewed the level of staffing and was satisfied that staffing levels are sufficient to meet service users’ needs. One staff member who was part-time had increased her hours in another one of Sahara homes to assist with staffing difficulties there, however this did not change her hours of duty at Shrewsbury Road. The Senior Support 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 Senior was responsive to service users’ needs who sought support from her throughout the inspection, 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 Senior informed that she regularly received training and Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 17 supervision to assist her. The manager assisting the inspector advised that all staff had received NVQ Level 2 or 3 training. Staff files contained all necessary personnel information required by regulations. However supervision notes dated to 2003 only. In addition, not all training received by staff was recorded or available in files. Training records seen in selected files went up to 2003. A generalised training schedule was seen, however this did not specify which staff members would receive the training. The standard concerning staff training could not therefore be properly assessed. Requirements are given to ensure that supervision and training records are kept up to date and in good order in files. Staff training must be linked to individually identified training needs through supervision and staff appraisals. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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): 38, 39, 40, 41, 42, 43 Service users benefit from staff who receive support and supervision to enable them to conduct their duties effectively. Policies and procedures are in place to further protect service users. A system of quality assurance and monitoring is required. EVIDENCE: Due to personal reasons, the Registered Manager had not always been available to manage the home directly since the last inspection, though alternative management support was arranged in her absence. The Registered Manager acknowledged that this had until now affected her ability to meet minimum standards in running the home. However a new permanent manager has been appointed to run another one of the Registered Manager’s homes within the organisation, which should now give the Registered Manager more time and opportunity to focus on improving standards within this home. The Senior Support Worker informed that the Registered Manager kept in close contact by telephone if unable to visit the home and was open and supportive when approached. Good management cover was otherwise available with Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 19 another manager from Sahara Homes. Recording practises have improved however need more work to improve them further. There are particular recording issues concerning care plans, risk assessments, staff files and other such requirements outlined in this report. A range of policies and procedures relevant to the service user group were available in the home. Valid health and safety certificates were available at this inspection meeting previously made requirements. A restated requirement concerning the need for a business plan was also met at this inspection. The home must have in place a system of quality assurance, including monitoring, review and improvement of the service provision, as according to regulations and National Minimum Standards. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 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 Standard No Score 1 3 2 x 3 3 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 3 12 x 13 3 14 3 15 3 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x 3 2 1 x 2 1 3 3 3 3 Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 21 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 YA6 Regulation 15 Requirement The Registered Manager must ensure that needs and actions specified in risk assessments to meet service users’ needs are also specified in service user care plans. The Registered Manager must ensure that the system of risk assessments is and improved. The Registered Manager must ensure that there are no gaps in recording the administration of medicines and that this system of recording is clear to all staff. The Registered Manager must ensure that signed statements are obtained from each service user or their representative concerning their views and preferred arrangements in the events of ageing, illness or death The Registered Manager must ensure that records are kept of all training received by staff and that training is clearly linked to training needs identified, DS0000022850.V275517.R01.S.doc Timescale for action 05/05/06 2 YA9 13(4) 05/05/06 3 YA20 13(2) 05/05/06 4 YA21 12(1) 05/05/06 5 YA35 18 1(c) 05/05/06 Shrewsbury Road (267) Version 5.1 Page 22 including staff appraisals. 6 YA36 18 1(a) The Registered Manager must ensure that all supervision records are kept up to date in files. The Registered Manager must ensure that a system of quality assurance, including monitoring, review and improvement of the service provision is in place, as according to regulations and National Minimum Standards. 05/05/06 7 YA39 24, 26 05/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA41 Good Practice Recommendations Better maintenance of service users’ files for ease of access to information. Shrewsbury Road (267) DS0000022850.V275517.R01.S.doc Version 5.1 Page 23 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. 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