Inspection on 08/08/06 for St Raphael`s Integrity Care Home

This inspection was carried out on 8th August 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 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

St Raphael`s Integrity Care Home 24/11/08

St Raphael`s Integrity Care Home 26/09/05

St Raphael`s Integrity Care Home 09/06/05

St Raphael`s Integrity Care Home 02/11/04

St Raphael`s Integrity Care Home 15/07/04

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 St Raphael`s Integrity Care Home 93-95 Stanhope Gardens Haringey London N4 1HZ Lead Inspector Peter Illes Key Unannounced Inspection 8th August 2006 09:45 St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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 St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Raphael`s Integrity Care Home Address 93-95 Stanhope Gardens Haringey London N4 1HZ 020 8800 6393 020 8800 0429 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) Mrs Eftychia Joannides Mr Phivos Joannides Mrs Eftychia Joannides Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 7 adults of either gender with a learning disability (LD) and one female over the age of 65 years who has a learning disability (LD(E)). 26th September 2005 Date of last inspection Brief Description of the Service: St. Raphaels Integrity Care Home is a care home registered to provide personal care for a maximum of eight residents between the ages of 18 to 65 years who have learning disabilities. One specified resident may be over the age of 65 years. The home consists of two adjoining two storey terrace houses that have been converted to become a single home. There are eight single bedrooms located on both the ground floor and the first floor. None of the bedrooms have ensuite facilities although each bedroom has its own sink. The two kitchens, dining room and lounge are on the ground floor. The front of the building is primarily paved. The back garden is partly paved and accessible to residents. It is attractively arranged and contains a variety of fruit trees and flowers. The home is situated in a residential area of Haringey and close to a large selection of shops and multi-cultural facilities located along Green Lanes and in Wood Green. St. Anns Hospital is about half a mile away. The home currently charges from £550 per week depending on the assessed needs of the service user. The registered manager stated that information, including the contents of CSCI reports is shared with stakeholders and a copy of the latest CSCI report is kept available in the home. The stated aim of the home is to provide a high quality of care within a comfortable and homely environment and to enable residents to lead as independent a life as possible. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last main inspection to the home was on 26th September 2005. A CSCI pharmacy inspector visited the home to inspect the storage, administration, recording and disposal of medicines at the home on 21st November 2005. The outcome of the pharmacy inspector’s visit is recorded in the Personal and Healthcare Support section of this report. This unannounced inspection took approximately 6½ hours with the registered manager and the registered provider being present or available throughout. There were 8 service users accommodated at the time of the inspection and no vacancies, although one service user was in hospital at the time. One new service users had been admitted to the home from another of the registered provider’s homes since the last inspection. The inspection included: meeting and speaking to five service users, two of them independently; discussion with the registered manager; discussion with the registered provider and independent discussion with one of the home’s care staff who was on duty at the time. Further information was obtained from a tour of the premises and documentation kept at the home. What the service does well: What has improved since the last inspection? Ten requirements were made at the last main inspection and a further four at the subsequent visit by the pharmacy inspector. The inspector was pleased to see that all ten requirements from the main inspection had been complied with as well as two of the pharmacy inspector’s requirements. The other two of the pharmacy inspector’s requirements are restated. The twelve requirements complied with were in the following areas: three areas relating to medication; three areas relating to furnishings and fittings in service user’s bedrooms; two identified areas in relation to risk management; staff training; frequency of service users meetings; quality assurance and an identified health and safety issue. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 6 In addition the pharmacy inspector made a good practice recommendation in relation to controlled medication and this was being followed. What they could do better: 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. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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 St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate policies to ensure that prospective service users needs will be fully assessed prior to their admission to the home. Once admitted service users needs are reassessed regularly, on a multi-disciplinary basis as needed, to assist the home continue to meet their changing needs. EVIDENCE: One new service users had been admitted to the home since the last inspection although they had been transferred from one of the registered provider’s neighbouring homes. The needs of this service user were well known to the registered manager and two staff members from the other home had temporarily transferred with the service user. The files of four service users were inspected and showed a range of assessment information that recorded their current needs and any changing needs. There was evidence on one file that the referring local authority had been involved in an annual review since the last inspection. There was also evidence that the home involved health care professionals if needed to assist in assessing any changing needs of service users. The home has a satisfactory admissions policy that indicates that new service users will be engaged in a thorough assessment to ensure that their needs are known to the home before they are admitted and that those needs can be met. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in documenting their needs in their care plans to assist the home’s staff in meeting these needs. Separate health care plans are also written by health care professionals where required to meet specialist health needs. Service users are assisted to make as many decisions for themselves as they can to promote their independence. Service users are also supported to take appropriate risks in their lives to assist them to safely achieve their aspirations. EVIDENCE: Care plans for four service users were inspected on their files. These plans related to the service users assessed needs with evidence that they were updated on a regular basis. The plans gave staff guidance on how to meet the service users needs. There was evidence that service users had been involved in reviewing their care plans. This was confirmed by service users spoken to and by the plans seen being signed by them. The plans were informed by a range of risk assessments, both generic health and safety risk assessments and individual assessments relating to individuals needs. Evidence was seen that one of the younger adult service users had suffered from pressure ulcers St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 10 since the last inspection. The registered manager stated that these were related to a specific medical condition and that relevant health care professionals had been involved in the treatment of the ulcers. Evidence was seen to substantiate this including a separate care plan record from the district nursing service. This showed that a district nurse had visited the home three times a week when the referral was first made. The inspector was pleased to see from the district nurse’s care plan that the pressure ulcers had now healed and that the district nurse was currently attending the home for weekly monitoring visits. Evidence was also seen that the home had acquired a specific mattress and cushions to assist this service user with their condition. The registered manager and staff were observed communicating appropriately with service users throughout the inspection. Service users spoken to indicated that their wishes and views were respected at the home. One service user stated that they had attended a recent review about themselves that had included staff from the home and from the referring local authority. The service user stated that they were asked if they would like to move on to more independent accommodation. The service user went on to say that they had declined this offer as they were happy at the home and liked the staff. Evidence was seen in the minutes from a recent service user meeting that some service users voted in the local authority elections in May 2006. The registered manager stated that it was discovered at that stage that one of the service users was not on the electoral role and that the home was assisting the service user to rectify this. The home is not appointee for any of the service users finances. The home does hold the personal allowances for some service users where appropriate. Records of this were sampled for one service user and were satisfactory. Service users spoken to confirmed that they were happy with the arrangements about their personal allowances. Satisfactory risk assessments were seen on the four service user files inspected. Generic health and safety risk assessments were seen including for: going missing, getting accidentally locked in the bathroom/ toilet and use of the kitchen and utensils within it. Specific risk assessments were seen on individual files as appropriate. A requirement was made at the last inspection that risk assessments be drawn up with regard to all service users whose taps have been disconnected in their individual rooms, due to a risk of flooding. The inspector was pleased to see that this had been complied with although one service user had moved on since the last inspection and all service users taps in their bedrooms were now reconnected. The inspector was also pleased to see that a requirement made at the last inspection that all risk assessments should be reviewed at least six monthly had been complied with. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 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): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a range of appropriate activities including activities that meet their cultural needs, particularly within the community. Contact with relatives and friends is maintained and encouraged in accordance with the service users wishes. Service users rights are responsibilities are respected and promoted within their daily lives. Service users also enjoy balanced and varied meals that meet their needs and preferences. EVIDENCE: Two service users attend college and two attend day services when they are well enough. Six of the eight are able to travel independently in the community with two currently needing staff support for this. All the service users have an activity plan in their files and are generally encouraged by the home to undertake relevant activities. One Greek Cypriot service user attends a local Greek Cypriot community centre for lunch on some days. Another service user told the inspector that they liked to go out to a local café for breakfast most mornings and that they St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 12 enjoyed this. There was evidence from staff and service users that some service users travelled further a field independently including to the West End of London by public transport. Service users spoken to confirmed that they had freedom passes for use on public transport. Service users are also supported to attend places of worship if they wished. The home has two Greek service users and the registered manager stated that a Greek priest visits the home monthly. Another service user is supported to attend a specific church of their choice and is also visited by visitors from that church. The registered manager went on to say identified service users are supported to visit a cemetery to light a candle for relatives when they choose. The provider organisation has a mini-bus that is used to take service users on outings. The registered manager stated that outings this year had included to the seaside, Clacton and Southend. She went on to say that service users also like going to a park in Potter Bar, Hertfordshire and for a fish and chip meal in that vicinity. The inspector was informed that some service users have been on holidays abroad with the provider organisation in previous years and that a holiday or short break may be planned for later in the year. Service users spoken to indicated that they enjoyed the trips out in the mini-bus. There were photo’s displayed around the home of various social events that service users had previously enjoyed. Seven of the eight service users have varying degrees of contact with relatives to the extent that they wish. This varies from one service user that visits relatives on a daily basis to others that have occasional contact such as at meetings. One of the service users has no contact with relatives. Service users are supported to maintain and develop friendships and relationships outside of the home, including appropriate sexual relationships, if that is what they wish. Evidence was also seen that some service users are potentially vulnerable to exploitation from others and that the home has developed ways of supporting service users where this was needed. The home is relatively small and domestic in its layout and one service user spoke of it as a family type home. Service users that wish have keys to their rooms and some service users spoken to confirmed this. Service users have full access to the communal areas in the home including the garden. One service user declined to speak with the inspector and was observed spending significant time on their own in communal areas of the home. This was clearly the service user’s choice and was respected by both staff and the other service users. A specimen menu for meals in the home was seen that included a range of healthful and varied meals. The registered manager stated that the menu was often varied or changed according to service users preferences on the day. Service users spoken to confirmed this and indicated that they enjoyed the food. Greek cultural dishes are also available for the Greek service users in the home or other service users who wish to try these. Records of service user meetings showed that individual requests and preferences regarding meals were sought from service users. The home keeps a record of what meals were actually served each day and this also showed a variety of healthful meals. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 13 There was sufficient food stored in the home including fresh fruit and vegetables. The food was also appropriately stored, which complied with a requirement made at the last inspection. Satisfactory health and safety records regarding the kitchen were seen including up to date records of fridge and freezer temperatures. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate personal support in accordance with their needs and preferences. Their mental and physical healthcare needs are met including through referrals to specialist community based health professionals as required although service users would benefit from further action to promote their dental care. Service users are also protected by clear polices and procedures regarding medication and its administration although two identified improvements are still needed in this area. EVIDENCE: The majority of service users need some assistance regarding their personal care. This is mainly in the form of verbal prompts although some require more structured supervision with identified tasks. One service user’s file indicated that they were subject to mild stress incontinence and that they were appropriately supported to deal with this. Evidence was seen that service users personal care needs are recorded in their care plans and in other documentation on their files. Service users spoken to indicated that staff gave them assistance in an appropriate manner. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 15 Service users files also showed that they were satisfactorily supported in addressing their healthcare needs by the home. Evidence was seen of contact with a range of health care professionals including GP’s, chiropodists and opticians. Service users are also supported to attend a range of hospital outpatient appointments when needed. One service user had a diagnosis of diabetes and evidence seen that they attended a clinic to monitor this. As described in the Individual Needs and Choices section of this report, one service user was supported in receiving specialist health care support regarding pressure ulcers. One service user was currently experiencing some mental health difficulties and evidence seen that they were receiving appropriate specialist assistance. This included a planned hospital admission to assist with this. The registered manager is also a qualified nurse. She was able to identify service users current health care needs, was knowledgeable about these and was able to effectively describe how the home was assisting with these needs. It was noted that two service user files seen indicated that they were supported to attend regular dental checks but the other two did not. The inspector was informed that some service users did not like to attend dental check ups and resisted these. The inspector understands this and is not unsympathetic to the potential conflict regarding supporting service users to make their own choices as opposed to promoting their physical wellbeing. However, a requirement is made that staff actively promote dental care for service users, actively encourage individual service users to attend at least annual dental check ups and clearly record the outcome of this in individual service user’s case records. Following the last main inspection a pharmacy inspector visited the home to inspect the storage, administration, recording and disposal of medicines at the home and the outcome at that time was as follows: The service users are protected by the home’s medicines policies and procedures except that the decanting of medication by staff from the pharmacy labelled bottles and containers introduces the possibility of error. The decanting of medication purely for the ease of administration is not considered to be good practice by the Royal Pharmaceutical Society of Great Britain. The medicines policy is complete but the care assistants were unable to find a copy of the policy before the manager arrived. A requirement is made regarding this. The service users sign their mental health care plan which includes their current medication, but there is no cross reference to this in the service user’s care notes. None of the service users are taking responsibility for their own medication. The records for the receipt, administration and disposal of medication of medication were satisfactory except that the entries in the book for the receipt of medication were not signed. A requirement is made regarding this. The medication was stored in a locked cupboard in the kitchen; the temperature of the cupboard was monitored and recorded. The records indicate that the temperature of the cupboard remains at 25oC or below. At the St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 16 time of the visit no medication requiring refrigeration was being stored and no Controlled Drugs were kept. The senior staff decant medication from the pharmacy labelled bottles and containers into dosette boxes each week to simplify the administration of medication, with this client group, for the care assistants. A requirement is made regarding this. A signed and checked record of this decanting is kept. The dosette boxes are labelled with the main medication but a short course of medication was found not to have been added to the labelling on the dosette box although it was on the administration chart and appears to have been given. From the sample examined the decanting process for the current week appeared to be satisfactory. Medication training had taken place in late 2004. Some of the staff were unaware that medication had to be kept in the home for seven days in the event of a service user’s death, in case there was a coroner’s inquest. A requirement is made regarding this. At this inspection the medication and medication administration records for three of the service users were inspected and were found to be satisfactory. The inspector was pleased to see that the requirements relating to the availability of the home’s medication policy and ensuring staff were aware that medication must be kept for seven days following the death of a service user had been met. A recommendation regarding seeking advice should controlled drugs be needed in the home was also met. There was insufficient evidence to demonstrate compliance with the requirements made about the way that all medication received into the home must be signed for or that discussion had taken place regarding medication being dispensed by the pharmacist using the monitored dosage system. These two requirements are restated. Discussion about these two requirements took place with the registered manager. The inspector’s view was that the registered manager had acted on the requirement made about recording the medication entering the home appropriately but had misinterpreted the requirement slightly. The registered manager also stated that there had been some discussion about the pharmacist using the monitored dosage system to supply medication to the home but did not have any documentation to evidence this. Although the requirements are restated it is the inspector’s view that the registered manager was acting in good faith at the time. Because of this the overall judgement for this section of the report is “good” rather than “adequate”. Should these requirements not be fully complied with following this inspection the judgement will not remain the same. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and others are able to express their views and concerns and have these appropriately dealt with by the home. Service users are also protected by a clear adult protection policy and procedure. EVIDENCE: The home has a satisfactory complaints procedure that was seen. The registered manager stated that no complaints had been made since the last inspection. Service users spoken to indicated that if they raised concerns with the staff or registered manager that these would be taken seriously and dealt with. The home also had a satisfactory adult protection policy and procedure that was seen and the inspector was informed that no adult protection issues had been reported to the home since the last inspection. The registered manager was aware of the issues involved and the actions that needed to be taken should a disclosure or allegation of abuse be made. Evidence was seen that adult protection training for staff is part of the provider organisation’s rolling staff training programme. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 18 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, 26 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home that is comfortable, well decorated, well maintained and meets their needs. The home was clean and tidy throughout creating a pleasant environment for both those that live and work at the home as well as for those that visit it. EVIDENCE: The home consists of two adjoining two storey terrace houses that have been converted to become a single home. There are eight single bedrooms located on both the ground floor and the first floor. None of the bedrooms have ensuite facilities although each bedroom has its own sink. The two kitchens, dining room and lounge are on the ground floor. The front of the building is primarily paved. The back garden is partly paved and accessible to residents. It is attractively arranged and contains a variety of fruit trees and flowers. The home is domestic in scale and meets the needs of the current service users. During a tour of the building the inspector saw all the communal areas and most of the service users bedrooms. The inspector was pleased to note that three requirements made at the last inspection regarding furniture in an St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 19 identified service user’s bedroom, repairs to a fire place in a service user’s bedroom and repainting a radiator had all been complied with. The home was clean and tidy throughout and had laundry facilities and infection control procedures that met the current service users needs. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 20 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): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A stable staff team is able to properly address the needs of the current service users. An up to date recruitment procedure contributes towards service users protection. Service users are also supported by staff who are appropriately trained in areas relevant to service users needs. EVIDENCE: The provider organisation has a rolling programme of National Vocational Qualification (NVQ) training for both managers and care staff in the organisation. The registered manager is aware of the requirement for at least 50 of care staff on duty to be qualified to NVQ level 2 in care. The staff rota for the home showed two staff on duty during the day and one staff in the evening and one staff sleeping-in at night. The rota for the day of the inspection showed a member of the registered manager’s family working that evening and sleeping-in to cover another care staff who was on leave at the time. The rota showed an initial and a surname. The inspector thought he knew the person who was a registered manager in another of the provider organisation’s homes. On further discussion it transpired that this registered manager was also on leave and it was another member of the family with the St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 21 same initial to their first name. The inspector was informed that both staff worked at the home on occasion, one more frequently than another. Given this, a requirement is made that the full first and surnames of all staff working at the home be shown on the rota to provide a clear written record of which staff worked which shift on any given day. The home has a satisfactory staff recruitment procedure that was seen and had been marked as reviewed in June 2006. This showed a clear procedure for recruiting staff including the requirements of the necessary checks needed to protect service users from unsuitable candidates. No new staff had been recruited since the last inspection. A criminal records bureau (CRB) clearance was sampled for one staff member of staff and this was satisfactory. The provider organisation has a rolling programme for staff training and evidence of training undertaken is sent to the CSCI at regular intervals throughout the year. Evidence of recent training that staff had undertaken was also seen during the inspection. The one member of staff spoken to independently confirmed that she had been on a range of training since the last inspection including: health and safety, dementia awareness, nutrition and diet, food hygiene dying and bereavement and managing challenging behaviour. The inspector was pleased to note that the training in managing challenging behaviour that staff had undertaken complied with a requirement made about this at the last inspection. The home also holds staff meetings every two months and minutes sampled evidenced this. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 22 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): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and staff benefit from the home being effectively managed by the registered manager. Service users also benefit from the homes quality assurance systems that incorporate their views on the service. Effective health and safety procedures contribute to protecting service users, staff and visitors to the home although further attention is needed to reviewing the fire precautions and maintenance of fire fighting equipment to further increase this protection. EVIDENCE: The registered manager is a qualified nurse and has also undertaken management training to national vocational qualification (NVQ) level 4 in management as required in the national minimum standards. During the inspection it was clear to the inspector that the registered manager had a clear understanding of the service users needs and of the issues involved in managing the home. The staff member spoken to independently was clear that St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 23 all staff enjoy appropriate support from the registered manager and registered provider on both a formal and informal level. There was evidence that the home consults with service users regularly regarding the ongoing functioning of the home. Satisfactory minutes of regular service user meetings were sampled, the frequency of these had been increased to at least six a year as required at the last inspection. Evidence was also seen of an annual service user satisfaction survey that the registered manager stated informed the homes business plan. This complied with a requirement made at the last inspection. Service users spoken to confirmed that they were consulted regularly about life in the home including on such subjects as the menu and where to go on outings. A range of satisfactory health and safety documentation was seen. This included a current: gas safety certificate, electrical installation certificate, portable appliance testing records, evidence of hot water temperature checks and of an in-house health and safety check. There was also evidence that the fire alarm and emergency lighting system were regularly serviced. However, it was noted during a tour of the premises that stickers on fire extinguishers seen indicated that it had been more than 12 months since they were serviced. It was also noted that there was also no documentation available in the home’s health and safety file to show that the extinguishers had been serviced in the last twelve months. A requirement is made that all fire fighting equipment must be serviced annually by persons competent to do so and that evidence is kept available in the home for inspection to confirm this. Evidence was seen that the home had reviewed its fire risk assessment in January 2006. However, the registered manager informed the inspector that because of the specific current needs of one of the service users the front door to the home was now locked by key. She went on to say that all staff on duty had keys to the door for use in an emergency. The registered manager stated that this was a relatively recent change and would be reviewed in the light of the ongoing and changing needs of the service user. The fire risk assessment had not been changed to reflect this change. In the light of the current practice and in view of the fact that only one member of staff sleeps-in at the home at night a requirement is made regarding this. It is required that the home reviews its fire plan, fire risk assessment and consults with the fire officer about these, including with regard to locking the front door of the home with a key. St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 24 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 X 2 3 3 X 4 X 5 X 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 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 2 X St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 YA19 Regulation 13(1) Requirement The registered persons must ensure that staff actively promote dental care for service users, actively encourage individual service users to attend at least annual dental check ups and clearly record the outcome of this in individual service user’s case records. The registered persons must ensure that the record for all medication received into the home is signed for (previous timescale of 16/12/05 not met). The registered persons must discuss with the home’s pharmacist and other pharmacists in the area, the dispensing of the medication for this and the other St Raphael’s homes into a monitored dosage system (previous timescale of 06/01/06 not met). The registered persons must ensure that the full first and surnames of all staff working at the home be shown on the rota to provide a clear written record of which staff worked which shift on any given day. DS0000010719.V298098.R01.S.doc Timescale for action 30/09/06 2. YA20 13(2) 30/09/06 3. YA20 13(2) 30/09/06 4. YA33 17, Sch.4 30/09/06 St Raphael`s Integrity Care Home Version 5.2 Page 26 5 YA42 23(4) 6 YA42 23(4) The registered persons must ensure that all fire fighting equipment is serviced annually by persons competent to do so and that evidence is kept available in the home for inspection to confirm this. The registered persons must ensure that the home reviews its fire plan, fire risk assessment and consults with the fire officer about these, including with regard to locking the front door of the home with a key. 30/09/06 30/09/06 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 St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 27 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 St Raphael`s Integrity Care Home DS0000010719.V298098.R01.S.doc Version 5.2 Page 28 - 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!