Inspection on 28/08/07 for Stoke Newington Common, 6

This inspection was carried out on 28th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stoke Newington Common, 6 05/01/07

Stoke Newington Common, 6 31/07/06

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 Stoke Newington Common, 6 6 Stoke Newington Common London N16 7ET Lead Inspector Peter Illes Key Unannounced Inspection 28th August 2007 09:00 Stoke Newington Common, 6 DS0000065733.V348855.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 Stoke Newington Common, 6 DS0000065733.V348855.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. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stoke Newington Common, 6 Address 6 Stoke Newington Common London N16 7ET 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) 020 8806 0303 020 8806 0303 6stokenewington@hillgreen.co.uk Hillgreen Care Ltd Mr Benedict Kigozi Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning Disability - Code LD The maximum number of service users who can be accommodated is: 6 5th January 2007 Date of last inspection Brief Description of the Service: 6, Stoke Newington Common is a privately operated care home that is registered to accommodate six younger adults with a learning disability. The home currently accommodates people with complex needs and behaviour that can challenge services. The premises is a large three storey terraced house opposite to Stoke Newington Common in the London Borough of Hackney. Accommodation is provided on three floors and the basement. The building was substantially renovated when it was registered in 2005 and all residents’ bedrooms have ensuite facilities including a shower, wash hand basin and toilet. Bus and rail links are very good and the home is near to a range of local amenities. The stated aim of the service is to support and guide people to live a normal life by enabling them to settle and integrate within the community, to become accepted and valued as individuals and to enjoy all the facilities and amenities available to all people within that community. At the time of the inspection, fees were charged at a weekly rate of £1400 £1700 dependant upon the person’s need. The provider must make information available about the service, including inspection reports, to people living in the home and to other stakeholders. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took approximately eight hours with the registered manager being present or available throughout. There were six people living at the home although one was in hospital at the time. No new people had been admitted to the home since the last inspection. The inspection activity included: meeting the five people living at the home although meaningful communication was very limited because of the communication needs of the five people; detailed discussion with the registered manager; discussion with the provider organisation’s director of care who visited the home during the inspection; discussion with four support workers, three of them independently and independent discussion by telephone with two healthcare professionals from different placing authority’s. Further information was obtained from: two feedback forms that people living at the home had been assisted to fill in; an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection; a tour of the premises and documentation kept at the home. What the service does well: The home is working hard to meet the complex needs of people living there, including people’s severe communication difficulties. Staff have access to a range of health and social care professionals to assist them in this work. One healthcare professional stated that in relation to the person at the home she was working with that “everything the home does it does well, the home has good care plans, risk management strategies and that staff are proactive at meetings”. The home supports and encourages people living there to make a range of informed choices about their day-to-day lives to the extent to which they are able. People living at the home come from differing cultural and religious backgrounds and these are respected in the care and support provided. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Stoke Newington Common, 6 DS0000065733.V348855.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 Stoke Newington Common, 6 DS0000065733.V348855.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The needs of people referred to the home are assessed to ensure that the home can meet their needs. Once admitted people’s needs continue to be reviewed to assist the home to meet their changing needs and to ensure that the home continues to have the necessary resources available to meet identified changing needs. EVIDENCE: At the last inspection a requirement was made that the home’s service user guide was further developed to include all the information outlined in Standard 1.2. This was to assist people living in the home, and their representatives, to have clearer information about the home. At this inspection I saw a revised service user guide that had been produced in pictorial format to assist this process. I also saw a revised statement of purpose. Both documents had been reviewed and revised since the last inspection to ensure that they covered all the information required. No new people had been admitted to the home since the last inspection. At the last inspection a requirement was restated that initial assessments of people’s needs, when they were first referred to the service, were maintained on site. This was to ensure that all the information about people living in the home was Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 9 available to staff to assist them in addressing those people’s needs. At this inspection the files for three people living in the home were inspected. These files contained a range of assessment information including a copy of the required initial assessments undertaken when people were first referred. The files also showed that people’s needs were reviewed on a regular basis to ensure that their changing needs were known to the home. One of the people living in the home was Jewish and assessment information about this person included their needs regarding their religion. Other people were from different ethnic minority communities and assessment information regarding their needs was also recorded. One person living at the home had recently been admitted to hospital on an emergency basis because of a specific health need that the home was having increasing difficulty managing. However, there was a real possibility of the person being discharged back to the home before appropriate multidisciplinary consultation had taken place to ensure that the home had the resources to appropriately care for that person. The registered manager and the provider organisation’s director of care were both concerned about this and the pressure they felt the home was being put under. They were seeking assistance from both health care professionals and the person’s placing authority in respect of this. They were both clear that the home should have the necessary health and social care support in place before re-admitting the person to ensure that all their current needs could be properly met. I strongly reinforced that this was the Commission’s expectation and that the home would be contravening regulations if proper arrangements were not put in place to do this. Despite the above the files inspected showed that a range of health and social care professionals were generally involved in many reviews. Records also showed that specialist reassessments of particular areas of need had been undertaken where this was felt to be appropriate. A senior occupational therapist from a placing authority was spoken to independently and stated that she was impressed by the home and that guidelines she had put in place for her client were being implemented properly. I also spoke to a community learning disability nurse from another placing authority who also made positive comments. She stated that in her experience “everything the home does it does well, the home has good care plans, risk management strategies and that staff are proactive at meetings”. I observed staff interacting with people living in the home during the inspection and spoke independently to three of the four support staff on duty on the day. They were able to demonstrate, both through discussion with them and through observing their routine interaction with people living in the home that they were aware of people’s differing needs. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs are well recorded in their care plans to assist staff in meeting these although some further clarity may further assist staff with this. People are supported to maximise their independence by making as many decisions as possible for themselves, which they appreciate. People are also supported and guided in relation to taking appropriate risks in their lives to assist them to safely achieve their aspirations although more detailed guidance is needed to maximise protection in an identified area. EVIDENCE: The three people’s files inspected all contained detailed and up to date care plans that were informed by current assessment information. Each plan contained a range of individual needs and gave detailed guidance for staff on how to meet these needs. The plans seen included the person’s physical and mental health needs, social network needs, dietary needs, daily living skills, medication and finance issues. The plans also included guidance for staff in Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 11 addressing people’s differing behavioural needs. Evidence was seen that plan’s took into account people’s cultural and religious needs. The registered manager was also able to describe practical ways that staff assisted people in these areas including: working in conjunction with the family of the Jewish person living in the home for guidance on Jewish traditions such as what to do on the Sabbath, during Passover and in the provision of Kosher food; describing how another person was supported with their religious needs and how dietary and personal care needs of people from ethnic minority communities were addressed. Evidence was seen of monthly evaluations of care plans by the relevant key worker. Some evidence was also seen through separate electronic documentation kept by the registered manager that he formally reviews the care plans on a six monthly basis and any changes made to the plans. He went on to say that any such changes identified were then recorded on the care plan. However, this process was not recorded on the copies of the plans seen so it was not possible for me to easily identify when such changes had been made on the plans themselves. The plans stated that the next review of the care plan should take place in 12 months time. A good practice recommendation is made that the care plans show a record of any reviews, the date of the review and who was involved in them, to further evidence this review has taken place and to confirm to staff that the document is current. Since the last inspection the home has also started to develop person centred planning for each person. The person centred plans (PCP’s) seen were in pictorial format and described the person’s wishes, aspirations and things that were important to them. The identified key worker plays a major role in developing these with the person concerned and the plans seen were signed or marked by the person themselves to encourage them to identify with the PCP. It was clear from the PCP’s that key workers had been creative in exploring what was important to the individual, particularly given the communication needs of the people living in the home. Staff were observed interacting with people living at the home in an appropriately friendly and respectful way throughout the inspection. All of the people living in the home have some limitations imposed on them relating to keeping them safe. Evidence was seen that these limitations were agreed and monitored through the assessment process and recorded in the person’s care plans. The home holds regular meetings for people living in the home to encourage them to participate in making decisions about daily life at the home. The provider organisation is appointee for the finances of four of the people living in the home and benefits are dealt with through their head office. Each of the four has a separate bank account in their own name with copies kept in the home. The respective families are appointees for the other two people living in the home. Financial records were sampled at random for two people and were found to be satisfactory. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 12 Each file inspected contained detailed and good quality risk assessments relating to that individual, these were current and subject to regular review. The risk assessments covered a wide range of potential risks that were relevant to that individual. They also gave guidance to staff on how to minimise the identified risks whilst at the same time promoting people’s independence. Risk assessments covered a number of areas including accessing the community, safety in the kitchen and bathing. However, it was noted on one risk assessment that the possible need for physical intervention may need to be considered but did not give any guidance to staff on how this was to be undertaken. I was shown the home’s separate policy on physical intervention and also told that staff undertook training on managing challenging behaviour. This training was focussed on techniques such as diffusing potentially violent situations but also included the use of restraint as a means of last resort to manage a potentially violent situation. The provider organisation’s director of care stated that the National Autistic Society accredited this training although documentary evidence was not available on the day to verify this. Staff spoken to confirmed that they had attended this training or were booked on it. However, a requirement is made that where a risk assessment identifies the possible need for physical intervention the written guidance for staff must be more specific about how this is to be undertaken. This is to include that only approved methods of restraint are used by staff that are trained and competent to do so. This requirement is made for the protection of both the person concerned and for staff who are required to manage such a situation. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to participate in a wide range of activities of their choice, including within the wider community. People’s dignity and choice is promoted by staff who interact with them in an appropriately respectful manner. They enjoy contact with relatives to the extent that they wish. People are also supported to enjoy healthy and nutritious meals that they like. EVIDENCE: The home has a specimen written weekly programme of activities for people, which was displayed in the home. This was seen to include a range of activities both within the community and in the home. Activities in the community included swimming, a trampoline session, bowling, visiting the local pub, cinema and supporting individuals to attend their synagogue or church as appropriate. The home has a seven-seated vehicle that is used to assist with transport to activities and also for a range of shopping and leisure outings. At the time of the inspection the only person who was able to drive the vehicle Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 14 was the registered manager and that could be a limiting factor in the flexible use of the vehicle. A good practice recommendation is made that the provider organisation explores how additional drivers could be identified to give more flexibility. I was told that recent visits had been undertaken to Wood Green, Finchley and Enfield and that all involved enjoyed had these. The registered manager stated that the daily activities in the home could be flexible and guided by people’s choices on the day. On the afternoon of the inspection the five people at the home went with four staff to the cinema and were obviously looking forward to that. Some people appeared a little anxious that I was not going to delay this trip because of my inspection visit, which I didn’t! The home has managed to promote the use of public transport for people living there. This is seen by the registered manager as a positive indication of the success of the home in promoting people’s independence as their needs in the past would have made this much more difficult and often unmanageable. Only one person living at the home is funded by their placing authority to attend an external day service. Other activities undertaken in the home include art and craft activities, assisting people with cleaning their rooms and assisting with some cooking. One person was seen cleaning their room with the assistance of a staff member and I was told that this represented real progress for that person. People living at the home have regular although varying contact with their families and this is important to them. Evidence was seen of family members visiting the home and of people visiting their families. The registered manager stated that people are sensitively guided and advised where appropriate regarding their own sexual feelings. This could include which behaviours could appropriately be undertaken in communal spaces and which behaviours are best undertaken in the privacy of their bedrooms. Appropriate guidelines were also in place to minimise the risk of people living at the home exploiting others or being exploited by others. Staff were seen to interact sensitively and appropriately with people living in the home including communicating with them using a combination of Makaton signs and other means of verbal and non verbal communication. There remain a number of appropriate limitations placed on all the people accommodated and details of these were seen recorded on files inspected. The home has a menu that is reviewed and amended in consultation with people living in the home and this showed a range of healthy and diverse meals. The home has good working links with the community dietician, who has been available to work with both people living at the home, and staff, to ensure peoples dietary needs were being met. People have access to culturally appropriate foods. Kosher food is provided for one person who also access to a separate refrigerator so that food is stored in accordance to the requirements of his faith. Consultation takes place with that person’s family regarding this. Another person who is West Indian in origin also had access to culturally appropriate meals. The menus seen included a range of culturally diverse foods Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 15 including Jallof rice with beef, yam, and plantain and I was told that if a person wanted something different from what was on the menu this could usually be accommodated. The home keeps a menu book to record what people eat including requests for meals that are not on the menu. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home receive appropriate personal support in accordance with their needs and preferences. The home is working hard to appropriately address people’s mental and physical healthcare including through referrals to a range of community based health professionals although more information from some of those professionals would assist with this. The home’s system for monitoring and administering medication to people has been improved to minimise the risk of incorrect administration. EVIDENCE: All of the people living in the home have significant support needs regarding their personal care. Evidence was seen from records in the home, from observation and from discussion with staff that serious efforts are being made by the home to provide appropriate personal care in the way that people prefer. This included that personal care was provided in a way that met people’s cultural needs such as ensuring people from ethnic minority communities had culturally appropriate support with hair and skin care. Each shift has at least one female member of care staff on duty to ensure that all Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 17 people accommodated can also access sensitive and gender specific personal care. Files inspected had detailed guidance in care plans and risk assessments for staff in meeting these needs. Evidence was seen that the physical and emotional health needs of people living in the home are taken seriously. All people accommodated are registered with G.P.’s in a local practice. Evidence was seen that the home was linking where practicable activities for people that were appropriate to promoting their health. An example of this was that one person was registered with a local Wellness club that promote health and fitness. Weekly weight charts are maintained and monitored for all people in the home. Evidence was seen that people are supported to attend a range of appointments with relevant healthcare professionals as required, including dentistry at a local hospital. Each file inspected contained an up to date health action plan. Evidence was also seen that people living at the home have access to specialist healthcare professionals including psychiatrists, psychologists, occupational therapists and speech and language therapists. Further evidence to support this is recorded in the Choice of Home section of this report. It was noted in files inspected that some people had attended routine review appointments with a local consultant psychiatrist since the last inspection and staff had recorded their understanding of the outcomes from those appointments in the person’s file. However, there was no written record available from the psychiatrist giving a clinical report of the visit or of the psychiatrist’s opinions or recommendations from those visits. In my experience psychiatrists will normally write to the person’s G.P. giving a summary of such visits and send a copy of this letter to the home. A good practice recommendation is made that the home writes to the consultant psychiatrist to request written feedback from such appointments so that this information accurately informs the care and support offered by the home. At the last inspection three requirements were made to improve the safe administration of medication in the home to increase protection to people in this area. The requirements related to: recording of medication received into the home, the recording of medication on the home’s medication administration (MAR) charts when it was administered and to ensure that there were robust systems in place overall for monitoring administration of medication. There was evidence at this inspection that these requirements were being complied with. The medication and MAR charts for three people living at the home were inspected. People had a medication profile on their medication file. Medication and the MAR charts for the three people were checked and were correct. It was also noted that the provider spot-checked medication and related records on their monthly unannounced monitoring visits. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to express their views and concerns and have these appropriately dealt with. People living in the home are protected by satisfactory safeguarding adult policies and procedures that staff are aware of. However, protection for one person living in the home and staff working at it would be maximised by more robust support from L. B. of Hackney, the home’s host local authority. EVIDENCE: The home had a satisfactory complaints procedure that included details of the Commission and a summary of the procedure was seen displayed in the home’s entrance hall. The home has also produced a pictorial summary of the complaints procedure that is now included as part of the pictorial service user guide. This is to promote further the concept for people living in the home that they can raise concerns and complaints if they are unhappy about something. The home had received one complaint since the last inspection and records of this, and the response from the home, indicated that it had been dealt with properly and in accordance with the procedure. The registered manager stated that no other concerns of complaints had been received at the home since the last inspection. No concerns or complaints about the service had been received by the Commission in that time either. The home had a satisfactory safeguarding adults procedure that had been reviewed and amended since the last inspection. A flow chart on the actions Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 19 staff should take in the event of a disclosure or allegation of abuse was displayed in the office. At the last inspection a requirement was made that the home’s safeguarding adults policies are further developed to include information about the organisation’s obligation to make referrals to the POVA list if appropriate. This was to ensure that staff were aware of this obligation. The requirement had been complied with. The home also had a copy of the London Borough of Hackney’s safeguarding adults procedure, which is the local authority the home is situated in. An allegation of abuse relating to one of the people living at the home had been made in 2006. The L.B. Hackney addressed this under their safeguarding adults procedure at the time. The home is currently working, in conjunction with the L.B. Hackney, to ensure that the person concerned remains safe. I was told that the actions currently being taken by the home in relation to this were as part of a protection plan agreed and coordinated by the L.B. of Hackney. This followed a formal safeguarding adults strategy meeting held in September 2006. The actions being taken by the home included imposing some limitations on the person concerned, which were recorded on an appropriate risk assessment. I was shown some correspondence between home and a L.B. of Hackney care coordinator that indicated the care coordinator was aware of restrictions imposed on the person. However I was concerned to learn that neither the home nor the provider organisation had a copy of the September 2006 strategy meeting minutes or the agreed protection plan to validate the actions the home was taking. This is despite the provider organisation being present at the strategy meeting and taking a key role in implementing the plan. The provider organisation’s director of care informed me that he was told in 2006 that he could not have a copy of the minutes or of the plan because they were “too confidential”. My concern is not that the home is taking the action it is, as this appears to be in the person’s best interests but that the home has not got sufficient documentation to validate the actions it is taking if challenged by a third party. A requirement is made that the provider organisation must formally request a copy of the protection plan from the L.B. of Hackney, specifically with regard to the actions the home is being asked to implement. This is to evidence that any restrictions being placed by the home on the person concerned are formally validated as in the person’s best interest and to protect the organisation and its staff if challenged for implementing those restrictions. The registered manager stated that no other allegations or disclosures of abuse had been made to the home since the last inspection. Evidence was also seen that staff training in safeguarding adults was ongoing and staff spoken to were able to state what action needed to be taken should an allegation or disclosure of abuse be made to them. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is comfortable although needs a number of improvements to ensure that it is maintained and equipped to meet their particular complex needs and for the comfort and safety of staff and visitors. People who live in the home, staff and visitors benefit from a home that is clean and tidy. EVIDENCE: Accommodation is provided on three floors and the basement. This is arranged as follows: on the second floor there are two residents’ bedroom and the manager’s/ staff office; on the first floor there are two residents’ bedrooms and a quiet/ multi-purpose room; on the ground floor there is one resident’s bedroom, kitchen, the main lounge/ dining room, laundry, a communal bathroom/ toilet and main entrance hall to the home. One further resident’s bedroom is situated in the basement. All residents’ bedrooms have en-suite facilities including a shower, wash hand basin and toilet. The property Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 21 underwent major refurbishment when it was registered in 2005. The home also has a small front garden and larger rear garden, both of which are paved. A number of people’s bedrooms were seen and had been personalised to varying degrees according to the individual’s needs and preferences. Overall the home was comfortable and well decorated although there are a significant number of improvements that need to be made to ensure that it continues to meet people’s needs. All the bedrooms and main communal areas have laminate flooring, which had been laid to meet the particular needs of the people who live there. It was noted however that in most of the bedrooms seen that gaps had appeared in the laminate flooring. I was told that these were gradually becoming worse as the floors need to be washed each day and the moisture was exacerbating the situation. Although none of the gaps were trip hazards they are unsightly and could become a health and safety hazard in regard to infection control. A requirement is made that the laminate flooring in people’s bedrooms must be repaired or replaced to minimise a potential health and safety hazard. In two of the bedrooms it was noted that doors and/ or drawer fronts on some of the bedroom furniture were either loose or in one case missing. The registered manager stated that furniture was repaired on a regular basis but because of people’s needs this furniture was subject to hard wear. The furniture itself did not look particularly robust for people with challenging behaviour. A requirement is made that furniture in people’s bedrooms must be kept in good repair and be robust enough to meet their needs. At the last inspection a requirement had been made that broken toilet seats in the en-suite bedrooms be repaired for the comfort and safety of people using them. This was seen to have been complied with. However, in the communal bathroom/ toilet it was noted that the toilet seat was missing. The registered manager stated that this had been broken and repaired on a number of occasions and had just been broken again. The toilet itself is of robust construction but, as part of its construction, the toilet seat is fixed to the toilet internally and requires more specialist attention to replace when broken. A requirement is made that the communal toilet must be kept in good repair to promote the health and safety and comfort of people using it. It was also noted that the flexible metal shower hose that is attached to the communal bath was starting to unravel and was a potential health and safety hazard. A requirement is made that the shower hose is replaced to minimise the potential health and safety hazard to people using it. At the last inspection a requirement was made that the home install an extractor fan in the lounge area to counteract cigarette smoke and this requirement had been complied with. However, since 1st July 2007 the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006 has come into force. The registered manager stated that two people living at the home smoked and none of the staff did. The smoking area in the lounge/ dining area Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 22 is not enclosed and does not comply with the above legislation. A requirement is made that the home must comply with the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006 to protect people living in the home, staff and visitors. It was also noted that the main light in the kitchen was not working. I was informed that because of its design the light needed specialist attention if it failed and this needed specialist input. I was informed that the faulty light had been reported four days previously but had not been attended to because of the bank holiday immediately preceding this inspection. A requirement is made that the light in the kitchen is kept in good working order and is repaired in a timely manner if faulty, this is to promote the health and safety of people using and working in the kitchen. The majority of the rear garden to the home is raised with a drop to the surrounding path varying between approximately ½ metre to ¾ metre. This raised area had just been paved to make it look more attractive and to provide an outside garden area for people to use. However, there was no rail or other protection to minimise the danger of people accidentally falling from the raised area. A requirement is made that adequate arrangements are put in place to protect anyone using the raised area of the garden at the rear of the home, to minimise the risk of accidents occurring. The home has satisfactory laundry facilities and infection control procedures that staff have received training in and put into practice. The home was appropriately clean and tidy throughout during the inspection. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A staff team with a range of qualifications and competencies, in sufficient numbers, support people living in the home although staff cover at night needs to be kept under review. The home’s recruitment policy assists in protecting people living in the home. People are also supported by staff who have access to appropriate training and formal supervision to assist in further meeting the needs of people living in the home and in there own personal development. EVIDENCE: The home had in post: a registered manager, one senior support worker and seven support workers. The registered manager stated that the home did not use agency staff and had known bank workers to minimise disruption to the home if staff cover was needed at short notice. The manager has now completed his registered manager’s award and the senior support worker has achieved national vocational qualification (NVQ) level 3 in care. Of the seven support workers four have achieved NVQ level 2 in care and the other three are working towards this. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 24 The registered manager stated that support staff worked shifts of 8 am to 8 pm or 8 am to 5 pm each day. Either 3 or 4 staff are on duty during the day with flexibility built in if there was an evening activity for people using the home that lasted after 8 pm. There is one waking night staff and an on call backup system at night. The registered manager’s hours are in addition to the rota. The staff rota was seen and reflected this position with four support staff on duty on the day of the inspection. The staff on duty reflected those recorded on the rota. The registered manager stated that given the sleeping patterns of the people currently living in the home the current staff deployment at night was assessed by the home as being satisfactory and met their needs, although this was kept under review. However, a requirement is made under the Conduct and Management of the Home section of this report requiring the home to review its fire precaution arrangements in view of new legislation and this will need to include the ability of staff to evacuate the home at night in the event of fire. Two new staff had been recruited since the last inspection and their files were inspected. These files contained: evidence of a criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check obtained by the provider organisation prior to the staff member starting work, a clear application form, two references, proof of identity with a photograph and evidence of entitlement to work where appropriate. The manager was clear about the importance of operating a robust recruitment procedure to assist protect people living in the home. Staff training records are kept and those sampled were satisfactory. The two new staff members had received a satisfactory induction. Evidence seen of other training included: infection control, protection of vulnerable adults, communication training, moving and handling and managing challenging behaviour. Evidence was seen that the provider organisation provides a rolling training programme that is available to staff from all its homes. Staff spoken to confirmed that they had attended a range of training courses since the last inspection and that they had found the training helpful. The manager stated that all staff were supervised at least two monthly and both documents sampled and staff spoken to evidenced this. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home and staff benefit from the home being effectively managed. People living in the home also benefit from creative ways of involving them and other stakeholders in quality assurance monitoring that contributes to identifying how the service can continue to improve. The home has generally effective health and safety procedures in place to protect people living there and others that work or visit the home. However, fire precautions need further review to ensure that this protection is maximised. EVIDENCE: The registered manager was able to demonstrate a high degree of knowledge regarding the needs of the people living at the home. This included how to address the needs of people with significant challenging behaviour and how to Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 26 support staff generally. He has now completed his registered managers award and has significant experience in working with vulnerable adults. Feedback from a senior occupational therapist from one placing authority and a community nurse from a Community Learning Disability Team from another placing authority was positive about the registered manager and the service provided by the home. The home monitors the quality of care in a number of ways. The home operates a key worker system and this is used as a mechanism for ascertaining the likes and dislikes of people living at the home to inform the care and support they are offered. Monthly meetings are held for people living at the home who are assisted by staff to make their views known regarding day-today routines. The home has also bought a commercial system for working with individuals to assist them overcome some areas of their behaviour that may challenge others. This includes meeting with a range of stakeholders and agreeing realistic objectives that are then monitored at the next meeting. All of this information informs the home to assist monitor and improve the quality of care it provides. At the last inspection a requirement was made that the provider organisation must ensure that monthly monitoring visits are effective in monitoring standards and practices and offer resolution to areas of the home identified as being in need of improvement. Reports sampled from these visits evidenced this with spot checks being undertaken in areas such as safe administration of medication, which was a concern at the last inspection. A range of satisfactory health and safety documentation was seen. This included; a gas safety certificate, portable appliance test certificate and an electrical installation certificate. Records seen also indicated that the number of incidents related to dealing with people’s challenging behaviour over the past 12 months had substantially decreased. The registered manager stated that this was due in large part to the increasing effectiveness of the service since it was registered in September 2005. The home’s fire log was inspected and was generally satisfactory with satisfactory evidence seen of fire fighting equipment being serviced and fire drills being undertaken. However, although regular fire drills were recorded since the last inspection these had all taken place at various times during the day. A requirement is made that the home undertakes periodic fire drills at night to ensure that staff on duty are able to effectively operate the fire evacuation procedures at night to ensure that people are fully protected in this area; a reference is also made to this in the Staffing section of this report. A fire plan and fire risk assessment, dated July 2006, were displayed in the entrance hall of the home. New fire regulations (Regulatory Reform -Fire Safety- Order 2005) have come into force from October 2006 and place increased responsibilities on providers and managers of registered care homes. Because of this a requirement is made that the home reviews its fire precaution arrangements, including its fire risk assessment and fire plan, to ensure compliance with the new fire regulations. The home must consult with Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 27 the fire officer as part of this process. This requirement is made to ensure that protection is maximised for all people using the home. Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 28 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 3 3 3 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 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 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 3 3 X 3 X 3 X X 2 X Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No 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 YA9 Regulation 13(7) Requirement Timescale for action 30/09/07 2. YA23 13(6) The registered persons must ensure that where a risk assessment identifies the possible need for physical intervention the written guidance for staff must be more specific about how this is to be undertaken. This is to include that only approved methods of restraint are used by staff that are trained and competent to do so. This requirement is made for the protection of both the person concerned and for staff who are required to manage the situation. The registered persons must 30/09/07 formally request a copy of the protection plan for an identified person from the L.B. of Hackney, specifically with regard to the actions the home is being asked to implement. This is to evidence that any restrictions being placed by the home on the person concerned are formally validated as in the person’s best interest and to protect the organisation and its staff if challenged for implementing those restrictions. DS0000065733.V348855.R01.S.doc Version 5.2 Stoke Newington Common, 6 Page 30 3. YA24 13(4) 4. YA24 23(2) 5. YA24 23(2) 6. YA24 13(4) 7. YA24 13(4) 8. YA24 13(4) 9. YA24 13(4) 10. YA42 23(4) The registered persons must ensure that that the laminate flooring in people’s bedrooms must be repaired or replaced to minimise a potential health and safety hazard. The registered persons must ensure that furniture in people’s bedrooms must be kept in good repair and be robust enough to meet their needs. The registered person must ensure that the communal toilet must be kept in good repair to promote the health and safety and comfort of people using it. The registered persons must ensure that the shower hose in the communal bathroom is replaced to minimise the potential health and safety hazard to people using it. The registered persons must ensure that the home the home complies with the Health Act 2006, smoke-free (Premise & Enforcement) Regulation 2006 to protect people living in the home, staff and visitors. The registered persons must ensure that the light in the kitchen is kept in good working order and is repaired in a timely manner if faulty, this is to promote the health and safety of people using and working in the kitchen. The registered persons must ensure that adequate arrangements are put in place to protect anyone using the raised area of the garden at the rear of the home, to minimise the risk of accidents occurring. The registered persons must ensure that periodic fire drills take place at night to ensure that staff on duty are able to DS0000065733.V348855.R01.S.doc 30/11/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 30/09/07 Stoke Newington Common, 6 Version 5.2 Page 31 11. YA42 23(4) effectively operate the fire evacuation procedures at night to ensure that people are fully protected in this area. The registered persons must ensure that the fire precaution arrangements, including its fire risk assessment and fire plan, is reviewed to ensure compliance with the recent fire regulations, (Regulatory Reform -Fire SafetyOrder 2005) The home must consult with the fire officer as part of this process. This requirement is made to ensure that protection is maximised for all people using the home. 30/09/07 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 YA6 Good Practice Recommendations The registered persons should record on care plans a record of any reviews, the date of the review and who was involved in them, to further evidence this review has taken place and to confirm to staff that the document is current. The registered persons should explore how additional drivers could be identified to drive home’s vehicle, to give more flexibility in its use for the benefit of people living there. The registered persons should write to the consultant psychiatrist to request written feedback from appointments held with people living in the home, this is so the information accurately informs the care and support offered by the home. 2. YA13 3. YA19 Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Stoke Newington Common, 6 DS0000065733.V348855.R01.S.doc Version 5.2 Page 33 - 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. 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