Inspection on 05/01/07 for Stoke Newington Common, 6

This inspection was carried out on 5th January 2007.

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

Other inspections for this house

Stoke Newington Common, 6 28/08/07

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 Sandra Jacobs-Walls Unannounced Inspection 5th January 2007 11:00 Stoke Newington Common, 6 DS0000065733.V326027.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.V326027.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.V326027.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.V326027.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st July 2006 Brief Description of the Service: 6, Stoke Newington Common, is a care home that offers support, guidance and accommodation to a maximum of six service users who have learning disabilities. The registered provider is Hillgreen Care Ltd. The home’s premises is a well maintained large three storey terraced house opposite to Stoke Newington Common grounds in the London Borough of Hackney. Bus and rail links are very good and the home is near to local amenities. The service has a well-established staff group and a registered manager in place. At the time of the inspection, six service users were accommodated. At the time of the inspection, fees were charged at a weekly rate of £1400 £1700 dependant upon service user need. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection of 6, Stoke Newington Common to place on January 5th 2007 for the duration of seven hours. Assisting with the inspection was the home’s registered manager and a member of the organisation’s senior management team. The purpose of the inspection was to assess the home against key National Minimum Standards and gauge its success in addressing outstanding requirements made at the previous inspection that was conducted in July 2006. The inspection process included observation of service users, discussions with staff and managers of the service, the review of two service users’ files, the review of key policies and procedures and other documents; the review of three staff personnel files and an accompanied tour of the home’s premises. As a result of the inspection findings twelve requirements and no recommendations were made. The inspector would like to thank all service users and staff who co-operated and contributed to the inspection. What the service does well: The service continues to meet well the identified needs of service users. The inspector was encouraged to note that much of the challenging behaviour of service users evident and observed at time of the previous inspection had been reduced significantly. Staff commented on the developing range of activities service users now enjoyed as a result of the stability they experienced since being admitted to the home. Staff worked very effectively with a number of internal and external involved professionals to enhance positive outcomes for service users. The inspector noted very comprehensive information recorded on service users’ files which assisting in needing identified needs. At the time of the inspection, the service was preparing to introduce Person Centred Planning as an approach to work with service users. It is hoped that this system of care will further individualise and help shape the goals and care plans for service users. Stoke Newington Common, 6 DS0000065733.V326027.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 Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 8 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.V326027.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The previous inspection had highlighted the home’s need to amend its Statement of Purpose document to include information about staff ‘s experience and qualifications. The inspector reviewed the revised document and was satisfied that appropriate amendments had been made. The home’s Service User Guide was also reviewed. This document is available in pictorial form making information more readily accessible to service users who do not read, however information in the document was still found to be inconsistent with the requirements of Standard 1.2 of the National Minimum Standards. Managers of the service had explained that contracts between the placing authority and the home was maintained at the organisation’s head office or in some cases, held by the local authority. It was explained that few of the home’s service users had the capacity to negotiate a contract/written agreement. This was acknowledged by the inspector, however in the absence of any such agreement it was the inspector’s view that the contents of the Service User Guide needed to be as explicit as possible in outlining what services, support and facilities were to be expected/available to service users upon admission. The home’s Service User Guide must be further developed to better outline services/facilities provided as per Standard 1.2 of The National Minimum Standards (Care Homes for Adults 18-65). Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 10 The inspector reviewed two individual files for service users living at the home at the time of the inspection. The inspector was satisfied that largely, very comprehensive information was evidenced, including very useful background information from the placing authority and other involved professionals. Managers of the service explained that as part of the admissions procedures, senior managers conduct initial assessments, usually at the residence of the prospective service users. The documented initial assessment for one service user was seen on file, but the second file reviewed did not evidence a documented initial assessment. This had been the case at the previous inspection and a related requirement had been made. Managers explained that this document had in fact been completed, but was likely to be held on file at the organisation’s head office. It later came to light that other file information pertaining to service users was also maintained at the head office premises and not at the home. The inspector was concerned for this practice and was of the view that it was best practice for all service user information to be maintained on site to, for example, facilitate ready access if requested and for the purposes of CSCI inspection. The inspector reviewed documentation of the delayed admission of one service user to the home following a necessary prolonged transition period. While the inspector was satisfied that initial visits to the home and home based activities had appropriately been facilitated for the prospective service user, documentation seen was not maintained in an orderly fashion, making chronological reading and confirmation of specific events very difficult. The home must demonstrate the orderly maintenance of service user information in line with sound confidentiality standards and best practice with regard to good record keeping. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 11 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): 6,7,9 &10 Quality in this outcome area is good. This judgement has been made using avail able evidence including a visit to this service. EVIDENCE: The inspector reviewed the individual files for two service users and was satisfied that comprehensive care plans were in place. Files seen contained good guidance to staff regarding service users’ needs and detailed who would be involved in meeting care plan goals, including professionals external to the home and Hillgreen organisation. The inspector was encouraged to note the explicit details of care plans offering clear guidance to staff regarding role responsibility. Care plans seen had been recently devised and were holistic in exploring service users goals. Areas routinely explored included physical and mental health needs, social network needs, dietary needs, daily living skills, medication and finance issues. Care plans contained comprehensive exploration of the behavioural issues of service users. Care plans devised by the service were in accordance with care plans devised by the placing authority, which was also evident on file. Service users’ general progress was charted via a monthly progress report that also highlighted any changing needs. Managers informed the inspector than Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 12 the anticipated introduction of Person Centred Planning, as an approach to care in the home would further enhance understanding of the changing need and the personal goals of service users. Managers gave good illustrations of service users’ participation in the decision making process, which included the increase in service users’ use of local trains, increased visits to the pub as opposed to disco on a Monday, menu choice, self determined visits to family members and participation in group recreational activities. Staff had received training in communication methods as such Makaton in an attempt to enhance effective working with service users and encourage decision making by service users. Monthly residents’ meetings are convened in the home and service users were encouraged to express their views on a range of subject matters. The inspector reviewed the home’s records of these meetings, which outlined issues such as health and safety, visitors, planning for Christmas, the home’s complaints procedure and discussion regarding the (then) probable admission of a sixth resident. With regard to risk assessments, both service user files reviewed evidenced detailed risk assessments. Issues identified on file included the use of public and private transport, using kitchen equipment, risks posed in facilitating a visit to the service user’s family home, accessing public places and the risk posed by the service user’s threatening behaviour to identify a few. Information contained on service user’s files was very comprehensive and detailed, however the home must ensure that all service user records/information are appropriately maintained (see Standard 2 above). Stoke Newington Common, 6 DS0000065733.V326027.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some service users shared with the inspector photographs of the home’s recent Christmas celebrations. It was clear that service users had enjoyed the occasion and some indicated as much. The registered manager commented that due to ongoing positive developments in the management of service users behavioural challenges and the sense of stability service users experience (in comparison to several months ago), service users were encouraged and enjoyed a greater range of recreational activities than previous. One service user continues to periodically attend leisure and learning workshops and all service users have access to and make use of local recreational facilities such as the pub, discos, the local gym/leisure centre, swimming activities, bowling, trips to the cinema etc. Going for walks and shopping is a regular activity. Service users also make good use of extensive grounds on Stoke Newington Common, a communal park area located directly across from the home. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 14 Service users whose religion was known were encouraged to participate in local worship. The registered manager, encouraged by the progress made by service users in accessing public places is planning a holiday for service users later in the year. Service users largely enjoy good communication and contact with their family members. One service user, who is orthodox Jewish, visits the family home every weekend. Another service user who comes from a large family has frequent family visits to the home, as do other service users. With regard to service users’ responsibilities and rights, residents and their advocates are encouraged discuss issues of individual rights, particularly at residents meetings. Service users were observed by the inspector to enjoy freedom of movement around the home and managers commented that they were encouraged to take responsibility for tasks around the home including cleaning, making beds etc. With regard to meals, dietary preferences, allergies etc were explored during the assessment process. Menu planning was facilitated by use of pictorial food cards, used by some service users while others made verbal choices. The home has made good working links with a local dietician, who has been available to work with service users and staff to ensure service users’ dietary needs were being met. So, for example, some service users require a high caloric intake, while others needing to reduce their weight are on low caloric diets. One service user shops and cooks independently of staff. Service users have access to culturally appropriate foods, e.g. Kosher foods were made available to one service user who also had a separate refrigerator to ensue foods were stored in accordance to the requirements of his faith. Another service user who is West Indian in origin also had access to culturally appropriate meals. The inspector reviewed the menu plan for the week of the inspection and was satisfied that meals offered were varied and nutritiously balanced. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 15 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 & 21 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two service user files reviewed by the inspector contained very good information that outlined the individual personal care needs of service users. Written guidance to staff was comprehensive and detailed in highlighting service users preferences and how best to manage personal care tasks and minimise distress. The registered manager was able to give good illustration of particular personal care needs of some service users. So for example, it was explained that despite all service user bedrooms being fitted with en suite facilities all but one of the six service users preferred to use the communal bath. One service user who enjoyed taking long baths was generally bathed last, so that there were minimal time restraints and to ensure that she was not rushed. Another service user had indicated that he wished to change the disposable razor that he used to use to one he saw advertised on television. For another service user, his father alone shaves his beard in accordance to religious obligations. The registered manager commented that the home does not Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 16 permit cross gender care and so both male and female staff is on shift to ensure this practice is consistent. Files reviewed by the inspector contained very good information regarding the physical and mental health support needs of service users; files evidenced individual health action plans. All service users are registered with local GP services and had access to dental, opticians and chiropody services. The inspector noted that for one service user who was diabetic written guidance was available to staff to assist the management of this condition; in particular highlighting the service user’s dietary needs. Files reviewed addressed health care issues such as mobility, weight loss and gain, issues around smoking, maintaining a healthy diet and the need for monitoring blood tests. Files reviewed also contained excellent documentation (from behavioural specialists and consultant psychiatrists) regarding the mental health support needs of service users and in particular related behavioural issues. Files seen contained excellent written guidance to staff about the management of some very challenging behaviour of service users in differing situations. Guidance seen provided staff with strategies to combat challenging behaviours and to recognise triggers. The previous inspection had highlighted the need for the service to develop policies that related to service user illness, ageing and death, during the inspection relevant policies were produced. Of serious concern during the previous inspection was staff’s administration and management of service users’ medication. On this occasion the inspector reviewed the medication information for three service users in detail and was again very concerned for the findings. The inspector observed that on the Medication Action Record (MAR) for one service user there were unexplained blanks where no entry had been made. Staff were unable to explained why this might be the case. On the MAR sheet for another service user, multi-vitamins and home remedy medication supplied by the service user’s mother was inaccurately accounted for on the MAR sheet; it would appear that documentation of the administration of this medication was for the month preceding the calendar month and not the current month, in essence the one MAR sheet recorded medication taken for two different calendar months, which is unacceptable. For another service user’s records, staff had failed in some instances to make use of the key codes to identify whether medication had been offered, taken, refused etc. and blanks were evident. This is unacceptable, particularly as the records allow the use of key codes to identify and track the administration of individual dosage of all medication. Managers of the service must also ensure that in instances where prescribed medication is to be administered else where Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 17 other than the home (e.g. the day centre) that staff use the appropriate key code to indicate this and not leave MAR sheet entries blank. The inspector noted another instance where it would appear that the prescribed dosage (three times a day) was recorded (and presumably offered) only twice daily. Managers explained that in this instance the service user was reluctant to take this medication (dietary supplements) and it was likely that the medication was consistently refused. The inspector felt this to be very poor practice and that the explanation was unlikely as staff would have little indication (other than the directions pre-populated on the MAR sheet) to indicate a third dose during the day was required. In reviewing the MAR sheet for yet another service user the inspector observed two staff signatures that indicated that on the day of the inspection two separate doses of Chlorpromazine tablets (100mg) had been taken by the service user. It later came to light that in fact the home had no supply of this medication and that the medication had been discontinued for the service user since the previous month. Additionally the inspector observed that for the same service user, the MAR sheet for the day before the inspection, (for a dosage of Risperdone), had not been signed by staff. Managers suggested that this might indicate that the medication had not been taken. However upon examining the relevant blister pack for the said dose, the pack was empty indicating that the medication had in fact been given, or possibly refused and disposed. The home’s management and administration of service users medication is of grave concern, particularly since the inspector was informed that staff had participated in medication training since the last inspection. Staff must demonstrate a better understanding of the home’s medication policies and practices in order to ensure the safe administration of service users medication. As a matter of priority, managers of the service must develop robust systems to monitor staff practices to eliminate/minimise medication/recording errors. It is the inspector’s view that dialogue between the home, its pharmacist and prescribing physician be conducted to ensure that all those involved in the management of service users’ medication have a good understanding of effective protocols. The inspector would encourage the service to take prompt action with regard to this area of the home’s function. Stoke Newington Common, 6 DS0000065733.V326027.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Managers of the service informed the inspector that since the last inspection staff had received adult protection training. The previous inspection had highlighted the need for the service to develop and implement a system to log specifically any allegation of an adult protection nature. During the inspection, the inspector reviewed the home’s ‘allegations book’, which contained three entries. The inspector was satisfied that all three incidents had been fully investigated, well documented and appropriately managed. The home had in place comprehensive adult protection policies and procedures; the adult protection procedures of the host local authority were also produced. However, the inspector advised that the home’s written policies include details of the organisation’s obligation to make referrals to the POVA list as appropriate. It was the inspector’s view that it was important that the organisation outline publicly this obligation and that staff were aware if its implication. The home has a satisfactory complaints procedure in place that was reviewed at the previous inspection. Managers of the home informed the inspector that no complaint had been made against the home since the last inspection. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector participated in an accompanied tour of the home’s premises and was satisfied that the home was clean and hygienic. All service user bedrooms were seen and considered well decorated and comfortable, (some service users had new orthopaedic beds) as were all communal areas of the home. The registered manager commented that clearance of the home’s garden area had been completed and plans to explore further landscaping were underway. The previous inspection had highlighted the need for broken toilet seats in the home to be repaired/replaced. During this inspection the inspector was informed and saw that three toilet seats in service users en suite facilities were broken. Managers explained that the toilet seats had been replaced since the last inspection, but had continued to break due to service users’ constant slamming of the seats. Managers indicated that it may be the case that entire systems may need to be replaced or more durable seats purchased. In either case, the situation as observed on the day of the inspection was unacceptable; Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 20 all broken toilet seats in the home must be replaced/repaired. This is a repeat requirement. The previous inspection had also highlighted the need for an extractor fan to be installed in the lounge area to counteract cigarette smoke since this was the home’s designated smoking area. The inspector observed during the inspection that the extractor fan had not been installed. Managers commented that the installation had been delayed and was due to be completed very shortly. This requirement is also repeated. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 21 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): 32,34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager commented that he felt that the staff group had developed positively as individual staff members and as a team. He illustrated this point by outlining staff’s ability to make sound decisions for themselves and be less reliant on emergency on call management systems when the registered manager was away from the home. The staff group was said to work cohesively together and have a good understanding of service users’ needs. The inspector observed the interaction between staff and service users during the inspection and was very aware of the care and patience demonstrated by staff. Staff members constantly communicated with service users, informing them of what was going to happen and why. Service users were also sensitively steered away from situations that might give rise to difficulties. Service users were clearly well supervised by staff, who took appropriate action in managing service users’ behaviour in situations where any risk was posed. The inspector also observed the ease with which service users responding to the directions of staff without any signs of distress. This is an important development as the Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 22 inspector’s observations of the behaviour of service users at the previous inspection were to the contrary. The inspector was impressed with the registered manager and other staff’s sensitive interaction with service users who had previously posed significant challenges. The registered manager and the staff group are commended for developing good working relationships with service users, which has contributed to the increasing stability of service users living at the home. The previous inspection had highlighted the need for the service to ensure that staff records include detailed employment histories of all employees. The inspector reviewed the staff personnel file for three members of staff of which all evidenced complete information as outlined in Schedule 2 of the Care Homes Regulations. All staff files reviewed contained CV’s that outlined full employment histories. With regard to training, the inspector was satisfied that staff had been provided with key training such as medication and adult protection training since the last inspection. In general the home’s staff group are qualified to degree level and personnel files indicated that staff also had relevant key training such as Makaton training, Person Centred Planning and food hygiene for example. Managers explained that the home did not employ agency staff but utilised permanent staff of other Hillgreen projects when necessary. Staff training facilitated by the organisation was available to all staff and the home had developed good links with the host local authority (The London Borough of Hackney) that had also agreed to provide some training to staff. Further, more specialist training and guidance via behavioural specialists, dieticians etc have been discussed elsewhere in this report. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Based on the evidence explored during the inspection, the inspector was of the opinion that generally the home was well run as service user enjoyed quality of life while living at the home. Most policies and procedures are in place, the staff group work cohesively as a team and the registered manager is seemingly competent in his role and is supported by the organisation’s senior management. The registered manager informed the inspector that he had recently completed the required management course, which had not been the case at the previous inspection. It was clear to the inspector that the impact of the service’s general development had resulted in positive outcomes for service users. This is perhaps best indicated by the marked decrease in service users’ challenging behaviour in recent months. The home must however, focus attention on Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 24 making improvements in service delivery and address some of the home’s (repeat) highlighted weaknesses more efficiently. It is difficult to assess the home as promoting and protecting the health, safety and welfare of service users in light of the very serious issues around the administration of service users’ medication. The inspector is satisfied that monthly unannounced monitoring visits were being consistently conducted and reported upon; reports subsequent to the previous inspection had been shared with the Commission. However, if the service is to improve, monitoring mechanisms must prove more robust and effective in identifying and offering solutions to identified deficiencies. Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 25 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 2 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 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 4 33 X 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 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 1 3 3 X 2 X X 2 X Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 26 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 YA1 Regulation 5 Requirement The registered manager must ensure that the Service User Guide is further developed to include information outlined in Standard 1.2 The registered manager must ensure that initial assessments completed by the service are maintained on site. (Previous timescale of 01/10/06 not met) The registered manager must ensure that all relevant service user information is maintained on site The registered manager must ensure that all service user information is appropriately maintained. i.e. information is maintained in an orderly manner The registered manager must ensure that staff receive appropriate training with regard to the appropriate recording of information on MAR sheets The registered manager must ensure that all medication received into the home is appropriately recorded on service users MAR sheets and DS0000065733.V326027.R01.S.doc Timescale for action 31/03/07 2. YA2 17(1)(a) 31/03/07 3. YA10 17 31/03/07 4. YA10 12(1)(a) 31/03/07 5. YA20 17(1)(a) 28/02/07 6. YA20 17(1)(a) 28/02/07 Stoke Newington Common, 6 Version 5.2 Page 27 7. YA20 17(1)(a) 8. YA20 17(1)(a) 9. YA23 13(1)(6) 10. YA24 23(2)(c) 11. YA24 23(2)(p) 12. YA39 26 staff make appropriate use of MAR key codes. (Previous timescale of 15/09/06 not met) The registered manager must ensure that MAR sheets indicate clearly instances where service users’ medication is discontinued The registered person must ensure that robust monitoring systems are in place to monitor the medication practices of staff The registered manager must ensure that the home’s adult protection policies are further developed to include information about the organisation’s obligation to make referrals to the POVA list as appropriate. The registered manager must ensure that broken toilet seats are replaced. (Previous timescale of 01/10/06 not met) The registered manager must install an extractor fan in the lounge area to counteract cigarette smoke. (Previous timescale of 01/12/06 not met) The registered person must ensure that monthly monitoring visit are effective in monitoring standards and practices and offer resolution to areas of the home identified as being in need of improvement. 28/02/07 31/03/07 31/03/07 31/03/07 31/03/07 31/03/07 Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 28 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 Stoke Newington Common, 6 DS0000065733.V326027.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East London Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 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.V326027.R01.S.doc Version 5.2 Page 30 - 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!