CARE HOME ADULTS 18-65
Tanfield House 80 Randall Avenue Neasden London NW2 7SS Lead Inspector
Julie Schofield Unannounced Inspection 27th October 2005 2:25 Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tanfield House Address 80 Randall Avenue Neasden London NW2 7SS 020 8452 6616 020 8830 5826 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Lucille Rabor Amanda Rabor Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Tanfield House (80 Randall Ave) is situated on the corner of Randall Avenue and Tanfield Avenue and is close to the shops at Neasden. Tanfield Avenue is on a bus route and it is relatively close to the North Circular Road. The nearest underground station is Neasden. It is a large detached house with a small garden at the front of the house and a garden at the rear of the property. The garage at the side of the house has been converted into an office for the domiciliary care and nursing agency that is also operated by the company. There is parking space available on the street outside the house. The home is registered for 5 adults with mental health problems and there are bedrooms on both the ground and first floor with bathing and toilet facilities on both floors. Communal space is situated on the ground floor and consists of a lounge and a separate open plan kitchen /dining area. There is a small office/sleeping in facility on the first floor and an office on the ground floor. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on a Thursday afternoon in October 2005. During the inspection a deputy manager from another Randall care home assisted with the inspection as the manager was off duty. The Inspector would like to thank the staff and residents who took part in the inspection. During the inspection a partial site visit took place and records were inspected. What the service does well:
The home involves the resident in decision-making. When a restriction or limitation on the use of any facilities in the home or the way in which the resident lives their life is necessary, in the best interests of the resident, this is subject to an agreement with the resident. The agreement is recorded and a copy is signed by the resident and kept on their case file. The need for the agreement is monitored and discussed at review meetings, which are attended by the social worker from the placing authority. The home supports residents in preparing residents for new challenges in their lives and supports them in adapting to change. A resident is moving to another Randall care home and this option was given to the resident as part of a plan to enable the resident to move towards more independent living in the future. The resident has confirmed that they are being supported to achieve this goal. Members of staff who understand the needs of residents give assistance with personal support. Recent staff recruitment has provided a Somali resident with a member of staff who is also Somali and who is able to develop the skills of the resident whilst drawing on their knowledge of the cultural and dietary requirements of the resident. Both the manager and the deputy manager (who works with all of the Randall care homes) have undertaken NVQ level 4 management training and members of staff in the home have access to NVQ level 2 and level 3 training. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 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
Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 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 Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not inspected. Standard 2 was inspected during the previous inspection. EVIDENCE: Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Standards 6 and 9 were inspected during the previous inspection. Residents exercise their right to make decisions about their lives. EVIDENCE: The residents said that they decided whether to take part in activities or attend drop in centres, how to spend their leisure time, whether to vote in the elections, when to get up in the morning or go to bed in the evening, when to visit friends or family and whether to attend appointments. One of the residents has decided that he would like to take the opportunity to move to one of the other Randall care homes and spoke about the reasons behind his decision and how the move could help planning for his future. He said that the managers are supporting him with this move. Residents have control over their own finances although the home is able to provide assistance to residents who need support to budget their money or need help with benefit problems. If there are any restrictions in relation to the facilities in the home this is subject to a written agreement with the resident, which their social worker is aware of and also in agreement with. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 Standards 12, 13 and 15 were inspected during the previous inspection. The resident’s right of choice, privacy and freedom of movement are respected. Residents are offered a balanced and varied diet. The appropriateness of cooking the meals for 2 care homes, which are in the same road, in one home and then taking the food to the other house must be confirmed writing by the environmental health officer. EVIDENCE: During the inspection residents left and returned to the home. They were able to come and go as they pleased although residents were encouraged to say where they were going and to give an expected time for their return. Residents are provided with a key to their bedroom door, unless there is a written agreement with the resident that this has been suspended. Residents receive their letters unopened, are called by the name that they prefer and have unrestricted access to the communal areas of the home. During the inspection an evening meal was prepared. It consisted of chicken, rice and vegetables. Residents eat their meals at different times, according to
Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 12 their different lifestyles. It was noted on the rota that the evening meal for 2 of the Randall care homes, which are in the same road, are cooked together in 1 of the homes. The home responsible for the preparation of the meal for both homes varies. The deputy manager said that the environmental health officer had been contacted and they had received advice about transporting the food from one home to another. Written confirmation about the suitability of this practice, by the environmental health officer is needed. Residents said that the meals served were satisfactory and there was a varied and balanced menu. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Standard 19 was inspected during the previous inspection. Residents receive assistance with or prompting with personal care in a manner, which respects their dignity. Residents are supported by staff to take their medication, at the times directed and in the doses prescribed by their GP, in order to promote their general health. However, disposal of used sharps must be prompt. EVIDENCE: Residents are able to attend to their own personal care needs although staff may need to prompt or to encourage them. The deputy manager spoke of residents being advised about wearing appropriate clothing for the season, if necessary. The staff team reflects the cultural and religious backgrounds of residents. Since the last inspection a member of staff who is Somali has been recruited and has been supporting a Somali resident in developing independent living skills. At present all the residents of Tanfield House are male and the staff team includes male support workers. The deputy manager said that staff have received training from the CPN about “reading signs and personal safety”. The storage of medication was secure and records were up to date. There was a container with sharps that were to be returned to the GP. These belonged to
Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 14 a resident who had recently died. The member of staff who said that they had undertaken medication training said that included information about why the medication was prescribed, what effect it has and what side effects might occur. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 Standard 22 was inspected during the previous inspection. An adult protection policy, familiarity with the interagency guidelines and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: There is a protection of vulnerable adults policy in place. The home has a copy of the local authority’s interagency guidelines. Staff confirmed that they have had protection of vulnerable adults training and management of aggressive behaviour training. The home has not reported any allegations or incidents of abuse since the last inspection. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 Standards 24 and 30 were inspected during the previous inspection. Residents enjoy comfortable communal areas in which they can relax, socialise or take part in activities. EVIDENCE: Communal space consisted of a lounge and a separate open plan dining/kitchen area. Since the last inspection the sheets covering the 3-piece suite in the lounge have been removed and a throw is covering the settee. While this is a practical arrangement the furniture still looks comfortable. There were also 2 folding chairs although there are sufficient comfortable chairs for all residents to use the lounge at the same time. There is access to a pleasant garden at the rear of the property. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The home continues to support staff undertaking NVQ training. All staff working with residents who have mental health problems need training that will enable them to understand the particular needs of residents and to provide the residents with appropriate support. The programme of mental health training must continue. The rota did not demonstrate that there was always sufficient staff on duty to support the residents, it did not record the hours worked in the home by the manager and it did not specify the number of hours that members of staff working in more than 1 Randall care home worked in total, across the company. A member of staff confirmed that the recruitment process protects the welfare of the residents. The home must forward a copy of their training and development plan to the CSCI. The plan must demonstrate that training provided enables staff to meet the objectives contained in the Statement of Purpose and is tailored to meet the individual and changing needs of residents. Individual supervision sessions enhances the overall support available to staff and is an opportunity to encourage personal development. EVIDENCE: The deputy manager said that she had completed her RMA training. One of the staff on duty said that they had completed their NVQ level 2 training and had just started level 3 training. The deputy manager said that there are 3 staff who were currently studying for their NVQ level 3 qualification and
Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 18 another member of staff who was studying for their NVQ level 2 qualification. The deputy manager said that some staff have begun to undertake training in mental health issues although one of the members of staff on duty said that they had not had any mental health training. At the start of the inspection 2 members of staff were on duty. A deputy manager from another Randall care home who provides support to staff in each of the Randall care homes came to 80 Randall Avenue to assist with the inspection. A copy of the rota was provided. The hours worked on site by the registered manager were missing from the rota. Each shift did not have the names of a sufficient number of staff to meet the needs of the residents and no names had been entered on the rota for the early shift on Sunday. This was brought to the attention of the deputy manager, during the inspection. A member of staff on duty said that they worked in two of the Randall care homes. One of the members of staff on duty said that they had been working in the home since the beginning of the year. They said that they had been asked to provide their passport, proof of address, their photograph, the names and addresses of 2 referees as part of the recruitment process. They had also been asked to complete an enhanced CRB disclosure application form. They had started to work in the home when these had been returned and were satisfactory. The deputy manager said that the home has a training and development plan but as the manager was not on duty it was not available. The manager of Tanfield House has a co-ordinating role for training across the company. The member of staff on duty listed a number of training courses that they have attended since the beginning of the year and in addition to their NVQ training. The home uses Learning Disability Award Framework accredited training and evidence of this has been provided on previous inspections. One of the members of staff on duty confirmed that individual supervision sessions were given to staff on a monthly basis and that staff meetings took place monthly. Staff said that supervision sessions were an opportunity to discuss any comments or suggestions that they may wish to raise. There was a notice in the office, which confirmed the date for the next staff meeting, and staff were aware of this date. Staff said that it was both a staff meeting and a training session. The deputy manager said that the annual staff appraisals had been carried out recently. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 Standard 42 was inspected during a previous inspection. The registered manager continues to develop her knowledge through further training and this contributes towards understanding the needs of residents and staff. There are systems in place for gathering feedback on the quality of the service provided by the home and this needs to be incorporated into an annual development plan. EVIDENCE: The manager spoke to the Inspector, after the inspection, and said that she had completed her Registered Manager’s Award training and was waiting for her certificate of achievement from the awarding body. The deputy manager said that there were a number of ways for staff to make comments about the service provided in the home. These included speaking directly to a manager of the company, giving comments during a staff meeting or discussing matters during supervision. A member of staff confirmed that
Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 20 they had used the staff meeting to raise an issue and that there had been the opportunity to discuss this. The home does not have a system of annual feedback questionnaires for members of staff to complete. Residents confirmed that residents’ meetings are held. The deputy manager said that feedback forms are given to relatives, social workers, district nurses etc for quality assurance purposes. The home needs to use the information received as a result of its quality assurance systems in the planning of its services and in formulating the home’s annual development plan. It was recorded in the policies and procedures file that these had been reviewed in May 2005. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X 3 X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 1 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Tanfield House Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X X DS0000036103.V261206.R01.S.doc Version 5.0 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA17 Regulation 16.2 Requirement That confirmation in writing, from the environmental health officer, that the practice of cooking a meal in another home and then bringing the cooked food over to Tanfield House is safe, is forwarded to the CSCI. That the used sharps are disposed of safely. That 50 of carers achieve an NVQ level 2 or level 3 qualification. That staff receive training in supporting residents with mental health problems. That the rota demonstrates that there are sufficient staff on duty at all times to support residents. (Previous timescale of 01 August 2005 not met). That the hours worked on site by the manager are included on the rota. (Previous timescale of 01 August 2005 not met). That when a member of staff works in more than 1 Randall care home the total weekly hours worked across the homes are recorded on each home’s rota.
DS0000036103.V261206.R01.S.doc Timescale for action 01/12/05 2 3 4 5 YA20 YA32 YA32 YA33 13.2 18.1 18.1 18.1 01/12/05 31/12/05 31/12/05 01/12/05 6 YA33 17.2S4.7 01/12/05 7 YA33 18.2 01/12/05 Tanfield House Version 5.0 Page 23 8 9 YA35 YA39 18.1 24.2 That a copy of the home’s training and development plan is forwarded to the CSCI. That the feedback obtained from quality assurance systems is used to plan and develop services and to formulate an annual development plan, a copy of which is forwarded to the CSCI. 01/12/05 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard YA28 YA39 Good Practice Recommendations That comfortable chairs are provided in the lounge, if needed, instead of folding chairs. That an annual staff questionnaire, which invites comments on the quality of the service provided by the home, is introduced. Tanfield House DS0000036103.V261206.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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