Inspection on 13/04/05 for Touchsky

This inspection was carried out on 13th April 2005.

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

Other inspections for this house

Touchsky 20/05/08

Touchsky 19/04/07

Touchsky 24/10/06

Touchsky 03/05/06

Touchsky 01/09/05

Touchsky 12/08/04

Touchsky 06/04/04

Touchsky 16/03/04

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

CARE HOME ADULTS 18-65 Touchsky 240/242 Odessa Road Forest Gate London E7 9DY Lead Inspector Rob Cole Announced Inspection 13th April 2005 10:00am 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 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 Stationary 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. Touchsky Version 1.10 Page 3 SERVICE INFORMATION Name of service Touchsky Address 240/242 Odessa Road, Forest Gate, London E7 9DY Telephone number Fax number Email 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 8534 0035 020 8926 6560 Mrs Florence Ndiedzei Muyambo Mrs Florence Ndiedzei Muyambo Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Touchsky Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 12th August 2004 Brief Description of the Service: Touchsky is a registered care home, registered to provide support and accommodation to six service users with mental health issues. The home is situated in a quiet residential area of Forest Gate in the London Borough of Waltham Forest. The home is close to shops, transport links and other local amenities, and is in keeping with other homes in the area. The home is privatley run. Touchsky Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Service users spoken to generally said they were happy with the home, and although there have been some improvements at the home since the last inspection, there is still room for improvement, for instance with care planning and medication. What the service does well: 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Touchsky Version 1.10 Page 6 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 Standards Statutory Requirements Identified During the Inspection Touchsky Version 1.10 Page 7 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 standard(s) 1,2,3,4 and 5 Although the inspector was satisfied that the home had appropriate paperwork in place to help prospective service users decide if the home was suitable for them, there are serious concerns over the actual practice of moving service users into the home, in that pre admission assessments are very basic, and service users are not always offered the opportunity of visiting the home before making a decision. EVIDENCE: The home has developed an admissions procedure since the last inspection. Both a Service User Guide and Statement of Purpose were in place, the Statement was comprehensive and included all information required by Schedule 1 of the Care Homes Regulations 2001, although the Guide needs updating to include details of fees payable and the rooms to be occupied. All service users are given a written contract/statement of terms and conditions, which is signed and dated by the service user and the homes manager. These included details of the rights and obligations of both parties and rules of the home. However, there was evidence that the actual admissions practice did not match the homes policies and procedures. There has been one new admission to the home since the last inspection. Even though this was a planned admission, the manager informed the inspector that neither the service user or their family had been given the opportunity to visit the house, and that the day they moved into the home was the first time they had been there. Further, Touchsky Version 1.10 Page 8 although a pre admission assessment had been carried out by the homes manager, this was extremely basic. It made no mention of the service users mental health, medical, cultural, religious and educational needs. The inspector asked if the homes documentation was accessible to service users, and the manager said they did not know if the most recent person admitted could read English, this had not formed part of their assessment. Touchsky Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 and 10 Overall the inspector was satisfied that service users have appropriate control and choice over their daily lives and the running of the home. However, service users safety and care is being compromised by poor risk assessing and care planning. EVIDENCE: There was evidence that service users have a large measure of control over their daily lives. Service users spoken to informed the inspector that they were free to get up and go to bed when they choose, and were able to go into the local community as they wished, and had keys to their bedrooms and the front door. The homes kitchen has recently been refurbished, and service users were consulted over the new design. Regular service user meetings have been held, service users said they found these useful, and they included discussions on menus, activities and health and safety matters. All service users have care plans in place, these are of varying quality. Some of those seen by the inspector were clear and comprehensive, covering medical needs, social and leisure needs and personal care needs; however, for others care plans were very basic, for example one care plan just included information on the service users personal care needs. The manager informed the inspector that all service users were on the Care Planning Approach (CPA) programme, Touchsky Version 1.10 Page 10 and that they all had CPA meetings at least annually, attended by the service user, their family, staff from the home, the social worker and the consultant psychiatrist. However, for one service user their was no evidence of a CPA meeting since 2002, the manager said meetings had taken place since then, but it is required that the home and the service user have access to the minutes of these meetings. All service users also have individual risk assessments in place, but these are also of varying quality, for example one service user has epilepsy, but there was no risk assessment in place around this. Touchsky Version 1.10 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 standard(s) 12,13,14,15,16 and 17 The inspector was satisfied that the home is able to meet service users needs in relation to diet, personal development and relationships with friends and families. However, more work needs to be done in matching leisure activities provided with the actual needs of service users. EVIDENCE: At present no service users are involved in any formal educational or employment opportunities, and service users spoken to informed the inspector that they did not wish to be. Service users are however involved in programmes to help develop their independence, for example with personal care. There was evidence that service users regularly access the local community, visiting cafes and parks, and using local transport networks including busses and trains, and on the day of inspection two service users were out at local shops. Service users also have access to a variety of social and leisure activities, both in-house and in the community. In–house service users have access to TV and video, music, board games and BBQ’s, whilst in the community service users Touchsky Version 1.10 Page 12 go swimming, to the cinema and to pubs and restaurants. However, service user meetings stated that service users would welcome more day trips organised by the home, and service users spoken to confirmed this. The manager said they would indeed organise more day trips, and it is required that the home meets service users needs in relation to social and leisure interests. Records are kept of menus, and these indicated that service users are offered a healthy, balanced and nutritious diet. The inspector was pleased to note that foodstuffs were no longer stored in locked cupboards, as was the case at the previous inspection. There was evidence that service users are able to maintain contact with family and friends as appropriate. Touchsky Version 1.10 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 standard(s) 18,19 and 20 The inspector was satisfied that service users receive support with personal care as appropriate, and that they have access to health professionals as required, although tighter records need to be kept in regard to this. However, the inspector has very grave concerns around medication issues within the home, most noticeably around the lack of staff training, the lack of a policy and poor recording of medications, all of which compromise service users safety in the opinion of the inspector. EVIDENCE: Only one of the current service users requires support with their personal care. The support required is clearly set out in their care plan, which evidences that the service user is supported to gain as much independence as possible with their personal care. Service users are able to choose their own clothing, and all were appropriately dressed on the day of inspection. All service users are registered with a local GP, and there was evidence that service users have access to other health professionals, including psychiatrists, CPN’s, dentists and opticians. Records are maintained of medical appointments, but these need to be more thorough, for example these records indicated that one service user has not seen their GP since they moved into the home, although the inspector was informed that they have seen their GP regularly. Touchsky Version 1.10 Page 14 As at the last inspection, there were still several issues found with regard to medication during this inspection. Some issues have been addressed, for example Medication Administration Records (MAR) charts were now found to be kept up to date, and all contained a recent service user photograph, records are maintained of medications entering the home and those that are returned to the pharmacist. However, there was no evidence that the home has a policy in place on medication, and the manager informed the inspector that not all staff have received training in medication before they are expected to administer it. Further, there were no guidelines in place around the administration of medications prescribed on an as required basis, and the instructions on medication labels were not always consistent with the instructions on the MAR charts. All of this must be addressed. Touchsky Version 1.10 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 standard(s) 22 and 23 The inspector had concerns that sufficient safeguards are not in place to help ensure service users are not at risk from abuse. Staff have not had training in this area, and there are no systems in place to safeguard service users money. EVIDENCE: The home maintains a complaints log, although the manager informed the inspector that no complaints have been received within the past year. The home also has a complaints procedure, this included contact details of the CSCI and appropriate timescales for responding to any complaints. However, this procedure was not on display anywhere within the home, and it is recommended that it is displayed prominently within the home. The home has a copy of the Local Authorities adult protection procedures, and also its own adult protection policy. However, this is not in line with current legislation, for example it does not make clear whose responsibility it is for carrying out any investigation into allegations of abuse. Staff spoken to by the inspector demonstrated only a limited understanding of the issues involved with adult protection, and as at the time of the last inspection, many staff have not received any training in this subject. It is a repeat requirement that all staff who work at the home receive appropriate adult protection training. The home keeps monies on behalf of service users. Records are kept of financial transactions involving service users monies, the manager informed the inspector that there should also be receipts, but these were not always in evidence. One receipt dated 4/3/05 evidenced that £23 of a service users money had been spent on turkey burgers, frozen pizzas and chicken Kiev’s, the manager said this should not have happened, as the home was responsible for purchasing food for service users. It is required that sufficient safeguards exist Touchsky Version 1.10 Page 16 to ensure that service users monies are spent appropriately, and that this money be reimbursed to the service user. Touchsky Version 1.10 Page 17 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 standard(s) 24,25,26,27,28 and 30 It is the inspectors judgement that the home is well maintained both internally and externally, and that it is suitable to meet its stated purpose. EVIDENCE: The home is situated in a quiet residential area of Forest Gate in the London Borough of Waltham Forest. The home consists of two houses converted into one. All service users have their own bedrooms, which meet National Minimum Standards on size requirements, and were decorated to service users personal tastes. Bedding, curtains and carpets were all well maintained and domestic in character. Bedrooms included adequate furniture, which had been repaired or replaced since the last inspection, and is now of a suitable standard. Communal areas consists of two sitting rooms (one of which is the designated smoking room), a dining room, a kitchen and a garden, which has appropriate garden furniture. Service users informed the inspector that they are involved in maintaining the garden. The home has adequate bathing and toilet facilities, consisting of two bathroom/toilets, and one toilet on its own. Bathrooms were clean and tidy, and since the last inspection they have all been fitted with locks, including an emergency override device. Touchsky Version 1.10 Page 18 The home has appropriate laundry facilities, which are domestic in scale. Hand washing facilities were situated close by to laundry facilities and throughout the home. COSHH products were stored appropriately, and measures are in place to help control the spread of infection. Touchsky Version 1.10 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 The inspector felt that the staff team has built up good relations with service users, and have a good understanding of their roles and responsibilities, although they would benefit from training in mental health issues. EVIDENCE: The home provides 24-hour care, including an emergency on call procedure. Through observation and discussion there was evidence that staff have a clear understanding of their roles and responsibilities, and all staff are given a copy of their job description. Staff appeared to have built up good relations with service users, and were able to communicate with them effectively in their preferred language. The home has policies in place on equal opportunities and recruitment and selection. However, this latter policy does not reflect the actual recruitment practice, in that the manager informed the inspector that service users were involved in the recruitment process, but this was not reflected in the policy. The inspector was pleased to note that since the last inspection staff are only employed after satisfactory employment checks have been carried out, including CRB checks, but the home still needs to have a full written records of staff’s employment history, including any gaps in employment. On commencing employment at the home, all staff receive a structured induction programme, which includes health and safety training and training on Touchsky Version 1.10 Page 20 service users issues. Training is provided throughout the year, staff have recently received training in fire safety and food hygiene, however, it is a repeat requirement that all staff receive training in working with adults with mental health issues. Nine of the thirteen care staff currently have or are working towards a relevant NVQ qualification. The manager informed the inspector that it is planned that all staff will have the opportunity of completing an NVQ in the near future. Touchsky Version 1.10 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41 and 42 The inspector believes the homes manager to be suitably qualified and experienced to work with the client group. However, more attention to detail is required, for instance with policies and procedures. EVIDENCE: The homes manager is a Registered Mental Health Nurse with over ten years experience of managing a care home. They have successfully completed the Registered Managers Award. Staff and service users informed the inspector that they found the manager to be approachable and accessible, and on the day of inspection were observed to interact with the manager in a relaxed manner. The home has various quality assurance systems in place, staff meetings, service user meetings and staff supervisions all contribute to the quality assurance within the home, and service users are issues with questionnaires; feedback from these was generally positive. Touchsky Version 1.10 Page 22 The home carries out various health and safety checks, for instance hot water temperatures, and since the last inspection the home now holds regular fire drills. Staff have received various health and safety training, including on manual handling and food hygiene. Confidential records are stored securely, and staff and service users can access them as appropriate. However, the home must ensure that it has all policies in place in line with National Minimum Standards, this was not the case at this inspection, for example there was no medication policy, while the adult protection policy was not in line with current legislation. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 2 1 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 Touchsky Score 2 3 Standard No 24 25 26 27 28 29 Version 1.10 Score 3 3 3 3 3 x Page 23 8 9 10 LIFESTYLES 3 2 3 Score 30 STAFFING 3 Standard No 11 12 13 14 15 16 17 3 3 3 2 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 2 3 3 x Touchsky Version 1.10 Page 24 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 YA6 Regulation 15 Requirement The registered person must ensure that all service users have a comprehensive service user plan in place, and these must be reviewed at least every six months. (Timescale 30/11/04 not met) The registered person must ensure that all service users have a comprehensive risk assessment in place, which identifies how risks can be reduced and managed.(Timescale 30/11/04 not met) The registered person must ensure that all dosage directions for medication on the Medication Administration Charts match the instructions on the medication label.(Timescale 30/11/04 not met) The registered person must ensure that all staff who work in the home receive training in Adult Protection issues.(Timescale 30/11/04 not met) The registered person must ensure that all staff receive training in working with adults Version 1.10 Timescale for action 30/6/05 2. YA9 13 30/6/05 3. YA20 13 30/6/05 4. YA23 13 30/6/05 5. YA35 18 30/6/05 Touchsky Page 25 6. YA1 5 7. YA2 14 8. YA4 12 9. YA6 15 10. YA14 16 11. YA19 13 12. YA20 13 13. YA20 13 14. Touchsky YA20 13 with mental health issues.(Timescale 30/11/04 not met) The registered person must ensure that the homes Service User Guide contains all information required by National Minimum Standard 1. The registered person must ensure that thorough pre admission assessments are carried out on all prospective service users prior to them moving into the home. The registered person must ensure that prospective service users are given the opportunity of visiting the home prior to making any descisions as to move in or not. The registered person must ensure that the home and service users have access to minutes of all service users CPA meetings. The registered person must ensure that service users have access to appropriate community based social and leisure activities in line with their assessed needs and stated preferences. The registered person must ensure that records are maintained of all medical appointments, including any follow up action required. The registered person must ensure that the home has a policy in place on the receipt, recording, storage, handling, administration and recording of medications. The registered person must ensure that all staff receive training in medication before they are able to administer it. The registered person must ensure that guidelines are in Version 1.10 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 Page 26 15. YA23 13 16. YA23 13 17. YA34 18 18. YA34 19 19. YA40 17 place for the administration of all medications prescribed on a PRN basis. The registered person must ensure that the homes adult protection procedures are in line with current legislation. The registered person must ensure that clear systems are in place to help ensure that the home spends money appropriatly on behalf of service users. The registered person must ensure that staff are recruited to the home in line with the homes policies on recritment and selection. The registered person must ensure that the home has a full written employment history for all staff employed at the home, including an explanation of any gaps in their emplyment history. The registered person must ensure that the home has all necessary policies and procdures in line with National Minimum Standards and current legislation. 30/6/05 30/6/05 30/6/05 30/6/05 30/6/05 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 YA22 Good Practice Recommendations It is that the homes complaints procedure is displayed within the home. Touchsky Version 1.10 Page 27 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway, Stratford London E15 4BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Touchsky Version 1.10 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!