Inspection on 03/05/06 for Touchsky

This inspection was carried out on 3rd May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 33 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 01/09/05

Touchsky 13/04/05

Touchsky 12/08/04

Touchsky 06/04/04

Touchsky 16/03/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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 Unannounced Inspection 3rd May 2006 10:00 Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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 Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Touchsky Address 240/242 Odessa Road Forest Gate London E7 9DY 020 8534 0035 020 8926 6560 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 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 DS0000007250.V292718.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st September 2005 Brief Description of the Service: Touchsky is a care home registered to provide support and accommodation to six adults 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 privately run. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on 3 May 2006 and was conducted by the Lead Inspector Rob Cole accompanied by Regulation Manager Tim Weller. The inspection was facilitated by the provider/manager who returned from leave to attend the home, staff on duty and service users who all participated in the inspection process. Whilst a number of improvements were noted at this inspection, several matters raised at previous inspections had not been addressed. Eight statutory requirements made at the last two inspections have still to be met and the home must now take urgent steps to comply with the stated requirements to avoid legal action. What the service does well: What has improved since the last inspection? What they could do better: Specific hygiene issues identified in this report must be responded to as a matter of urgency. It is hoped that the completion of the refurbishment and redecoration programme will greatly assist this. Quality assurance systems available in template format to be implemented in practice. Medication records must be accurately maintained to evidence compliance with prescribers directions for administration. A number of requirements that have exceeded set timescales for compliance on more than one occasion are made again in this report. Failure to comply with statutory regulations impacts negatively on service users and further failures to comply will result in enforcement action being taken. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 6 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. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The home does not make full necessary information available to prospective service users and their representatives. The content of information available is not always consistent with the services provided and therefore does not accurately represent the home. EVIDENCE: The Manager produced a revised copy of the Service Users Guide for inspection. The 21 page document was generally well laid out and provided some useful information for current and intending service users and their representatives. The guide contained a sufficient summary of the homes Statement of Purpose, a standard form of contract, a summary of the complaint procedure and contact details for the Commission. However, the Service Users Guide did not contain or make reference to the most recent inspection report published by the Commission. When asked, staff were unable to produce an inspection report and, contrary to the homes Statement of Purpose, no copy was available ‘at reception’. Whilst the terms and conditions were described, no range of fees was detailed. The above are requirements of law and must be remedied. Requirements have been made at two previous inspections and failure to comply in response to requirements made in this report will result in enforcement action being taken. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 9 Additionally, the described staffing structure of the home was inaccurate as a designated deputy manager was named when in fact this person was not the post holder as stated by the manager during the inspection. Further comments relating to the management structure are contained elsewhere in this report. The Statement of Purpose had been updated in April 2006. Although generally this was a comprehensive and well-composed document, it contained details that were not applicable to the home (i.e. that the home had a “call system”) and suggestions were made whereby it could be improved to more accurately describe the services offered. Since no new admissions had been made to the home since the last inspection, initial assessments, and introductory visits were not assessed on this occasion. Referrals were being actively pursued and it is envisaged that outstanding requirements would be assessed at forthcoming inspections. Contracts were available on randomly selected service user files. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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): 6, 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. Although improvements have been noted, further work is required to bring care plans to meet minimum standards. Positive engagement with service users should also be further developed. EVIDENCE: Randomly selected service user plans were reviewed. It was encouraging that the most recently appointed staff were aware of the details relating to information held on service user plans. It was of concern however that some key information was missing from care plans. Where personal care was an assessed need for example, there was a discernable lack of detail in the care plan to inform staff how to deliver that care according to the service users wishes and preferences. There continued to be an absence of information relating to social activities. There was evidence of conflicting material on care plans that was described as ‘practice’ by the manager. Information held on care plans should be complete, accurate, dated and signed and there was an absence of these features on paperwork generally. Monitoring and review was similarly insufficiently recorded. Whilst there was no evidence to suggest that care was inappropriately delivered, it is essential that Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 11 care plans comprehensively include relevant information and an outstanding requirement is therefore repeated. It was positively noted that a keyworker system was used in the home. Staff spoken with demonstrated a degree of understanding of the role of a keyworker, though it is acknowledged that the staff members on duty were relatively new in post. Some elements of the keyworker role required to be developed (i.e. the arrangements for assisting service users in making purchases and greater service user contribution to care plan production). Risk Assessments were in place. These were reviewed at appropriate intervals. There were examples of positive interactions between staff and service users (for example, a member of staff quietly spoke with a service user who became agitated). There were also observed instances where choice was not actively promoted (a service user was asked if they wished to rest in their room whilst simultaneously being physically prompted to go there). Inconsistent responses were noted (three staff responded to the same challenging behaviour from a service user in three different ways) and institutionalised models of care were used (a service user was required to collect toilet roll from a communal area whenever needed). Although the manager gave an explanation for this, creative methods of managing the situation had not been explored and the service users dignity was thereby compromised in an unacceptable manner. Consistency and positive practice can only be achieved if underpinned by reference to an agreed and documented approach outlined in the care plan – this could not be evidenced. It was observed that service user meetings were held and minutes were reviewed at the inspection. The manager produced a confidentiality policy for inspection. This had not previously been present in the policy and procedure manual available to staff but was placed there during the inspection. The policy had been updated since the previous inspection and was now fully appropriate for purpose. Instances were however observed during inspection where staff paid insufficient attention to preserving confidentiality; sensitive issues relating to service users care were discussed in the presence of other service users. It is now an expectation that all staff are familiar with and clear about implementation of the revised confidentiality policy. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 12 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): 11,12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. It is the inspector’s belief that the home must do more to promote the lifestyle of service users. Appropriate and sufficient community based social and leisure activities must be provided, and improvements are needed with food hygiene issues. EVIDENCE: The inspector was informed that at present no service users wish to be involved in any formal education or employment opportunities. Service users spoken to confirmed that this was indeed the case. There was evidence to suggest that service users have regular access to the local community. Service users access local shops, parks, woods, and cafes, and on the day of inspection one service user visited a local café with staff support. Service users have their own bank accounts, and routinely visit their banks to withdraw money. Service users access public transport, including buses and minicabs. One service user occasionally attends a synagogue. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 13 In house, service users have access to social and leisure activities, such as television and music. The Statement of Purpose states that service users will be supported to participate in a variety of community based social and leisure activities, but there was little evidence to support that this was the case. For instance, service users had weekly activity charts included within their care plans. For one service user these stated that they liked to go to the pub, bowling and swimming. However, the daily log for this service user evidenced that the only community based leisure activity that they had been offered in the previous six weeks was a trip to the funfair. It is required that the home provides sufficient community based social and leisure activities in line with service users assessed needs and stated preference. Service users are able to see visitors as they wish, and are able to see visitors in private. Service users have access to a telephone - although the payphone intended for this purpose was not working at the time of inspection - and are given their own mail to open. The home has a visitors policy, which states that visitors are welcome at any time. Staff were observed to interact with service users, and not just with other members of the staff team. At times service users made it clear they wished to be left alone, and this was seen to be respected by staff. The manager informed the inspector that one service user was involved with the daily routines in the home around housekeeping, e.g. keeping their bedroom tidy, however, this was not specified in their care plan, and this is required. Menus are planned by service users, and records are kept of menus. However, menus did not reflect any subsequent changes made to the menu, for example, on the day of inspection the menu indicated it was pork chops for lunch, but in fact the meal was chicken casserole. Food cooked on the day appeared appetizing, and the menu indicated that service users were offered a varied, balanced and nutritious diet. The kitchen was clean and tidy, and fresh fruit was available. However, the inspector found several items of food stored, including perishable food that had passed their use by date. Further, the fridge and freezer temperatures had not been checked regularly, for instance records indicated that they had been checked on only five of the twenty two days immediately prior to the inspection. It was also noted that the lunch on the day of inspection was prepared by a member of the staff team who had not received food hygiene training, and that this was a regular occurrence. All of this must be addressed. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. Medication continues to be an area requiring improvement in order to demonstrate safe administration in accordance with prescribers instructions. Service users personal care needs must also be clearly documented to evidence continuity of care delivery. EVIDENCE: A care plan required completion with regards to personal care delivery. This was previously required, has yet to be addressed and must now be achieved to avoid enforcement action being taken. Associated monitoring and recording of this care must also be clearly evidenced in order for the standard to be considered met. There was no documentary record of a service users reported desire not to be assisted with shaving, for example. Service users in general appeared independent around the home, choosing to move freely between common and personal spaces. The Statement of Purpose implied that as a norm service users medication is to be administered by staff. There was no evidence that service users had been re-assessed for their ability to manage their own medication and the practice was not encouraged. Service users were not therefore empowered to take Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 15 responsibility for this aspect of their daily living and it is suggested that this area might be further assessed and/or promoted. For a service user with a diagnosed medical health condition, there was insufficient evidence available to demonstrate what action had been taken to pursue a formal health investigation. The issue was made complex by the service users reluctance to cooperate with further investigation or treatment. However, records should be maintained to evidence; identified proposed actions, the involvement of specialist agencies and how the service user is supported to manage their emotional wellbeing. Medication was reviewed. Records of stock received/held were insufficient such that a full audit of the system was not possible. The medication policy and procedure were unclear as to the recording of receipt of medication and both the documents and practice must now be corrected. Although the home used a purpose designed Medication Administration Record (MAR), dating of records relating to medication administered was poor. The spaces designated for recording quantity and date of receipt were similarly not being used consistently. In one case two MAR charts for the same service user recorded that the medication regime had been administered - by several staff - on five consecutive days at double the prescribed dose. The manager reported that under instruction staff had been requested to sign the second of the MAR charts retrospectively, although the medication had not been given twice. Advice about accurate maintenance of statutory records was clearly given. A random specific inspection of medication was conducted for medication prescribed during the months prior to this inspection. For one prescription 16 tablets were missing and not accounted for. For another prescription four tablets had been signed as given but were still present There was no evidence that staff had undertaken or been satisfactorily assessed as competent to administer medication. Particularly given the above findings, this is now imperative. A sample signature sheet was also recommended to clearly identify the medication administrator at each medication round. The above was of concern and previously made requirements have been repeated. Further failure to comply with the relevant regulations will result in formal legal action being taken. It was noted that a two versions of a document detailing actions to be taken in the event of sudden death were present on service users files. In one case, both versions were available on the same file. One of these contained inaccurate actions to be taken and this was brought to the attention of the Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 16 manager during the inspection. As is the case with all policies and procedures, a single, dated document is required for clarity. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. It is the view of the inspector that more needs to be done to ensure that service users are protected from the risk of abuse. Polices and procedures need amending for both complaints and adult protection, and the home must ensure that staff receive appropriate adult protection training. EVIDENCE: The home has a complaints log, although the manager informed the inspector that the home has not received any complaints in the past year. The home also has a complaints procedure, and an abbreviated version of this was on display within the home. However, the complaints procedure did not include any timescales for responding to complaints. The manager informed the inspector that all complaints received will be acknowledged within three days, and investigated within twenty eight days, and it is required that the complaints procedure is amended to include this information. The home has a copy of the Local Authorities adult protection procedure. When the inspector asked to see a copy of the homes own adult protection procedure, they were presented with three different policies. It was not clear or easily evident which was the current policy. The policy which the manager said was current was not in line with current legislation, for example it did not make clear the homes responsibility for notifying the CSCI and Local Authority of any suspected cases of abuse, or who had responsibility for carrying out investigations into allegations of abuse. It is required that the home has one clear and consistent adult protection policy, which is in line with current legislation. Staff spoken to on the day of inspection demonstrated a poor understanding of the issues involved around adult protection, and it is required Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 18 that appropriate training is provided for staff, and that they all have a clear understanding of their roles and responsibilities with regard to adult protection issues. The home holds money on behalf of service users in a locked safe. Records and receipts are maintained of money spent on behalf of service users. Those records checked by the inspector appeared accurate and up to date. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The environment is largely of an acceptable standard. Some attention is required to matters of hygiene and health and safety to secure service users wellbeing. EVIDENCE: The home comprises two adjacent Victorian terraced houses that have been converted into one property. It was positively noted that work had recently been completed to install double glazed windows at the home. At the time of inspection however, appropriate curtain fixings had still to be fitted so as a temporary measure net curtains had been crudely hung to provide privacy and dignity. It was felt that the front door could be replaced or repainted to further enhance the general appearance of the home in the residential area. Externally to the rear of the property a garden was laid to lawn and a raised paved area was in need of re-laying where a number of flagstones were loose and posed a health and safety hazard. Internally the property was described by service users as ‘homely’ and ‘alright’. Decoration had been undertaken and the programme of works was still to be completed in respect of bathrooms which were in badly need of attention from Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 20 both an aesthetic and health and safety perspective. It was considered that bathrooms could be made more pleasant for use if they did not double as the storage area for mops, and cleaning materials. Hygiene standards in the home were variable. Particular attention was required to bathrooms/toilets where there was evidence of faeces on internal door handles, where blistered damaged painted surfaces made thorough cleaning impossible, a general build up of limescale was apparent around sanitary ware and pedestal mats were worn and dirty. It was also noted that toilet paper, soap and hand towels were not available at any of the toilets or hand basins. Whilst the behaviour management of one service user was described as the reason for this measure (as discussed elsewhere in this report), there was no evidence to suggest that alternative strategies had been explored for the benefit of all at the home. Shared common areas; the lounge, smoking lounge and dining room were compact though appeared to meet the needs of the current service user group. If the home were at full occupancy however, space would be at a premium if meals were taken together. Service users also require good mobility to enjoy safe and unhindered movement around the home. It was positively noted that new carpet had been laid to stairs and landing. Three service users rooms were viewed with the consent of their occupants. Both were plainly though acceptably decorated and made comfortable with the addition of personal effects. Service users were content with the arrangements. An unoccupied bedroom was also viewed. The room had good natural light and was spacious though appropriate and clean bedding must be available and the pillows must be replaced before the room is occupied. Privacy in the home is currently compromised by the location of the payphone (itself not working at the time of inspection) in the dining room adjoining the open plan lounge. It was suggested that a wireless telephone be considered to replace the apparatus that was not working, but in any case, a functioning telephone must be made readily and freely available to service users. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 and 36 Quality in this outcome area is adequate. This judgement had been made using available evidence including a visit to this service. The inspector was satisfied that the home is staffed in sufficient numbers to meet service users needs. However, staff would benefit from regular formal supervision, and training as appropriate to their job. EVIDENCE: The home provides 24-hour support, including an emergency on-call procedure. There was a staffing rota on display, and this accurately reflected the staffing situation on the day of inspection, and since the last inspection now includes details of the hours worked in the home by the manager. There was some discrepancy between the staffing structure that was outlined in the Statement of Purpose, and the actual staffing structure. For example, the Statement of Purpose stated that the home had a deputy manager, but in fact there is a manager, an administrator and a senior support worker, but no deputy manager. The Statement must accurately reflect the actual staffing structure. Further, not all staff are provided with a job description, for example there was no job description in place for the administrator. The inspector checked the job description for the senior support worker, this referred to their nursing duties, although the home is not registered to provide nursing care. All staff must be provided with a job description, which accurately reflects their roles and responsibilities. The home holds staff meetings, minutes are kept, Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 22 these evidenced discussions around health and safety and service user issues. However, the last meeting took place in December 2005, the manager informed the inspector that meetings should take place every six weeks, and this is recommended. The home has policies in place on equal opportunities and recruitment and selection. The inspector checked several staff employment files at random, these included all necessary checks, including proof of ID and satisfactory CRB’s. Staff informed the inspector that they received induction training on commencing work at the home, this includes the environment and service user issues. Records are maintained of staff training, these indicated that since the last inspection staff have now received training in working with adults with mental health issues. However, it was found that staff have not undertaken all required statutory health and safety training, such as first aid, food hygiene and fire safety, and this must be addressed. It was further noted during the course of the inspection that some staff demonstrated a poor level of understanding around epilepsy, even though several service users have epilepsy, and it is required that staff receive appropriate training with regard to epilepsy. Of the eleven care staff employed at the home, two have a relevant care qualification, and it is required that a least 50 of the care staff have such a qualification. There was evidence that staff receive formal supervision. Records are kept, these indicated that supervision covers performance, training and medication issues. However, records suggested that supervision is infrequent, for example two staff have had only three formal supervision in the past year. It is required that staff receive regular formal supervision, at least six times a year. All staff undertake an annual appraisal. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 and 43 Quality in this outcome area is good. This judgement had been made using available evidence including a visit to this service. In the inspectors judgement that the manager is suitably qualified and experienced to carry out their roles and responsibilities. However, more attention needs to be paid to quality assurance, and ensuing that all necessary policies and procedures are in place. 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. Since the last inspection the home has developed a questionnaire for service users, relatives and social and health care professionals, to gain their feedback on the running of the home. However, this has yet to be implemented, and it is Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 24 a requirement that the home implements systems to gain service users feedback to inform future planning within the home. Copies of previous inspection reports are kept at the home, however, these are kept in the locked office, and can only be accessed when the manager or administrator are in the home. It is required that reports are made available for interested parties to view as they require. The home needs to ensure that it has all necessary policies and procedures in place in line with National Minimum Standards and the Care Homes Regulations. At present, the home has more then one version of some of its policies, for example there were three different versions of both the adult protection policy and the missing persons policy. Further, procedures were not always in line with current legislation, such as the adult protection procedure. This must be addressed. Fire fighting equipment was situated around the home, but this had not been serviced since the 8/4/05. It is required that fire-fighting equipment is serviced at least once every twelve months. Fire exits were clearly signed and free from obstruction, and the home has fire risk assessment place. Fire alarms are tested weekly, and were last serviced on the 16/12/05. The home carries out regular fire drills. There was evidence that the home has had in date gas, PAT and electrical installation safety checks. The home had in date employer’s liability insurance cover in place. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 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 1 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 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 2 32 2 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 2 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 2 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 1 2 3 3 2 2 3 2 3 Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 26 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 31/12/05 not met) The registered person must ensure that an accurate record is maintained of medication brought into the home and the medication procedure must reflect that practice. The registered person must ensure that medication is administered in accordance with the instructions of the prescriber. The registered person must ensure that all staff who work in the home receive training in Adult Protection issues. (Timescale 31/12/05 not met) The registered person must ensure that the homes Service User Guide contains all information required by National Minimum Standard 1. (Timescale 31/12/05 not met) DS0000007250.V292718.R01.S.doc Timescale for action 31/08/06 2. YA20 13 30/06/06 3. YA20 13 30/06/06 4. YA23 13 31/08/06 5. YA1 5 31/08/06 Touchsky Version 5.1 Page 27 6. YA1 1 7. YA10 12 8. YA19 13 9. YA14 16 10. YA27 23 11. YA20 13 12. YA20 13 13. YA7 12 14. Touchsky YA23 13 The registered person must ensure that the Statement of Purpose is amended to accurately reflect the services the home can provide. The registered person must ensure that all staff carry out their duties with due regard to the confidentiality of service user information. The registered person must ensure that full information is maintained of interventions to support service users with specific medical diagnoses. 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. (Timescale 31/12/05 not met) The registered person must ensure that standards of hygiene are maintained at an acceptable level throughout the home. The registered person must ensure that the home has a policy in place on the receipt, recording, storage, handling, administration and recording of medications. (Timescale 31/12/05 not met) The registered person must ensure that all staff receive training in medication before they are able to administer it. (Timescale 31/12/05 not met) The registered person must ensure that service user choice is effectively promoted and that care practice does not covertly inhibit service users from fully exercising their rights. The registered person must ensure that the homes adult DS0000007250.V292718.R01.S.doc 31/08/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 30/06/06 Page 28 Version 5.1 15. YA40 17 16. YA16 15 17. YA17 16 18. YA17 13 and 16 19. YA17 13 and 18 20. YA17 13 21. YA22 22 22. YA31 18 protection procedures are in line with current legislation. (Timescale 31/12/05 not met) The registered person must ensure that the home has all necessary policies and procedures in line with National Minimum Standards and current legislation. (Timescale 31/12/05 not met) The registered person must ensure that service users responsibilities for housekeeping tasks are specified in their individual plan. The registered person must ensure that accurate records are maintained of all meals provided for service users. The registered person must ensure that all food substances used within the home are used within their sell by date. The registered person must ensure that all staff involved in food preparation in the home have undertaken appropriate food hygiene training. The registered person must ensure that the temperatures are checked and recorded daily of all fridges and freezers in the home used to store service users food. The registered person must ensure that the homes complaints procedure includes timescales for acknowledging and investigating complaints received. The registered person must ensure that all staff are provided with a copy of their job description, and that this job description accurately and clearly reflects the roles and responsibilities of the specific post it relates to. DS0000007250.V292718.R01.S.doc 31/08/06 31/08/06 30/06/06 30/06/06 31/08/06 30/06/06 30/06/06 31/08/06 Touchsky Version 5.1 Page 29 23. YA32 18 24. YA35 18 25. YA35 13 and 18 26. YA36 18 27. YA39 24 28. YA39 24 29. YA21 12 30. YA24 23 32. YA42 13 and 23 33. YA30 16 34. Touchsky YA30 16 The registered person must ensure that at least 50 of the care staff in the home obtain a relevant qualification in care. The registered person must ensure that all staff employed at the home undertake training in issues around epilepsy as appropriate. The registered person must ensure that all staff employed in the home undertake all necessary statutory health and safety training as appropriate. The registered person must ensure that all staff receive regular formal supervision, at last six times a year. The registered person must ensure that copies of previous CSCI reports of the home are made available to view in the home as required. The registered person must ensure that systems are in place to seek and record the views of service users on the home to help inform future planning. The registered person must ensure that details of action to be taken in the event of sudden death are both accurate and consistently available. The registered person to ensure that health and safety hazards are minimised by re-laying or otherwise making safe the raised patio area. The registered person must ensure that fire extinguishers within the home are serviced at least once every twelve months. The registered manager to complete refurbishment of bathrooms to a standard compliant with regulations. The registered person must make arrangements to replace DS0000007250.V292718.R01.S.doc 31/08/06 31/08/06 31/08/06 31/08/06 30/06/06 31/08/06 30/06/06 31/07/06 31/08/06 31/08/06 30/06/06 Page 30 Version 5.1 and frequently launder or otherwise remove the mats in the bathrooms where these are in an unhygienic condition. 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 YA31 Good Practice Recommendations It is recommended that the home holds regular staff meetings, at last six times a year. Touchsky DS0000007250.V292718.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East London Area Office 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 DS0000007250.V292718.R01.S.doc Version 5.1 Page 32 - 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. 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