CARE HOME ADULTS 18-65
Turle Road (19) 19 Turle Road London N4 3LZ Lead Inspector
Ms Franki Solomon Unannounced Inspection 10:00 16 November 2005
th Turle Road (19) DS0000020972.V263554.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 Turle Road (19) DS0000020972.V263554.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. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Turle Road (19) Address 19 Turle Road London N4 3LZ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7281 2231 0207 281 2231 Psychiatric Rehabilitation Association Ms Christine Kennedy Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Home for adults with mental health needs, three of whom may also be over the age of 65. 25th May 2005 Date of last inspection Brief Description of the Service: Turle Road is owned by the London Borough of Islington. The Psychiatric Rehabilitation Association undertakes responsibility for the management and maintenance of the care home. Turle Road is registered with the Commission for Social Care Inspection to accommodate up to six adults with enduring mental health support needs. The home accepts referrals from the statutory services. The home provides 24-hour care through the deployment of five permanent members of staff, including the registered manager. The home does not encourage the use of agency worker. Known bank staff are employed when required. The property is a semi-detached house with a small conservatory and has a rear garden. The property is domestic in nature and consists of six single bedrooms, communal lounge, a large kitchen and a utility room. The office is on the ground floor and doubles up as the staff sleepover room. Turle Road is situated in a residential area in North London halfway between Holloway Road and Seven Sisters Road. Bus routes are close by and Finsbury Park Underground is a 20 minute walk away. Street car parking is limited. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the second unannounced inspection for the year April 2005 – March 2006. The inspection took place over one day in the presence of the Personsin-Charge (1 on the morning shift and 1 on the afternoon shift). The focus of the inspection was to inspect the requirements made at the last inspection and to look at those key standards not inspected at the last inspection. The inspection was a tour the premises, examination of documents and care plans and to speak with service users. The Commission had received a complaint and the inspection was also to examine records and to check the policies, procedures and the management of that particular complaint. Also to speak with service users to establish whether the complaints procedure was adhered to and how complaints in general were dealt with. The inspector found the complaint to be unsubstantiated. The registered manager was off due to illness and two staff were on annual leave. The inspector met with the two remaining staff on duty. The staff member (Person in Charge) who was on duty until noon, remained on duty for the inspection until 3.30 p.m. and the second staff member (Person in Charge) took over for the latter part of the inspection. The inspector would like to thank the residents and staff for their hospitality and their co-operation during this inspection. What the service does well:
The home is run in the best interest of service users, within a risk assessment that involves service users. It became clear during the inspection, having discussed with residents and staff that staff are professional in their knowledge of the needs of service users. Residents’ monthly meetings ensures residents have a voice in the running of the home. That residents are treated with respect and consulted on all matters of the support they need. Particularly in relation to the complaint from a relative; upon the examination of documents, discussion with the resident concerned, and interviews with staff it was found that the complaint was unsubstantiated. The complaints policy and procedure is robust and the residents’ support needs are well catered for. There was a happy relaxed atmosphere from residents. The inspector was invited by residents to join them at dinner. Those residents who were at the
Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 6 home, sat round laughing and joking. During the mealtime conversation, residents spoke well of the manager and staff and compared Turle Road favourably with other homes they had lived at. What has improved since the last inspection? What they could do better:
The home could do with modernisation, it has no Personal Computer. A P.C. would enable the Registered Manager and staff to have paperless communication with PRA via emails, and have access to relevant information via PRA’S Intranet. A full complement of staff is 1 Registered Manager and 4 full time Support Workers (1 Manager and 2 Support Workers on each Day Shift). On the day of inspection, the Manager was off on sick leave, leaving 2 Support Workers (Persons-in-Charge). However, upon the inspectors arrival there was only 1 Support Worker (Person-in-Charge) for each part of the day shift. It was not clear how 1 staff could be expected to manage in the event of an emergency and to the benefit of service users. The home should consider carefully their staffing arrangements or contingency arrangements when unexpected staff shortage occur for the safety and welfare of both residents and staff. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 7 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. Turle Road (19) DS0000020972.V263554.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 Turle Road (19) DS0000020972.V263554.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): Not assessed on this occasion. EVIDENCE: Turle Road (19) DS0000020972.V263554.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): Not assessed on this occasion. EVIDENCE: Turle Road (19) DS0000020972.V263554.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): 12, 13, 15, 16 & 17. The home supports service users to live a life of their choice in the community, to be with family and friends and to live an independent life within the limits of a risk assessment. EVIDENCE: Arrangements were in place for service users to develop skills. The aim of the home is to support service users for rehabilitation into the community. Some of the service users have reached retirement age and expressed the view they do not wish to pursue paid employment. One resident was involved in voluntary work. Another resident said they “hoped in the future to get a job”. In-Charge in the registered manager’s absence on the day. Both showed indepth knowledge, not only of those service users whose key-worker they were, but of all residents. Care plans demonstrated good recording. However the format of the care plans did not permit recording to show clearly; • individual identified needs
Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 12 • • • action taken evaluation of needs and date of future evaluation/ reviews. Within the format available, recording was detailed, clear and relevant. Except for one sheet, all care plans were signed off by the key-worker and the service user. One page in a service user’s care plan was not signed off by the service user. The key-worker informed that the resident had refused to sign. The inspector discussed this with the staff and recommended the reason should be noted on the care plan. A recommendation has been made in terms of the format and signing off. On the day of inspection, residents were seen to come and go as they wished and to go about their everyday tasks such as preparing a snack in the kitchen, going for a walk or chatting to each other. Three residents spoke at length with the inspector and confirmed that they received good support and were enabled to be involved with the community and participate in a life that suited them. They also said staff encourage and support them to be part of the community. Residents talked about the tasks they undertake in the home. They were proud that they had chores and duties which were their responsibilities. For instance residents do the shopping for food in the home and take turns to prepare meals. One service user was visiting a relative. Three service users spoke freely about their relationships. Menus seen were varied. Because of the unannounced inspection and only one staff being on duty, service users were asked whether they would be willing to have a take-away. The suggestion was greeted with enthusiastic cheers. Everybody made their own choice. There was a very relaxed and happy atmosphere round the dining table. Residents chatted and joked with the inspector and each other. Turle Road (19) DS0000020972.V263554.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): 20. The home’s arrangements for the safe storage, administration and disposal is good. EVIDENCE: Policies and Procedures were in place in terms of medication. None of the service user’s self medicate. Service users were however encouraged to be aware of their medication needs. Service user’s came to the office without prompting for their medication. The inspector interviewed both staff regarding the use of the different medication. Staff demonstrated clear knowledge of medication, the purpose of medication and its side effects. The medication file with the medication also had detailed information on the various medications. Medication was held in a secure place. A check on the medication showed records and actual medication agreed. Residents were asked about their medication and their views and attitude. Residents were clear about the reason for their medication. One resident in particular said they had discussed with the G.P. and their consultant that they wished to alter the dosage of their medication. They were pleased to report that together they were able to have a planned reduction of their medication with ongoing monitoring.
Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 14 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. Arrangements are in place in terms of complaints. Service users can feel confident their concerns or complaints will be listened to and appropriate action taken. EVIDENCE: Policies and procedures to deal with complaints were in place. The inspector’s unannounced inspection was also to inspect an allegation made from an external person about the home around complaints. The complaint was found to be unsubstantiated. The complaints procedure was clear and a complaints book recorded complaints appropriately. The inspector had a full discussion with residents. Some of the comments were: • • “I find the manager very understanding – the best I’ve had. I have no complaints. Like anywhere, in any family, everybody has their moments. They (staff) have done a lot for me.” “I had a complaint about the shower – because I don’t like showers. They fixed something up for me and now I can have a shower without being nervous. I have a careful diet and staff help me to check my diet. I am lucky to be here. I have no complaints. I could complain to any staff or the manager if I needed to.” “If I had a complaint I would go to (the manager). I tell them when I feel nervous – they help. It’s a very nice place. I feel safe here”.
DS0000020972.V263554.R01.S.doc Version 5.0 Page 15 • Turle Road (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 & 30. The home is homely and generally comfortable but in need of risk assessment in certain areas and in need of repair and redecoration. The home was generally clean and hygienic given the support needs of residents. EVIDENCE: The home is a residential house which has had some conversion to accommodate individual adults who are not related. The residents have mental health support needs some of which mean that residents are not always motivated to be particularly tidy. This means that the support that residents require are that they have to be prompted and encouraged to tidy communal areas and their bedrooms. Some bedrooms looked neglected but given that residents should be treated with respect and have choice, staff have to balance that with the need for relative tidiness. Some residents’ furniture (chest of drawers and wardrobe) were broken and needed replacing. A requirement has been made. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 16 In one resident’s room a repair had been undertaken on the wall by the light switch and door. The repair was shoddy and needs to be tidied up. A requirement has been made. There is a shower on one floor in a small space. The design of the shower means that to enter or leave the shower causes a health & safety hazard. A requirement has been made. Generally the home was clean and hygienic and the front and rear gardens were tidy. Turle Road (19) DS0000020972.V263554.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): Not assessed on this occasion. EVIDENCE: Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 18 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): 39 & 42. The home involves residents and takes into consideration their views. The health and safety of service users in terms of a their smoking policy is an issue of debate amongst service users and the registered manager and provider are making every effort to resolve the issue. EVIDENCE: Arrangements were in place to monitor customer satisfaction. Residents felt at ease and comfortable to voice their views and are confident their views are taken into account. There are monthly residents meetings. At one of the meetings the residents had identified a new microwave oven was needed. Residents were pleased with the new microwave. The issue of smoking was raised with the inspector. The home has a nosmoking policy because of the risk of fire in bedrooms, and risk of smoking related hazard to the residents who are non-smokers. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 19 A requirement has been made in terms of the smoking policy (different from the requirement made on this issue at a previous inspection). Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 20 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 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 4 16 4 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Turle Road (19) Score X X 4 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000020972.V263554.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation Requirement Timescale for action 29/05/06 2 YA42 13(4)(a),(b),(c) The Registered Person must ensure the home is homely, safe and free from hazards. This refers to; • the broken furniture • wall repair and decoration of the resident’s bedroom • the set-up of the shower and the entry and exit to and from the shower. The Registered Person must 13(4)(b consult with the Environmental Health Department the feasibility of any proposals for the separate location for those residents who are smokers. 30/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 22 1 YA16 To have Care Plans signed off by both keyworker and resident, and in the event of a refusal to sign, to indicate the reason for refusal. Turle Road (19) DS0000020972.V263554.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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