Inspection on 26/07/06 for Turle Road (19)

This inspection was carried out on 26th July 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Turle Road (19) 16/11/05

Turle Road (19) 25/11/04

Turle Road (19) 06/08/04

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 Turle Road (19) 19 Turle Road London N4 3LZ Lead Inspector Ms Jill Marriott Unannounced Inspection 26th July 2006 10:00 Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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.V287289.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Home for adults with mental health needs, three of who may also be over the age of 65. 16/11/05 Date of last inspection Brief Description of the Service: 19 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 mental health support needs. The home accepts referrals from the statutory services. The home has five permanent members of staff, including the registered manager and provides 24-hour care. The home does not encourage the use of agency worker. Known bank staff are employed as required. The property is a semi-detached house with a small conservatory and 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. There is a range of travel facilities close by. The cost of a placement at Turle Road is £561 40p per week. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection for the year 2006/7. The inspection took place on 26/07/06 and took six hours to complete. The inspector spoke with service users and members of staff and inspected all of the key standards. The inspector also toured the building, examined records and service users files, The manager was not on site at the time of the inspection. There were four members of staff in the building. One who was leading the morning shift and one worker who was to be the only member of staff on the late shift. The inspector would like to thank staff and service users for their participation in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: Requirements have been made in respect of: The complaints procedure. The ongoing issue of redecoration. Ensuring the front of the building is kept clean and tidy. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 6 The, need to up date Criminal Record Bureau Disclosures. The need for all policies and procedures to be reviewed and up dated, including those mentioned in the report. The implementation of a yearly development-plan. 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.V287289.R01.S.doc Version 5.2 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 Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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): Standard 2 was assessed at this inspection. Quality in this outcome area is good. The process for assessing the needs of prospective service users is good. EVIDENCE: Service users living at Turle Road have been there for at least seven years. There are no vacancies at present. The home has a referral process, which was seen by the inspector. The procedure includes prospective residents visiting the home on several occasions including an overnight stay prior to moving in. The referral information collated during the assessment period includes a life history and medical needs as well as issues related to diet, cultural, religion and ethnicity. Once a decision is made regarding the suitability of the project a placement is offered on a three-month trial basis. Files show that care plans are re assessed each month to ensure that the project can continue to meet the need of each service user. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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 the following standard(s): Standards 6 7 and 9 were assessed at this inspection. Quality in this outcome area is good. Service users are consulted through out their stay about their changing needs. They are well supported to make decisions about their lives. EVIDENCE: Service users who spoke with the inspector said that they were aware of their needs assessment and spoke regularly with their key worker and the manager about any changes that may be needed to the care plan. Evidence showed that care plans are reviewed with service users each month. Three files seen by the inspector show that service users are encouraged to take some responsibility for their day-to-day lives. One care plan showed that the service user is working toward self-administration of medication. It was clear from discussion that the service user is aware of this plan. Entries seen on another file show that care workers have worked with a service user to ensure important medical appointments are kept. In-spite of all the encouragement given the person has still not attended. The appropriate steps have been taken to encourage and support this person to attend on the next Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 10 date given. The home has alerted the Community Psychiatric Nurse and the GP of the situation. Another service user told the inspector that help is always available to ensure finances are clear to them and that they know exactly what money they have spent and what they have left each day. All files tracked included up to date risk assessments regarding the making of day-to-day decisions. The staff team, generally the key worker discusses the days activities and any issues arising with each service user. Particular attention is paid to the risks involved and how these can be reduced or avoided. Risk situations are recorded and where necessary shared with the appropriate professionals. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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): Standards 12, 13, 15, 16 and 17 were assessed at this inspection Quality in this outcome area is good Service users are supported to maintain as much independence in their lives as is possible. EVIDENCE: The aim of this project is to support service user to become as independent as possible enabling them to eventually return to live in the community. Service users told the inspector that they choose their own activities one person said they enjoy going to the day centre and often have meals and coffee out in the local community. Another told the inspector she liked to paint and was encouraged to do so by the staff. Another said they enjoy going to the local pub with friends. The inspector asked if service users felt there were enough planned activities feelings about this were mixed but on the whole most felt there were. Evidence on files showed that service use are supported and encouraged to keep in touch with families and friends. In some cases this is just cards and letters, other service users visit families and friends and invite them to Turle Road. One service user appears to stay with family most of the time this Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 12 situation has been assessed and is monitored regularly to ensure the placement at Turle Road remains appropriate. It is clear from discussion and from observation of practice that service users are treated with dignity and respect at this home. Members of staff always knock on doors before entering a room and service users said that daily routines and issues are always discussed with them. The inspector was told that staff were helpful and were always around if needed. The homes menu was seen by the inspector this showed that a varied diet is offered with a choice of meals available. Service users said that they prepare their own breakfast and lunch and they take turns to help staff to shop for food, prepare evening meals, and wash up. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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): Standards 18,19 and 20 were assessed at this inspection Quality in this outcome area is good. Service users receive personal support to enable them to maintain their independence. EVIDENCE: From discussion with staff and service users and from the files seen it is clear that minimum support with personal health care is needed. However some of the service users are 70 and their needs could change very quickly. Care plans are reviewed with service users each month by key workers and any changes to care needs are noted and discussed with service users and in Staff meetings. Records show that physical and emotional, needs are assessed regularly by the appropriate medical professionals involved. The inspector saw CPN assessments on files and records of GP appointments. Care workers said that if there were any medical concerns the GP would be called immediately. The home has a medication policy and procedure this policy has not been reviewed since October 2003. The, inspector was told by the Responsible Individual that all policies and procedures are under review and copies of these will be sent to the Commission for Social Care inspection when complete Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 14 Files show the correct procedures are followed regarding medical issues. One file tracked shows various recordings regarding a service user who has not kept an appointment for “Depot Medication”, it was clear from the file that this issue has been discussed with the CPN and recordings show that the appropriate steps have been taken regarding risk to this service user. The key worker will be responsible for encouraging the service user to attend a further appointment made and the CPN will inform the home if the appointment is not kept. Another file showed that a plan was being formulated to assist a service user to self-administer his medication. Medication records show that some medication has gone missing from the home. Following an investigation it is likely that it has been thrown away with some empty tablet boxes. The incident has been discussed with all members of staff who are aware of the need to check the content of all boxes before disposing of them. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 were assessed at this inspection. Quality in this outcome area is good. The home has a complaints policy and procedure, which forms part of the service users guide to the home. Both the complaints policy and the homes protection policy need to be reviewed. EVIDENCE: The home has a complaint policy and procedure, which was seen by the inspector. This policy was appropriate but the content has not been reviewed since 2002. The inspector examined the complaints book, which included two complaints dated earlier this year. One complaint has been dealt with appropriately the other related to a member of staff being racially abused by a service user had not been resolved. It was clear from discussion with the staff team and records seen that the complainant has not received a formal response to the complaint and doesn’t know if it has been resolved. The inspector has discussed the situation with the Responsible Individual for Turle Road who has explained that the incident is still being investigated and the service user will be written to regarding the inappropriateness of her actions. The member of staff will get a formal response to the complaint. Records show that this complaint has not been dealt with, within the given timescales of the homes policy. The homes adult protection policy has not been reviewed since December 2003. The government “No Secrets Policy” was available on the staff notice board. Members of staff said they would all be undertaking POVA training within the next six months. Members of staff who spoke with the inspector Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 16 were able to describe accurately the procedure they would follow if an allegation or complaint was made related to adult protection. Service users told the inspector that they feel safe in the home and are aware that they can talk to the manager or any member of staff on duty about any concerns they may have. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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 the following standard(s): Standards 24 and 30 were assessed at this inspection Quality in this outcome area was adequate. This home is clean and comfortable but is in need of decoration and repair. EVIDENCE: The inspector toured the building and looked at two service users rooms. Both rooms had adequate furniture and a lockable cupboard for safe keeping of valuables. Service users said they were happy with their rooms but knew they needed redecoration. There was a builder on site during the inspection blocking in some pipes in one of the rooms. Some areas of the home have undergone repairs these were identifiable by the torn wallpaper around the repair. Wallpaper on the first landing was also peeling off of the walls. There were no odours evident in the house at the time of the inspection. Issues related to decoration and repair, were highlighted at the previous inspection. It is clear that service users rooms and some communal areas in this home are in need of redecoration. The requirement will be repeated. The back garden was well preserved but the front of the house was in need of some gardening work and cleaning. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 18 Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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 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): Standards 32, 34 and 35 were assessed at this inspection. Quality in this outcome area is good. Service users are supported by, a trained and competent staff group. EVIDENCE: All members of the staff group apart from one are trained to the standard of NVQ level 2 in care. The one member of staff is waiting for a date to begin the training. The staff group told the inspector that they receive regular training and have undertaken medication, first aid and food hygiene training recently. They are at present waiting for dates to attend POVA and health and safety training. From observation of practice and discussion with staff and service users it was clear that staff are very much aware of the needs of the service users and interact with them in a positive and respectful way. The recruitment policy and procedures was up dated in August 2004 and appears to be appropriate. Following the inspection the inspector visited the Human Resource Department three files were seen. All files have a Job Description and a contract of employment. Up to date Criminal Records Bureau Disclosures (CRB) were not available on all files seen. None of the files showed two references. This is because the staff group were all recruited prior to the Care Standards Act 2000. Any staff recruited in the future will have two references and a CRB disclosure prior to the post being offered. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 20 Action must be taken to ensure all that all members of staff in this home have an up to date CRB disclosure. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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 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): Standards 37, 39, 40 and 42 were assessed at this inspection. Quality in this outcome area is good. Service users are involved in the running of this home. Monitoring visits take place by the registered provider regularly each month. EVIDENCE: The manager of 19 Turle Road is registered with the Commission for Social Care Inspection. A registration certificate and insurance documents are displayed on the wall in the office at the home. Files seen included relevant documentation, including a living will and a copy of the licence agreement. Service user surveys have just been completed in this home these were seen by the inspector. Views were well documented and were very positive. Service users are also asked for their opinions during the regulation 26 visits, which take place each month at the home and in house meetings. These documents are used to inform the annual development plan for the home however this plan has not been reviewed since November 2004. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 22 A list of policies and procedures were seen by the inspector some of these were quite old and need to be reviewed. For example the complaints procedure is dated 2002 and the adult protection policy has not been revised since December 2003 the recruitment policy was apparently reviewed in August 2004 this document was not available at the home. The inspector was told that all of the homes policies and procedures including the statement of purpose are under review at present. Health and safety documents were seen and show that monitoring of health and safety in the home takes place regularly. Weekly and monthly checks of equipment take place and contractors review the fire equipment. The last inspection of fire equipment was carried out on 11/04/06 the last gas certificate was issued on 28/07/05 a five year electrical wiring certificate was issued in January 2005. Information shows that the water tanks are tested regularly for Legionella and for temperature control. Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 23 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 2 3 X Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 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 YA22 Regulation 22(4) Requirement Timescale for action 2 YA24 The Registered Person must 15/10/06 ensure that all complaints made at the home are dealt with appropriately and within the given timescales. 13(4)(a),(b),(c) The Registered Person must 30/11/06 23(2)(b)(d) ensure the décor of the home is of a good standard at all times. This refers to the decoration of communal areas and service users rooms. A plan of decoration for the home must be developed and a copy sent to the Commission. This requirement is repeated. 3 YA24 23(2)(b) 4 YA34 19(4)(b)(i) Schedule 2 (7)(a)(b) The Registered Person must ensure that the front garden of the house is kept clean and tidy at all times. The Registered Person must ensure that all members of staff have up to date Criminal Records Bureau Disclosure certification. DS0000020972.V287289.R01.S.doc 16/10/06 15/10/06 Turle Road (19) Version 5.2 Page 25 5 YA40 YA41 24 The Registered Person must ensure that all of the policies and procedures for this home are reviewed regularly and updated as necessary. The updated policies and procedures must be signed and dated by the Responsible Individual 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA16 Good Practice Recommendations To have Care Plans signed off by both key worker and resident, and in the event of a refusal to sign, to indicate the reason for refusal. The Registered Person should ensure that there is an annual development plan for the home, based on a systematic cycle of planning-action-review, reflecting the aims and outcomes for service users and which incorporates the views of service users . 2 YA39 Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 26 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 © 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 Turle Road (19) DS0000020972.V287289.R01.S.doc Version 5.2 Page 27 - 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!