Inspection on 17/10/05 for Vartry Road, 18

This inspection was carried out on 17th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vartry Road, 18 06/09/07

Vartry Road, 18 07/08/06

Vartry Road, 18 03/05/05

Vartry Road, 18 05/10/04

Vartry Road, 18 29/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Vartry Road, 18 18 Vartry Road London N15 6PT Lead Inspector Karen Malcolm Unannounced Inspection 17th October 2005 11.00 Vartry Road, 18 DS0000060634.V252147.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 Vartry Road, 18 DS0000060634.V252147.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. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Vartry Road, 18 Address 18 Vartry Road London N15 6PT 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 8693 6088 020 8299 4818 Choice Support Care Home 4 Category(ies) of Learning disability (0) registration, with number of places Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd May 2005 Brief Description of the Service: 18 Vartry Road is registered as a care home providing personal care for service users between the ages of 18 and 64 who have learning disabilities. Choice Support are the registered provider. The home provides accommodation and support for four service users and is situated in a residential area of Haringey close to shops and transport facilities near Seven Sisters’ Road. St. Ann’s Hospital is about a mile away. The stated aim of the home is to ensure for service users: presence in mainstream community life, choice, competence, participation, respect, individuality, flexibility, co-ordination with other agencies and racial, cultural and religious sensitivity. The premises consists of a two-storey terrace house with three single bedrooms on the first floor and one single bedroom on the ground floor with en suite faciilites, with the remaining being provided with washbasins. The kitchen, laundry area and dining / lounge rooms are all on the ground floor. There is a private back garden which is partially paved and grassed. The office area situated on the first floor also doubles up as a sleeping room. A second sleeping room is on the ground floor. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and lasted approximately seven and a half hours. The shift leaders on both shifts assisted the inspector throughout the inspection, which was open and positive. The manager was not available on both days of the inspection due to personal matters. Feedback was given by the inspector to the staff on shift and the service manager for Choice Support over the phone. The home supports four service users with learning disabilities. All the service users have lived in the home for a number of years, one of the service users has lived in the home since it opened. At present there are no vacancies. In the home on the day were two care staff, two service users, one relative visiting and their social worker. On day two were one care staff and one service user. Service users not in the home were at their allocated day centres and on day two one of the care staff was out shopping. Prior to this inspection the Pre-inspection Questionnaire and action plan were submitted to the Commission. Included in the package were three feedback forms, two from relatives and friends and one from a care manager. The main comments received were generally positive. The areas of concern have been addressed in the main body of this report. Part of this inspection process was to check whether the requirements from the previous inspection have been complied with, to examine three service users care plans, interview care staff and examine a number of policies and procedures and records relating to the care of the service users living in the home. The inspector was unable to interview the service users in the home due to their communication difficulties. However, the inspector was able to speak to one relative. What the service does well: What has improved since the last inspection? Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 6 At the previous inspection there were thirty-four areas of improvement and one recommendation. At this inspection twenty-nine areas of improvement had been addressed. These related to the following: • The manager had made a referral to the dietician for one specific service user. • Healthcare appointments are recorded on individuals care plans • Guidelines are now in place for one specific service user who has seizures • The baby-monitoring device in one service user’s bedroom has been reviewed with the occupational therapist. • A specific service users management risk strategies have been rereviewed with the multi-disciplinary team. • Appropriate storage cupboards in the hallway are now in place • The oven grill glass door is now replaced. • The vanity sink unit has now been repaired • The nails found in one specific service user’s bedroom wall are now removed. • Weekly records of water temperatures are now been recorded • Consultation had been made with the Learning Difficulties Consultant regarding service users healthcare. Staffing records were not examined at the time of this inspection. One recommendation identified as good practice, was not addressed by the home relating to the statement of purpose presented in pictorial format. The registered person is commended on achieving compliance with twentynine of the thirty-four areas of improvements arising from the previous inspection. What they could do better: This inspection has identified seventeen areas of improvement and four recommendations. Five of the areas for improvement have been restated from the previous report. The registered person is required to submit an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The action plan must describe how the registered person ensures that each service user is consulted appropriately with regards to their contracts. Monthly summaries are completed consistently and daily logs are completed with sufficient detail regarding individual’s daily needs. The registered person is to ensure that service users with communication difficulties are given positive choices at mealtimes and guidelines are in place to ensure that care staff follow this appropriately. The guidance notes by the occupational therapist should be followed, monitored, reviewed and evidenced and service user’s risk assessments are to be updated when any changes occur. A number of minor maintenance issues are to be addressed, the manager is to cease the practice of storing clinical waste bags in the garden and the clinical waste contract is to be reviewed. The manager is to ensure that on each shift a qualified first aider is indicated on the rota. The registered provider must submit to the Commission an application regarding the manager Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 7 and the manager must arrange a meeting with a relative regarding the health and care needs of a specific service user. The four recommendations stated in the table at the back of the report are deemed a good practice. 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. Vartry Road, 18 DS0000060634.V252147.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 Vartry Road, 18 DS0000060634.V252147.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): 1&5 Service users were confident that their needs, prior to moving into the home were assessed appropriately, which results in service users receiving a good standard of care. The home has failed to ensure that all service users who reside in the home have the opportunity to understand and agree the statement of terms and conditions provided by the home. EVIDENCE: All the service users have lived there for a number of years. One user has lived in the home since it opened. At the previous inspection two areas of improvement were identified relating to the Statement of Purpose and contracts. Both documents had been completed and amended. However, the contracts examined had a written statement in place stating ‘service user unable to sign’. The manager must make reasonable efforts to ensure the contracts are understood and accepted by the service user and/or their representative. This must be documented. Therefore the information recorded on individual’s contract is incomplete and this must be reviewed. It is also recommended that due to the service users communication difficulties the contracts should be presented in a format and language appropriate to meet individual’s needs. Vartry Road, 18 DS0000060634.V252147.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): 6&7 While service users know that their needs are assessed, the home has failed to ensure that service users monthly reviews are updated to reflect changing needs or that agreed changes are recorded and actioned. The absence of this information potentially puts service users at risks of their needs not being met. EVIDENCE: Three care plan files were examined. Key workers do not complete monthly summaries consistently. At the previous inspection it was identified that service user’s cash tins were not appropriately maintained. A guidance policy is in place for all care staff to follow with regards to checking cash tins daily. It was also identified at the previous inspection that daily log sheets are to be completed with sufficient details regarding the individual’s care. The log sheets clearly set out appropriate prompts to enable care staff to fully complete the daily logs after the shift. It was evident that a number of log sheets examined still lacked sufficient detail with regards to individual’s activities participated in and dietary intake. This was concerning since one specific service user’s dietary needs are being monitored closely by the home. This has been addressed in this report Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 11 under ‘Personal and Healthcare Support.’ Therefore this requirement is restated. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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): 12, 15 & 17 Service users engage and benefit from a full, active and social lifestyle. Service users are offered a wide range of various meals. There are concerns, however that these choices are not always recorded appropriately ensuring that individual’s health needs are being met properly. Service users are able to have appropriate family and personal relationships. Therefore service users are happy and fulfilled with their life EVIDENCE: The inspector saw a comprehensive programme of activities for each service user. This is displayed on the office wall. There was documented evidence that service users engage in a range of activities appropriate to their interests and abilities. One staff member stated that since the previous inspection all the service users have enjoyed a week’s holiday to the coast. Three service users have five-day placements at Ermine Road, a specialist day centre for people with learning disabilities, and one user is scheduled to attend three times each week, although they sometimes make the choice to attend Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 13 less often. Service users also take part in various activities including going shopping and for walks in the park. One specific service user, who was referred to the dietician, recommended clearly that the service user’s physical activities must be increased and the home should try to make a referral to the Occupational Therapist (O/T) for guidance. It was evident that service user’s weekly physical activities had not been increased and there was no evidence that a referral or contact had been made with an Occupational Therapist regarding safe and clear guidance for staff to support the individual appropriately. The menu plans and the weekly shop were examined. It was evident that the home provides service users with a healthy, nutritious balanced diet following on from the recommendations made by the dietician for one specific service user’s health needs. Foods such as fresh fruits, bran cereals, fish and low fat dairy spreads and yogurts were available. The dietician made six recommendations regarding one service user’s dietary needs, due to a complex health issue. The recommendation stated that the service user should have, fruit juice, a high fibre breakfast such as bran, to have at least five portions of fruit or vegetables a day, 6-8 glasses of water, fish such as oily fishes and low fat spreads and yogurts. This particular service user’s daily menu plans were examined. Recorded was that consistently high fibre breakfast was given to the individual, however, tea was still given as a beverage. There were no records of the individual’s daily evening meal recorded or the amount of water drunk daily. This was discussed with the staff member after the handover. It was advised that a clear account of the specific service user’s dietary intake must be recorded and reviewed. At the previous inspection it was identified that the registered persons ensure that service users with communication difficulties are given informed positive choices at meal times. Written step-by-step guidance notes were required on how this is appropriately communicated to each service user. The action plan received by the Commission prior to this inspection stated that ‘all service users will have the use of communication boards with picture cards and photographs to ensure that service users choose their meals appropriately’. Staff were asked about the picture cards and photographs. Staff stated that these are no longer in use as service users are able to make informed choice without the cards. It was not evident from the care plans and through direct observation how individuals are able to make appropriate informed choice, bearing in mind that each service user has specific communication need. Therefore this requirement is restated in this report. Two service users’ parents were in regular contact with the home, they visited regularly. One service user relative and their social worker were visiting at the time of this inspection. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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): 19 Service user’s physical and emotional health needs are met by the home. This is not always consistent, monitored or reviewed when any changes occur to an individual’s health. Therefore service users can be put at potential risk with regards to their care. EVIDENCE: The service user review records contained details of visits to the doctor, dentist, optician and other healthcare professionals such as medication and health reviews with the learning disabilities consultant. As one of the service users that has epilepsy is prescribed rectal Valium, staff have received training in its administration. A comprehensive guidance note is in place to assist staff. Records show that two service users have received treatment at the accident & emergency since the previous inspection. Copies of Regulation 37 reports have been submitted to the Commission. The service user who has a baby-monitoring device in place, regarding night time care has been reviewed with the Occupational Therapist (O/T). At the previous inspection it was identified that a specific service user, who had been admitted to hospital with complex health issues, is to be referred to a dietican, and records of actions to be kept on file and reviewed. The inspector Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 15 reviewed the written records for this particular service user. There was evidence in place that the home had sought appropriate healthcare support from a dietican however, the inspector identified that a specific service user’s care plan and risk assessment did not adquately reflect the advice given. In practice, staff were not following the advice closely enough in terms of the diet being provided. A number of requirments are re-phased and restated in this report. A service user’s relative who was visiting raised a number of concerns regarding the specific service user’s current healthcare needs and the potential risk that the user could go missing from the home. The relative stated they have raised their concerns with the staff but were not confident that these have been addressed appropriately, due to staff changes. The relative’s other concern was that the service user had developed some additional health issues over the past two weeks and felt that nothing has been done, with regards to a new mattress and input from a continence advisor. Staff spoken to state that the service user’s relative visits each Monday. They are aware of the relatives concerns and said that they do their utmost to address them with the relative. Furthermore the relative does insist during their visits that the lounge door remains open, so that they can observe the service user wandering around the home safely. A panel button keypad for the front door is in place. This is alarmed and connected to the fire alarm, if activated. The care plan for this specific service user was examined. It was evident that no risk assessments with regards to the potential for this service user going missing were on file. There was no information recorded regarding the relative’s weekly visits, and requesting the lounge door to be open during the visit. It was advised that the lounge door must remain shut at all times. The manager must arrange a oneto-one meeting with the relative regarding the lounge door and their overall concerns. The continence advisor is to be sought and a record of the action/s and recommendations to be recorded. It is also recommended that magnetic door closure or a similar device can be installed on the lounge door in view of the fact that this door is in constant use. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 16 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 Service users and their relatives know that their views are listened to and appropriate policies, are in place. However complaints or concerns are not always consistently recorded or monitored, therefore service users and their relatives cannot always be confident that their views will be dealt with appropriately. EVIDENCE: At the previous inspection it was identified that the complaint policy should be in pictorial form to guide service users with communication difficulties to complain positively. There were no records of any complaints having been received. One service user’s relative spoken to had a number of concerns regarding the care and support of their relatives. This has been addressed under the section relating to ’Personal and healthcare Support’. The Commission has received three comment cards. The feedback received was generally positive. One comment card stated that the relative was concerned with the timescale regarding their individual’s purchase of their own vehicle. At this inspection it was evident that the vehicle has been purchased. In place was clear and comprehensive guidance policy relating to ‘travel at work’, which included motability care and responsibility for drivers’, the vehicle’s logbook, who are the allocated drivers and insurance documents. It was advised that this file containing a number of confidential private documents must be kept securely and not on the shelf in the office. It was evident that the section relating to all eligible drivers was not completed. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 17 The other comment made addressed the high turnover of staff in the home. This is a corporate issue and has been addressed by the home with permanent bank staff covering required shifts in the home. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 18 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, 27 & 30 The standard of décor improved greatly therefore providing service users with a pleasant, warm and inviting environment in which to live. There are a number of minor maintenance areas that need to be addressed however. The home is clean, however, the manager needs to ensure that the home is hygienically maintained with regards to clinical waste. EVIDENCE: The house is located near to local amenities such as public transport and local shops and is comfortable and on a domestic scale. The home has a lounge/dining room on the ground floor and a spacious kitchen. The home has four single bedrooms. There is one bedroom that has quite limited useable space as it is below 9.3 sq metres. This bedroom had compensatory space in the form of additional communal space. During the tour of the home the inspector noted that the bedrooms that were seen were comfortable and well furnished and had been personalised to suit the personalities and interests of their occupants. The home’s internal structure had been recently decorated. The external structure was being decorated during the two days of the inspection. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 19 The home was found to be reasonably clean and tidy. It was evident in the bathroom, that there were no paper towels available in the dispenser. The dispenser in the separate toilet had paper towels available, however, it was difficult to access especially for the service users. The staff stated that in the past service users have taken the paper towels out and place them in the toilet, blocking the system. It was advised that a roll towel holder could be introduced. This would enable service users to dry their hands at their own leisure and the issue of paper towels blocking the toilet system would be eliminated. It was advised this system should to be reviewed. It was evident that appropriate storage in the hallway had been sought. The laundry room was found to be satisfactory. The kitchen cupboards had been repaired and the oven replaced. The lampshades were also replaced, the nails exposed in one service user’s bedroom have now been removed and the vanity unit repaired. The lounge/dinning area is clearly divided. It was identified at the previous inspection that one of the armchairs blocking one of the fire doors to the lounge was broken. It was advised that the area must be rearranged so that the door is not blocked. The action plan submitted by the manager, stated that this particular service user liked their armchair in this position and it has been this way for many years. It is required that a clear risk assessment regarding the specific service user’s needs to be addressed in the individual’s care plan. The home’s environmental and fire risk assessment must include this in the yearly report. The armchair remains worn and broken and it was evident that the large settee needs replacing too. Two minor maintenance issues that needed addressing related to R’s bedroom. The drawers under the bed were broken and a lampshade was needed. In the garden, three yellow clinical waste bags were found. The staff member stated that the contractors collect the clinical waste weekly and the clinical waste is usually kept in the bathroom until this time. In the bathroom there was one appropriate bin in place. It was advised that all clinical waste must be kept in an appropriate secure clinical waste bin. It was also recommended that the current contract should be reviewed if service user’s care needs are changing. There were a number of buckets and mops positioned in the garden. The staff member stated that each bucket has a specific use. A bucket list was on the kitchen notice board. It was not clear from the list which mops were used with each bucket. It was advised that each bucket and mop must be clearly labelled. There was a broken bicycle in the garden belonging to one of the service users. It was advised that this must be repaired or removed if not used. This must Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 20 be completed in consultation with the service user and their representative and a record of should be kept on file. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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): 33 & 35 A competent and effective staff team supports service users. The registered person however, has failed to ensure that care staff have appropriate breaks whilst working and that their training and development needs are reviewed. Therefore service users cannot be assured that the staff who support them are appropriately trained and managed. EVIDENCE: At present the staff team consists of three full-time carers. This includes the team manager, two-part time care staff and two permanent bank staff covering the vacant full time posts. The allocated care hours for the home are 260 hours per week. At present the home has a vacancy of 111 hours. The two permanent bank staff are currently covering these hours. A staffing rota was shown. It was evident that one member of staff who works full time completes on a weekly basis two long days, consisting of two fifteen hours shifts and one six hour shift. The rota shown did not clearly indicate whether or not care staff receive appropriate breaks, especially the member of staff who works fifteen-hour shifts. At the previous inspection it was identified that personnel records are to be maintained in the home. The inspector was unable to inspect these documents at the time due to the team manager not being available. The inspector plans to inspect these at future inspections. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 22 Copies of training information were submitted to the Commission along with the Pre-Inspection report prior to this inspection. It was evident that staff have undertaken a number of training opportunities including infectious diseases, breakaway/diffusion, epilepsy, challenging behaviour, appraisal, diversity, ‘values team day’, fire safety and key worker. Staff spoken to confirmed this. It was evident that a number of courses listed attended by care staff were out of date and training such as adult protection, moving and handling, first aid, food hygiene and NVQ in care were not included. It is advised that the training needs of individual care staff must be reviewed. On each shift there must be a qualified first aider and this is to be indicated on the rota. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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 & 42 The registered provider has failed to ensure that the there is a manager in post to ensure that the service users benefit from a well run and managed home. Service users health and safety are being regularly reviewed and monitored. EVIDENCE: The team manager has been in post for a number of months. During the inspection the team manager was unavailable. It was not evident whether the registered providers had submitted to the Commission an application to register the manager. The health and safety certificates were all in place. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. It was identified that all areas of potential risk regarding fire were addressed appropriately. In place was a comprehensive environmental and fire risk assessment format, which was very impressive. The last annual environmental and risk assessment checks were completed in August 2004. It was advised that this must be updated to include the relative’s concerns as Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 24 addressed under ‘Personal Care and Support’ and the fire door that is not in use being blocked by an armchair. At the previous inspection it was identified that the home had an infestation of cockroaches in the kitchen. It was evident that the manager had consulted with the pest controllers, since a number of traps were visible. Weekly water temperature checks are completed. The fax machine not working at the previous inspection is reported to be in working order at the time of this report being completed. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 2 Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 X 2 X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 X 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X 2 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Vartry Road, 18 Score X 2 X X Standard No 37 38 39 40 41 42 43 Score 2 X X X X 2 X DS0000060634.V252147.R01.S.doc Version 5.0 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 YA5 Regulation 5(1)(b) Requirement The registered person must consult with each service users or their representative on their behalf regarding their contract/statement of terms and conditions between the home prior to the contract being signed and dated. The registered person must ensure that monthly summary reports, completed by care staff on behalf of the service users are completed monthly and these are monitored and reviewed. (Previous timescale of 30th July 2005 not met) The registered persons must ensure that each service users daily log sheets are kept up to date. The daily log sheets are to be completed in full, detailing all the events, activities, incidents that are required on the sheet. The registered person should monitor and review the daily log sheets to ensure they are being completed. (Previous timescale of 30th DS0000060634.V252147.R01.S.doc Timescale for action 30/12/05 2. YA6 15(2)(b) 30/12/05 3. YA6 17(1)(a) 30/12/05 Vartry Road, 18 Version 5.0 Page 27 June 2005 not met) 4. YA17 16(2.i) 15(2.b) The registered person must ensure that service users with communicational difficulties are given informed positive choices at mealtimes. Written step-bystep guidance notes on how this is appropriately communicated to each service user is to be on file. This is to be reviewed and monitored by the registered person. (Previous timescale of 30th June 2005 not met) The registered person must ensure that the Occupational Therapist (O/T) guidance notes as set out in a specific service user’s care plan is followed, monitored and reviewed accordingly. Records of the outcome must be kept on file. (Previous timescale of 30th August 2005 partially met.) The registered person must ensure that the risk assessment for a specific service user care and health needs are up dated accordingly. The risk assessment is to detail accurately the action taken and how this is to be monitored and reviewed by the home. The registered person must ensure that the specific service user whose bed drawers under the bed were broken are repaired or replaced. The registered person must replace the lampshade that is missing from one service user’s 30/12/05 5. YA19 17(1.a)Sch 3(2.m) 30/12/05 6. YA9 14(2) 30/12/05 7. YA27 23(2)(d) 30/12/05 Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 28 bedroom. 8. YA30 13(4)&16 (2)(k) The registered person must ensure that all buckets and mops kept in the garden are clearly labelled to indicate which area of the house they are to be used in. 30/12/05 9. YA30 The registered person must ensure that the paper towel dispensers have at all times a supply of paper towels. 13(4)(a)(c) The registered person must cease the practice of storing clinical waste yellow bags in the garden. The registered person must review the current clinical waste contract, to ensure that clinical waste bags are stored appropriately. The registered person must ensure that on each shift there is a qualified first aider. The named care staff must be indicated clearly on the rota. The registered person must review each of the care staff training and development needs. Training such as adult protection, food hygiene and manual handling must be reviewed. The registered person must ensure that care staff have appropriate breaks. The registered person must submit to the Commission as soon as possible the application of the current manager in post, to register as the manager of DS0000060634.V252147.R01.S.doc 30/12/05 10. YA35 13(4) 30/12/05 11. YA35 18(1)(c)(i) 30/01/06 12. YA33 WTD1998 30/01/06 13. YA37 8&9 30/12/05 Vartry Road, 18 Version 5.0 Page 29 14. YA22 15(1) 15. YA42 13(4) 16. YA19 12(1)(b) Vartry Road. Notification that the application has been submitted must be made to the lead inspector. (Previous timescale of 30th August 2005 not met.) The registered person must 30/12/05 arrange a meeting with a specific service user and their relative with regards to their health and care. Records of the meeting held must be kept on file and action from the meeting reviewed accordingly. The registered person must 20/11/05 ensure that all fire doors are able to effectively self –close at all times and are not wedged open. The registered person must seek 30/11/05 advice with the continence advisor regarding the specific service user whose care needs have changed recently. Evidence and advice given must be recorded and kept on file. The registered person must purchase a new mattress for the specific service user whose care needs have changed. The registered person must consult with the specific service user or their representative and take appropriate action regarding the broken bicycle that is being stored in the garden. 17. YA24 23(2)(c) 30/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000060634.V252147.R01.S.doc Version 5.0 Page 30 Vartry Road, 18 1. Standard 5 2. 3. 30 42 4. 7 It is recommended that the registered person should review the current contracts in place to reflect the communication needs of the service users who reside in the home. The registered person should review the current use of the paper towel dispensers. Magnetic door hold or a release mechanisms fitted to any fire doors in the home that young people/staff members routinely prefer to leave open for extended periods of time during the day or night should be considered. Alternatively the registered person should consult with the London Fire Emergency Planning Authority (LFEPA) with regards to risk assessment in relation to the safety aspect of having fire doors remaining open. It is recommended that the registered person should seek professional advice for example an advocate, with regards to ensuring that service users’ rights to make decisions are upheld. Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Vartry Road, 18 DS0000060634.V252147.R01.S.doc Version 5.0 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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