Inspection on 07/08/06 for Vartry Road, 18

This inspection was carried out on 7th August 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 18 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 17/10/05

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 Key Unannounced Inspection 7th August 2006 10:25 Vartry Road, 18 DS0000060634.V296735.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 Vartry Road, 18 DS0000060634.V296735.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. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 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.V296735.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 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 is 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 facilities, 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. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. “The cost of placements is £1,133.44 per week. Following “Inspecting for better lives” the provider must make information available about the service, including inspection reports, to service users and other stakeholders. Additional cost are for water cooler, massage therapy and chiropodist. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and lasted approximately six hours. The manager assisted the inspector throughout the inspection, which was open and positive. The inspector gave feedback to the manager. 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 two other visitors. Service users not in the home at the time of the inspection were at their allocated day centre. Prior to the inspection report being completed a relative received one-comment card. The comment made by the relative related to staffing levels. They commented that they have raised this matter before but felt that this remains an issue. The relative also stated that they do not have access to a copy of the home inspection report. Other questions raised were seen as positive. Part of this inspection process was to check whether the requirements from the previous inspection have been complied with, to examine two 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 at the time of the inspection, due to their communication difficulties. Overall the inspector’s impression was that the home remains well managed and some progress has been made to meet a number of areas of improvement from the last inspection. The manager that was very open and helpful throughout the inspection What the service does well: Vartry Road provides a good level of support to four people with learning disabilities and communication difficulties in the community. All service users have lived at the home for a number of years. The service users all attend a day centre except on the weekends. Weekend activities are planned in advance and all service users receive an annual holiday supported by the home. Each service user has their own bedroom that reflects individual’s taste and style. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: This inspection has identified nineteen areas of improvement and nine recommendations. Four areas for improvement have been restated from the previous report. These relate to keeping documentations of meeting held, ensuring training records are kept up to date and seeking further advice from a continence advisor. 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. . Under ‘Individual Needs and Choices’ regarding service users care plans and decision-making relating to service users finance must be addressed to that service users are not at risk from harm. The financial arrangements in place for service users must be reviewed to ensure service users are fully protected. Under ‘Lifestyle’ service users’ needs are being appropriately met however, service users’ religious beliefs must not impinge on other service users’ needs and a log of all visitors must be recorded. Under ‘Personal and Healthcare Support’ the manager must seek professional advice with regards to ensuring that individual service users needs are being fully addressed particularly these service users who refuse treatment. Under ‘Concerns, Complaints and Protection’ it was evident that the manager has no recorded information on a discussion with a specific service user’s relative. This was required at the previous inspection therefore this requirement was restated. It was also evident that support staff had not undertaken Protection of Vulnerable Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 7 Adults (PoVA) training. Under ‘Environment’ there were a small number of minor replacement and repairs needed. Under the outcome for ‘Staffing’ it was evident that these documents were poorly kept. Under ‘Conduct and Management of the Home’ it was evident that quality assurance is completed by the organisation. The manager post had been recently advertised and the outcome this is awaited. Unmet requirements impact upon the health and safety of service users. Failure to comply with the timescales will lead to the Commission for social Care Inspection considering enforcement action to secure compliance. The five 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.V296735.R01.S.doc Version 5.2 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.V296735.R01.S.doc Version 5.2 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): 2&5 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. 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. However, 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 four service users have lived at the home for a number of years. One user has lived in the home since it opened. The home is for service users with learning difficulties. At the previous inspection it was required that the registered person consults with each service user or their representative on their behalf regarding contract/statement of terms and conditions between the home. At this inspection it was evident that a contract with the Housing Association and Choice Support were on file. Both documents were signed and dated. However, the contract by Choice Support was not on headed paper and the contract mainly pertained to individual’s fee contribution, and did not clearly state what the overall care was being provided by the home. Therefore it was clear as to what care packages individual were being supported for. It was also required at the last inspection that the manager must make reasonable efforts to ensure that the contracts are understood and accepted by each service user and/or their representative especially those service users with Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 10 communication difficulties. It was the opinion of inspector that although service users had signed each document it is likely that they did not fully understand the content of what was being written. Therefore this requirement is restated and amended in this report. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 11 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 & 9 Quality in this outcome area is poor. This judgement has been made using evidence gathered both during and before the visit to this service. Each staff care plan includes a comprehensive risk assessment. Key working system enables staff to establish special relationships with individual service users. Service users make decisions about their lives with assistance as needed. However, with regards to individual’s personal finance this is unclear as to whether individuals are advised. Therefore service users could be at risk from financial abuse. EVIDENCE: Two care plans were examined. Each service users has a named Key worker. Monthly summaries and daily logs have improved since the last inspection and the care staff complete these consistently. Risk assessments have been updated and evidence of this was on file. This is a great improvement from the previous inspection. At this inspection it was evident that one of the two service users missing person picture on file was not a current picture. This should be replaced. Reviews were discussed with the manager. It was evident that two reviews are planned over the next two weeks. In further discussion with the manager Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 12 it was evident that all service users’ care and support needs have changed since the last inspection. This was due to many factors. One issue related to one service user who constantly refuses medical intervention, evidence of which was recorded on file. Three service users have difficulty in sleeping during the night. The manager stated that this has been an on going issue although this was the first time it has been highlighted as a concern to the inspector. The service users’ poor sleeping patterns are having an adverse effect on support staff completing their sleeping-in duties. Due to this the manager has completed a risk assessment for one specific service user who needs at night have become a health and safety issue. The areas of risk for this specific individual are: • Tripping, slipping or falling on the stairs or in the bathroom area • Flooding the bathroom at night • Disturbing others by banging and slamming doors • Lack of sleep during the night The outcome of monitoring records was that the specific service user is up several times during the night. The service user’s night time care needs, is that one to one support is needed and the service user has very little sleep, despite being prescribed a mid anti-depressant. The service manager along with the home manager have written a letter to the Commissing Officer with regards to ‘Request for night-wake support needs assessment at Vartry Road’ to increase the care hours and change the current sleeping-in to waking night. It is the opinion of the inspector that the overall assessment of each service users needs must be addressed alongside their night time care needs. The other areas of risk relate to individual’s healthcare need, which is in some instance becoming a crisis as service users are constantly refusing treatment pertaining to their health. Therefore the inspector is requiring the registered person request from the placing authority a thorough review of need for each service users placed in the home to ensure the correct care plan is in place and that the home can meet individual changing needs. Along with this the manager must up-date each service users care plan, to ensure that all changing needs have been highlighted and appropriate arrangements are in place to minimize any potential risks. Due to the service users communication needs it is difficult for the home to ensure that individual right’s to making positive choice with regards to their rights and particularly their healthcare is not always up-held appropriately. In discussion with the manager it was evident that at least two relatives play an important part in their loved one lifes, ensuring that their rights are upheld. However, sometimes this can be difficult as the relative choices may be their own opinions rather than that of the individuals’. The home has sought, advice and support for one specific service user via an independent advocate. This has been an excellent process as the advocate was able to locate the service user’s next of kin. However, due to the demand on this service, the specific service user is no longer entitled to this service. The manager is seeking further support and advice through the local Learning Disability Team. The Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 13 home also had additional support via the Learning Disability’s lead consultant, however the consultant has now left and this service is unavailable. The manager states that this support is now completed by the individual’s GP. It was advised that support staff could be trained to ensure that the individual is being given informed and positive choices with regards to all aspect of their care. One service user’s financial records was examined. The manager informed the inspector that the service manager of the organisation is the appointee for each of the service users. All service users have individual accounts; however, information pertaining to these was kept at Head Office. Each service user has two financial books kept in the home. One pertains to income and the other to all expenditures. Requests for personal money is made by the home on a request sheet, one copy is sent to Head Office and one copy remains on file. The inspector tracked a number of transactions recorded. In discussion with the manager she explained how the system of personal monies is requested and what expenditures are made. Personal monies are check daily by the shift leader before a shift begins. One request for money related to a water bill, which was shared by each service user in the home. The manager explained that prior to Choice Support taking over; the home had a water cooler provided by the previous care providers. However, payment for this was withdrawn. One relative requested that this should be replaced. The organisation agreed to this, but charged the cost of this to the service users. A number of expenditure related to a charge of £29.40 stated ‘contribution to food’. The manager explained that each week each service users contributes £29.40 towards the weekly food budget and Head Office contributes £13.50 for staff cost. This practice is reported to have been in operation since the organisation took over approximately two years ago. It was advised that food cost must be incurred in the home’s allocated food budget. The inspector is concerned at the practice of obtaining the weekly food budget from individual service users’ personal monies and obtaining the cost of the water cooler bill from each service users. The registered person must have on each service users contract a clear account of accommodation fees. This is to include the fees paid by the placing authority, each individual’s contribution and the method of payment made. Further enquires are to be made by the Commission in respect of this practice. The other concern relates to the high cost of £30 per week for one specific service users massage sessions. It was advised that the manager should ensure that this activity is reviewed six monthly, to ensure that the activity in place remains beneficial and cost effective for the individual concerned. Evidence of this must be recorded on the individual’s file. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to this service Service users engage and benefit from a full, active and social lifestyle. Service users are offered a wide range of various meals. 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. The manager stated that since the previous inspection one service user has enjoyed a week’s holiday to the coast and all the service users are going on holiday in September for a week. Individual service users contribute to the cost of their holidays. 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 less often. Service users also take part in various activities including going Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 15 shopping and for walks in the park. On the day of the inspection there were no activities planned for the two service users who were at home. One service user had their relative visiting and other guests. The manager informed the inspector that this specific service user’s father had recently died and the service user’s relative was holding a small ceremony in the home at the request of the relative. The home has one shared communal space, which is adequately sized. It was discussed whether the permission of the other service users was requested, considering that the one service user was in the home of a Muslin faith although not practicing. It was the opinion of the inspector that this must be discussed with the relative sensitively. Apparently the manager stated that this is a regular request. It was also advised whether or not alternatives arrangements could be made to ensure that the individual service users’ needs are met. Due to the circumstances the inspector did not speak to the relative visiting. Within the service there is evidence of a reasonable awareness and understanding of equalities and diversity. The visitor’s book was examined. It was evident that the three visitors that came after the inspector had not signed in the book. The home has a strong commitment to enable service users to develop their skills including social, emotional, communication and independent skills The home has a visitor’s book in place. However, the relative and their guest had not completed this. It was advised that the staff could complete this on the relative’s behalf as long as there is a record maintained by the home. The menu plans was examined. It was evident that the home provides the 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. Menu plans are completed daily on individual daily logs under each section. It was evident that service users have a regular supply of water in the home as the water fountain is in the lounge area. A requirement with regards to the water fountain has been made. At the previous inspection it was required that the registered person ensures that service users with communicational difficulties are given informed positive choices at mealtimes. Written step-by-step guidance notes on how this is appropriately communicated to each service user is to be on file. The manager stated that she had tried to contact the speech and language therapist who wrote to the specific service users stating that they are on a waiting list. The manager in the meantime has contacted the day centres individuals attend and got some advice on what ‘Objects of Reference’ they use with the service users. This has been transferred this into the home. On the wall in the lounge/dining area above the dining table was a poster with some ‘Objects of References. However, it was evident the information on the poster was limited and some more work was needed. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users know that their healthcare needs are being addressed within the home. However, this is not always consistently, monitored or reviewed when any changes occur to an individual’s health. Therefore service users can be placed at potential risk with regards to their overall care. The home’s has a good medication policy and procedure administered by competent and trained staff. Therefore service users know that they are safe and protected. EVIDENCE: The staff team adheres to medication procedures. Medication is supplied in blister packs and is colour code for each times of the day. Records of Medication Administration Records charts were examined; these were found to be in good order. Therefore service users are protected by the home’s policies and procedures. . Healthcare notes are maintained. One service user’s care plan was case tracked. The specific service user has a number of health problems, which the home is trying to manage, however the individual constantly refuses medical appointments. Since the last inspection this specific service user has had five Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 17 appointments with the chiropodist, dentist, GP and optician. Following each appointment the information recorded that an individual refused treatment. One appointment related to a personal issue and pessaries were prescribed. In discussion with the manager it was evident that the staff administered this medication, due to the service user’s communication difficulties it was not possible to establish their consent to this. It was advised that staff could only administer this type of prescribed medication if they are appropriately trained and deemed competent to do so, and that appropriate guidance is in place. There was no evidence that staff have undertaken this. Upon reading the healthcare records. There was one incident recorded relating to a service user being injury on their head. It was not evident from the records, the specific of the incident, what action was taken and if there was any follow-up regarding the service users health care. This was evident on a number of healthcare forms read by the inspector. A service user had a severe cut to their head the cause was unknown. The records in place were not clear as to where the injury was. However, service user went to the local hospital and treatment was given. It was evident on a number of healthcare records examined that specific information regarding the appointment, treatment given, action taken and whether there is any follow-up had been omitted. This was addressed with the manager at the time of the inspection. At the previous inspection it was required that registered person seeks advice with the continence advisor regarding the specific service user who care needs had changed recently. In discussion with the manager this has been completed and appropriate continence aid had been supplied for the individual. However, the types of continence aids provided may not suit the individual needs at night due to the individual not been able to support themselves during this period. Therefore it was required that the manager seeks further advice from the continence advisor regarding this specific service user. Two staff have attended a communication awareness course, which is organised by the local authority’s learning disabilities team. The manager is waiting for further training course for the rest of the staff. It was advised that the staff that have attended should share what they have learnt to the rest of the team. Weight charts of individuals are kept. However, the reason/s why this is in place nor what is the individual’s appropriate target weight was not recorded. Since 20/08/05 to 30/07/06 the specific service user has lost over one stone. All service users are on a healthy-eating plan and this specific service user has a walking programme which they complete daily. The findings in this outcome group are that service users’ health care needs are met within the home. Healthcare needs are monitored; however, appropriate action and intervention needs to be reviewed by the manager, to Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 18 ensure that the individual service users’ healthcare needs are being fully addressed Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 19 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 & 23 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users and their relatives know how to complain 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 listened to or acted on appropriately. Service users are protected by policies and procedures pertaining to abuse. However, the staff supporting are not appropriately trained to report and recognise the signs of abuse. Therefore service users maybe at risk from harm if the correct procedures are not always followed. EVIDENCE: At the previous inspection it was required that the registered person arranges a meeting with a specific service user and their relative with regards to their health and care needs and a number of concerns the relative had. It was also required that a records of meetings held must remain on file. In discussion with the manager it was evident that although contact has been made with the service user’s relative no record of what was discussed or actioned had been made. The manager stated that a number of the conversations were over the telephone. The home does have a separate complaints log regarding the specific relative complaints as home feels they need to have accurate accounts. In the complaints log two of the four complaints recorded related to the specific service user’s relative. However no record of the outcome of the complaint was recorded in the logbook. The manager showed the inspector two letters, which were kept in a drawer in the office of the response to two of the complaints recorded. Head Office addressed these complaints. It was advised by the inspector that any records of complaints made by a service user Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 20 or any other person, must have including detail of the investigation, action taken and outcome. The home must ensure that all complaints are responded to within a set timescale upon a receipt of a complaint. The organisation has amended its abuse policy to be in line with the local authority’s procedures. This was impressive. In discussion with the manager it was evident that Protection of Vulnerable Adults (PoVA) training had been undertaken by the manager, however, the remaining staff team had not undertaken this training. Four staff confirmed this during the handover. This was concerning since at the last inspection, this was a requirement. The manager also stated that the Choice Support is organising training for all staff with regards to PoVA. However, no dates were set. A requirement for training has been made under the outcome group ‘Staffing’ in this report. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 21 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 Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to this service. The standard of décor improved greatly therefore providing service users with a pleasant, warm and inviting environment in which to live. The home is well lit, clean and tidy. There are a number of minor maintenance areas that need to be addressed however. 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, 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 was found to be reasonably clean and tidy. The laundry area was also found tidy too. The home provides a physical environment that is appropriate to the need of the service users who live there. The old armchairs and sofa were replaced with new comfortable ones. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 22 The areas of concern relating to the maintenance of the ground floor toilet flooring and the dustbins in the front of the home, which were over flowing. The manager stated that the local council had not completed a collection of the bin last week. It was later found out the local authority was on strike. The communal carpet in the hallway and lounge were worn and in need of replacing. The manager stated that the Occupational Therapist (OT) had completed a referral for a walk-in bath for the service users changing needs. It is reported that the Occupational Therapist is going to write to the housing association. At the previous but one inspection it was required that the registered persons reviews the baby monitoring device in a specific service users bedroom. This was completed by the home and OT called the Commission to state that the device was suitable. However, in disucssion with the manager it was evident that this device wasn’t suitable. Therefore it is required that the registered person completes a risk assesment on why this device is not now suitable and seeks athernative arrangements that would suit the service user private needs. At the previous inspection it was evident that the clinical waste was stored appropriately and mops were appropriately labelled to indicate which mop is use for which area. Garden areas looked more inviting and comfortable for service users to access at their own leisure. The lounge/dinning area is clearly divided; however, this is the only communal area for service users and visitors to use. Therefore this could be a problem with regards to privacy. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 23 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): 32, 34 & 35 Quality in this outcome area is poor. This judgement has been made using evidence gathered both during and before the visit to this service. The home support and encourage the development of a competent staff team. Training provided needs reviewing. Training provided tends to be internal. There is a comprehensive training plan and much of the training is out of date. The home’s recruitment procedures are poorly maintained by the home and a number of relevant information is missing. Therefore service users are not fully supported or protected by the home’s recruitment policy and practices. EVIDENCE: At present the staff team consist of seven support workers, this includes the team manager. Two-part time support worker and two permanent bank staff covering the vacant full time posts, two support workers are currently on maternity leave and one is due to return to work soon. The allocated care hours for the home are 260 hours per week. A copy of the staffing rota was shown. The manager stated that the bank system is very good. As part of the inspection procedure, the inspector observed the staff handover. The process was very detailed. After the handover the inspector asked a number of questions regarding supervision, service users care plan information, changes to individual service users’ healthcare needs, training and staff morale. It was evident that support workers were knowledgeable about individual care needs and all stated they had received regular supervision. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 24 However, changes, with regards to a specific service user’s healthcare need were discussed. Four staff personal records were examined. The findings are that one-bank staff personal records were not available. The manager explained that this specific bank worker mainly works at another care home within the organisation. Two of the four personal records did not have Criminal Records Bureau (CRB) certificate on file, three records did not have an application in place and none of the staffing records contained references. The findings were that the manager maintained staffing records poorly. Training was discussed and it was evident that over 50 of the staff team have completed an NVQ level 2 and above. The manager stated that the organisation provides a number of in house training for staff. Staff spoken to state that the training received is very good. Although support staff have undertaken a number of courses, such as infection control, manual handling, first aid, fire awareness and food hygiene it was evident from the records that a number of the staff training undertaken was in need of up dated. It was advised that the manager checks all records and ensure that staff training is up-dated. The manager completes supervision it was advised that supervision should follow the format as set out in 36.4 of Care Homes for Adults (18-65) NMS, as that the information recorded was very brief. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 25 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, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. The management of the home is satisfactory and overall the records are well managed. Service users’ are assured that their health and safety is promoted and protected. Therefore service users’ health, safety and welfare is always fully promoted and protected. The home is run in the best interest of the service users, as the management and staff ensure service users’ needs are up most in the day to day running of the home. EVIDENCE: The manager has been in post for over a year. Since being in post the inspector has only corresponded to the manager over the phone or via letters. The acting manager stated that the home’s manager’s post has been advertised and interviews were held the previous week. However, the acting stated that she has not heard what the outcome is of her interview, as there were a number of candidates who had applied. The acting manager has the necessary experience to run the home. The acting manager trains and develops staff that is generally competent and knowledgeable to care for Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 26 service users. The service is planned to be user focused and generally works in partnership with families of service users and professionals. The home has developed a health and safety policy that generally meets health and safety requirements and relevant legislations. Policies and procedure are in place. The organisation undertakes yearly quality assurance questionnaires, results of which are published. The health and safety certificates were all in place. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 27 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 3 X Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 28 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 amend the current contracts in place to ensure they cover the matters that are in National Minimum Standard 5.2. (Partially met within the timescale of 30/12/05) The registered person must review each of the care staff training and development needs to ensure that they are up to date. Training such as food hygiene, infection control, fire awareness, first aid and manual handling must be reviewed to make sure it is current. (Previous timescale of 30/01/06 not met.) The registered person must ensure that a record of all meetings held with a specific service user’s relative is kept on file. This is to include telephone conversation and any action taken. (Previous timescale of 30/12/05 not met.) Timescale for action 30/09/06 2. YA35 18(1)(c)(i) 30/09/06 3. YA22 15(1) & 22 20/09/06 Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 29 4. YA19 12(1)(b) 5. YA7 13(4)(b) 6. YA7 13(4)(b) 7. YA7 5(1)(b) 8. YA7 15(2)(b) 9. YA12 12(4)(b) The registered person must ensure all complaints logged are actioned and recorded appropriately. The registered person must seek further advice with the continence advisor regarding the specific service user whose care needs have changed recently. (Partially timescale of 30/11/05 not met) The registered person must cease obtaining the cost of the water cooler bill from each of the service users in the home. The cost of the water cooler must be incorporated in the home’s overall budget. The registered person must cease the practice of obtaining the weekly food budget from service users personal monies. The registered person must have on each service users care plan a clear account of each service users accommodation fees this is to include the fees paid by the placing authority, each individual’s contribution and the method of payment made. The registered person must ensure that the specific service user’s massage activity is regularly reviewed, to ensure that the activity in place remains beneficial and cost effective for the individual concerned. The registered person must ensure that service users wishes with regards to religious beliefs do not impinge on others in the DS0000060634.V296735.R01.S.doc 30/09/06 20/09/06 20/09/06 30/09/06 30/10/06 30/09/06 Vartry Road, 18 Version 5.2 Page 30 home. 10. 11. YA15 YA19 17(2) Schedule 4.17 13(1)(a) The registered person must maintain a record of all visitors to the home. The registered person must seek professional advice with regards to ensuring service users healthcare needs are being addressed appropriately especially those service users who are at times refusing treatments. The registered person must ensure that all healthcare records are specific to the treatment given or appointment attended. For example the action taken and whether or not there is/was any follow-up action required. The registered person must ensure that the specific service users weight chart has in place guidance regarding target weight and the reason why the individual is on a healthy eating plan. The registered person must ensure that all staff undertake Protection of Vulnerable Adults training (PoVA). This must be in line with the local authority’s procedures. The registered person must replace the communal carpet in the home, especially the hallway and the stair areas. The registered person must address the flooring in the ground floor toilet as this is becoming hazardous for service users to access independently. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 31 30/08/06 30/10/06 12. YA19 13(1) & 17 30/09/06 13. YA23 13(6) 30/09/06 14. YA24 23(2)(d) 30/10/06 15. YA24 12(1)(2)(4)(a) 16. YA35 7, 9, 19 Sch 2.7 17. YA35 7, 9, 19 Sch 2 18. YA17 16(2)(i) 15(2)(b) The registered persons must review the baby monitoring device in the specific service users bedroom. This is to include, obtaining an alternative device that is more suitable for the individual needs with regarding the service user’s privacy/freedom. The registered person must not employ any further person to work in the care home in any capacity without first obtaining a satisfactory CRB Disclosure check including a POVA check along with other information required by regulation. All staff employed since 27th July 2004 without an enhanced CRB Disclosure that includes a POVA check, must only work under the individual and direct supervision of a named staff member who has been appropriately checked The registered person must ensure that recruitment procedures are followed and evidence of this is available on each staff members file. The registered person must complete the ‘Objects of Reference poster. 30/10/06 30/09/06 30/09/06 30/09/06 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 YA5 Good Practice Recommendations The registered person should ensure that the DS0000060634.V296735.R01.S.doc Version 5.2 Page 32 Vartry Road, 18 2. YA20 4. 5. 6. YA36 YA42 YA17 7. YA37 8. 9. YA7 YA12 contract/statement of terms and conditions between the home and the service user is on headed paper. If any service user is prescribed any pessaries the registered person must ensure that on the care plan, clear instruction by the district nurse as to how the medication is administered. Consent given by the service user or their representative on their behalf with regards to care staff administering their medication must be in place. Only care staff that are trained by the district nurse can administer the medication. A listed of all trained care staff is to be placed on the front of the specific service user’s Medication Administration Records chart (MAR), with the dates of training undertaken. The registered person should ensure that supervision follows the format of the 36.4 of the Care Homes for Adults (18-65) NMS. It is good practice to have on each shift at least one staff member who is a qualified first aider. It is good practice for support staff that have on alternative course to share the skills they have learnt within the staff team. As this could enable the staff to work better with service users needs. When the new manager has been appointed 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 Vartry Road. Notification that the application has been submitted must be made to the lead inspector. The registered person should consider giving the manager access to the home’s financial budget. The registered person should discuss with the specific relative about their relative’s religious beliefs and look at alternative and suitable places to accommodate the individual religious ceremonies when they occur. Vartry Road, 18 DS0000060634.V296735.R01.S.doc Version 5.2 Page 33 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.V296735.R01.S.doc Version 5.2 Page 34 - 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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