Inspection on 01/05/08 for Whittington House

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Adequate service.

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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whittington House 24/10/08

Whittington House 11/09/07

Whittington House 05/04/07

Whittington House 12/10/06

Whittington House 06/04/06

Whittington House 15/08/05

Whittington House 29/04/05

Whittington House 15/09/04

Whittington House 24/05/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Whittington House 46 Dongola Road London N17 6EE Lead Inspector Susan Shamash Unannounced Inspection 1st May 2008 11:00 Whittington House DS0000010799.V362634.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 Whittington House DS0000010799.V362634.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. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whittington House Address 46 Dongola Road London N17 6EE 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 8376 9219 F/P 020 8376 9219 Mr Francis Cleland Mr Francis George Cleland Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2007 Brief Description of the Service: Whittington House is owned and managed by a private individual, Mr Francis Cleland who owns a number of similar small homes in the North London area. The home is registered to provide a service to up to three people with mental health problems. Current weekly fees as of May 2008 are £750 - £1500. The home is located in a densely populated area off Philip Lane, close to shops, pubs, the post office and other amenities. The home was opened in August 1999 and consists of a two-storey Victorian house with a newer, ground floor extension that is used as the kitchen. All the homes three bedrooms are single although none have en suite facilities. It is on an ordinary domestic scale and fits in well with the surrounding area, with a conservatory and small garden to the rear. The homes aims and objectives state that it provides support for residents to be part of the local community and to develop leisure and social activities. Inspection reports are made available to residents by them being informed when new reports have been received, and that they may ask to see the office copy whenever they wish to. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection lasted approximately five hours and was carried out as a routine unannounced visit to the home and in order to check on compliance with the requirements made at the previous inspection. There were two people living in the home and I was able to speak to both of them. One resident had moved out of the home and no new residents had been admitted since the previous inspection. I was assisted throughout, by one staff member, and the manager was also available briefly during the visit. I also spoke to three relatives of one resident, who visited the home during the visit. I spoke to two staff members and the registered manager and observed residents’ relationships with staff and each other. I conducted a tour of the premises and inspected resident’s and staff files, health and safety records and other records relating to the home’s management in order to gain an understanding of people’s experience at the service. What the service does well: Feedback from residents indicates that they are generally happy with the way they are supported at the home. The home’s main strength is at supporting residents who are relatively independent, to maintain and improve their living skills, whilst respecting their privacy. All residents have care plans that are reviewed regularly and are consulted about these. The home provides culturally appropriate foods to residents according to their preferences. Staff members are generally knowledgeable about their roles and responsibilities within the home, and are welcoming to visitors. A relaxed and pleasant atmosphere is generally provided at the home, with good relationships formed between staff and residents. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: More detailed information should be recorded in care plans and updates, to evidence that people receive regular support in meeting their goals. There is still a need for further consultation with one person regarding their food preferences, to ensure that they are satisfied with food served at the home. People living at the home should be encouraged to visit the optician regularly, and a number of improvements are needed in the storage, recording and administration of medicines, to ensure that their health needs are met. A record must be available for recording any complaints or concerns raised about the home, to ensure that these are taken seriously. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 7 The unoccupied room at the home must be fully cleaned and redecorated to eliminate the unpleasant odour. An immediate requirement was made regarding recruitment procedures, and no new staff member may commence work at the home until all appropriate recruitment checks are carried out, in order to safeguard people living at the home. Staff must be provided with current training in first aid and food hygiene to ensure the safety of people living at the home. More efficient management of the home is required to ensure that all agreed appointments are honoured, to ensure that the rights of residents and their relatives are respected. It remains required that the home’s quality assurance system be further developed to incorporate the views of people living at the home, visitors and health and social care professionals. Finally a satisfactory electrical installation certificate must be obtained for the home to ensure the safety of people living and working at the home. 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. The summary of this inspection report can be made available in other formats on request. Whittington House DS0000010799.V362634.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 Whittington House DS0000010799.V362634.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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home can be sure that their needs and goals will be assessed appropriately prior to their admission to ensure that these can be met. EVIDENCE: The staff member on duty advised that no new residents had been admitted since the previous inspection, although one resident had moved out of the home into alternative residential care accommodation. This was later confirmed by the manager and people living at the home. Each person’s care plan included assessments of their individual needs including lifestyle choices, religious and emotional needs. These assessments were seen to inform the care plans available for each person living at the home as appropriate. People living at the home confirmed that they were consulted about their needs and preferences. There were records of the support provided to residents, and progress made on working towards their individual goals, although there remains room for Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 10 improvement in this area as described under Standard 6. Residents spoken to indicated that they received support in meeting their needs and goals, and staff members were able to describe the support that they provided. One resident told me ‘I’m happy here – I don’t want to move.’ Whittington House DS0000010799.V362634.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs and goals are assessed appropriately however there remains insufficient evidence that they are adequately met. People can be sure that they will have the opportunity to make decisions and take informed risks about their lives although they would benefit from more support to learn independent living skills. EVIDENCE: Care plans were available for both people living at the service, and contained relevant information regarding appropriate areas of support. The signatures of residents were also included indicating their involvement in the care planning process. Residents that I spoke to also confirmed that they were encouraged to be involved in this process. Records indicated that care plans and risk assessments for residents were being reviewed at least six-monthly as appropriate. Resident meeting minutes indicated some consultation about how the home is run, and this was Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 12 confirmed by staff and residents spoken to. Daily notes recorded for people living at the home indicated that each was encouraged to make their own decisions about their lifestyle and routines. Those spoken to confirmed that they were able to make their own choices about relationships and that their cultural and religious needs were respected by staff at the home. Inspection of key working notes, care plan evaluations and review meeting records indicated an increase in entries about how staff support individuals with budgeting, hygiene issues and depressive moments as required, although they did not specify progress made or the exact nature of support provided. Residents that I spoke to indicated that they were generally getting the support that they needed from staff including some support to develop cooking skills. At the previous inspection, I noted that review meeting minutes indicated some areas of concern raised for an individual person living at the home, which were not carried forward into that person’s care plan. During the current visit I noted that although some progress had been made in this area, there was still a need for more detailed information to be recorded in care plans and updates, particularly in addressing goals and needs agreed at review meetings e.g. sleeping patterns, budgeting and cooking skills, to evidence that these are being addressed appropriately. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home have opportunities to undertake supported leisure opportunities within the local community. Freedom is provided for residents to engage in personal relationships and maintain contact with family members and friends. Their rights are respected, although they would benefit from more support to encourage independent living skills. People’s dietary needs are catered for with a varied selection of food, although there is room for improvement in this area. EVIDENCE: Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 14 I spoke to both people living at the home and examined each person’s care plan, as well as discussing residents’ lifestyle choices with staff members on duty and observing routines within the home. Staff spoken to were aware of the need to respect people’s choices with regard to sexuality, religion and cultural preferences. Minutes of house meetings and discussion with staff and residents indicated that residents are encouraged to be involved in housework, and that they have an opportunity to discuss their preferences about the home. Both residents go out independently using public transport during the day. They advised that they receive staff encouragement in participating in meaningful daytime activities, but both choose not to be involved in structured activities. Both residents are very able to maintain social contacts independently and indicated that they did so on a regular basis. One resident maintains family contact by phone or post, as their family members live abroad. During the inspection, family members of the other resident arrived at the home to see them, and also for a prearranged appointment with the home’s manager. However the manager was unable to meet them at the prearranged time and finally arrived approximately one hour late to the meeting. This was experienced as a lack of respect shown to the family members. A requirement is made accordingly under Standard 37. At the previous inspection, residents confirmed, that they had enjoyed a short break away from the home in Brighton, over the summer, including an overnight stay. Since then photographs and records showed that residents had been on a supported trip to the Bluewater shopping centre and the Beckham Academy. Other activities included supported shopping trips, pub trips, meals out, a 55th birthday party for one resident, and card games within the home. Staff and residents spoken to confirmed that they had been involved in these activities, and that there had been an improvement in the number of activities provided by the home. It was noted that the number of activities arranged had increased since the decrease of resident numbers from three to two. It is important that the provision of supported activities does not decrease once a new resident is admitted to the home. Minutes of the last resident meeting indicated that a further overnight trip was planned to the coast shortly. The manager confirmed that this was the case, and residents told me that they were looking forward to the trip. Records of food served to residents indicated that a varied menu is served including some Caribbean food for residents who request this. One resident Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 15 told me that the standard of food served had improved in the last few months. However one resident remains generally dissatisfied with the meals provided to them, and tends to eat out in local cafes instead. The home was well stocked with a range of foods including some fresh fruit and vegetables, meat and fish and food storage arrangements, including labelling, were appropriate as required at the previous inspection. As required at the previous inspection, residents advised that they were now receiving more support to cook for themselves at home, although they still predominantly relied on staff to cook the meals, and ate out frequently. Whilst it is clear that there has been an improvement in this area (also indicated by key working records and resident meeting minutes), the actual support provided and progress made, needs to be recorded to evidence progress made in becoming independent in this area. There must also be further consultation with one particular person living at the home regarding food purchased and served, to ensure that their preferences are respected. Whittington House DS0000010799.V362634.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home receive appropriate physical and emotional support. However their health is not fully protected by adequately rigorous medication procedures. EVIDENCE: Resident plans, and feedback from those spoken to indicated that they are treated with respect and that their privacy and dignity are maintained. Records also indicated that people living at the home generally attend regular healthcare appointments with staff support as appropriate, and those spoken to confirmed this. However inspection of records and discussion with staff and residents indicated that they had not had optician appointments for at least two years. This is required, and follow up appointments should be arranged annually. In the event that a resident chooses not to attend, this needs to be recorded. The medication administration records (MAR sheets) appeared to be completed appropriately. No residents are self-medicating, and a pharmacist dispenses Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 17 all possible medicines into weekly dossett boxes. Records indicated that these were being administered appropriately. However when I asked the staff member on duty how he would correct a mistake on the MAR sheets (where a dosage of medicine was signed prior to its being given) he advised that he would use Tippex. Any mistakes must be clearly crossed through with a single line, and no Tippex may be used on MAR sheets, as these are legal documents. Records were being maintained of medicines received at the home, and those returned to the pharmacist. However although a medication cabinet was available in the office for storage of medicines, I was concerned to note that medication for the next week was being stored in a drawer on the desk in the office instead on the medication cabinet – although there was plenty of room for it to be accommodated in the cabinet. A requirement is made accordingly. Discussion with relatives of one person living at the home indicated that doses of their medication were often left in their bedroom for them to take. Therefore it is not possible for staff to observe that this medication is taken and sign for it. Discussion with the manager confirmed that this had also been brought to his attention on the day of the inspection, and that he would ensure that staff do not sign for the administration of medicines to any person living at the home, unless they have seen the resident take it. One person is prescribed an ‘as and when’ medicine (PRN) which records show, they rarely needed to take. Discussion with staff and the manager confirmed that this was the case. However this medicine must be recorded on all current MAR sheets for the resident, with guidance in place as to when it should be taken. A loose tablet of one person’s medication was found in the medication cabinet. It could not be identified from looking back over MAR records, as to when this tablet had been dispensed. A receptacle needs to be made available for storing and returning loose tablets of prescribed medicines that are not taken by people living at the home, for any reason, to ensure these medicines are returned safely to the pharmacy. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. It is unclear if residents can be sure that their complaints or concerns about the home will be acted upon effectively. Whilst they are safeguarded by adult protection procedures and staff training, inadequate recruitment procedures may place them at risk of abuse. EVIDENCE: The home’s complaints procedure and adult protection procedure and guidance for staff regarding whistle blowing are adequate. The complaints procedure is posted in the home, however the local CSCI area office contact details now need to be changed again. This must be addressed to ensure that staff and residents are provided with the correct information. A copy of the Haringey Adult Protection Policy and Procedure is also available within the home. Evidence was available within staff files that all staff at the home had undertaken training in the protection of vulnerable adults as appropriate. The manager and staff member indicated that no complaints had been recorded since the previous inspection, however there was no record available for the recording of complaints at the time of the inspection. I advised the manager and a staff member that use of this record is necessary to show that the home is receptive to concerns and complaints made. Residents spoken to advised that they would feel able to express any concerns Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 19 or complaints to staff, or the manager, if necessary, and my observation of staff and resident interactions indicated that this was the case. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements have been made to the environment in which residents live, so that it is comfortable and adequately decorated. People’s bedrooms are personalised as appropriate and there is a reasonable level of hygiene within the home, with the exception of one resident room, which is currently vacant. EVIDENCE: Residents spoken to advised that the location and layout of the home meet their needs. There is sufficient communal space for three residents and the cleanliness in the home was generally of an acceptable standard. One bedroom which was not in use, however, still smelled strongly of urine, although staff said that it had been cleaned on several occasions. It is required that this room be fully cleaned, refurbished and decorated prior to any new resident being admitted to the home. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 21 Individual bedrooms were decorated according to people’s choices and were personalized. One resident told me that they had had new carpet fitted in their room. Another told me that ‘the room is good.’ Garden furniture is provided in the rear garden, and residents told me that they enjoyed using this area when it is warm. The rear garden wall continues to be a hazard, due to pressure applied by the roots of a tree from an adjacent garden. The manager has previously provided evidence of communication with the neighbour regarding this issue. In the meantime preventative action remains in place, with the affected area of the garden fenced off, to protect the safety of staff and residents using the garden. It remains recommended that the issue of this wall be followed up so that a long-term solution can be found. Prior to the previous inspection the front garden path had been repaved, action had been taken to clear weeds and ensure a level surface in the rear garden and the bathroom, banisters and external windowsills had been repainted. Soap and paper towels were provided in the bathroom as appropriate. People living at the home had been consulted regarding whether they wish to have light shades in their bedrooms and the home’s corridors for their comfort. Residents spoken to confirmed that they did not wish to have lampshades in these areas. The bath mat in the communal bathroom on the first floor, was worn and marked, and should be replaced. New sofas, chairs, carpet and a rug had been provided in the lounge, and new dining room chairs were also provided giving these rooms a smarter appearance. However a couple of old chairs in these room should be removed or replaced, as they are marked and do not fit in with the new décor for the comfort of people living at the home. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are available to provide residents with flexible support outside of the home. However inadequate recruitment procedures are in place, placing residents at the potential risk of harm. People are generally protected by a range of relevant training to meet their needs safely with the exception of current food hygiene and first aid training. Staff are adequately supported and supervised to ensure that they support residents in line with best practice. EVIDENCE: Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 23 Examination of the staffing rota showed that three staff members currently work regularly at the home, alongside the manager. Discussion with residents and review of activities records indicated that sufficient staff are now available to support residents with a flexible selection of activities both within and outside of the home. Residents were positive about the support provided by the staff team, and relatives spoken to advised that they had always found the staff team to be very helpful. All three staff files were inspected and two were found to include satisfactory enhanced CRB (Criminal Records Bureau) disclosures, two references, identity documents, application forms, inductions records, training and supervision records. However no CRB disclosure undertaken by the home’s provider, was available for the newest member of staff member. A CRB disclosure from the staff member’s previous employer was available, and two references, however these did not include a reference from their previous workplace and there was no evidence that they had been verified. The provider confirmed that he had not requested an enhanced CRB disclosure for this staff member prior to their commencing work at the home. Shortly after the inspection, the provider provided the CSCI with a copy of a reference from this staff member’s previous employer, which advised had been kept in a different folder. An immediate requirement was made during the inspection visit, that an identified staff member must not work unsupervised within the home at all times with immediate effect until an appropriate enhanced CRB disclosure, a verifiable reference and a risk assessment are provided to the local CSCI area office. Cover was obtained for the shift at which this staff member was due to work on the day of the inspection, and the home provided a copy of the staff rota for the next week, showing how all shifts would be covered in the interim period as appropriate. No new staff member may commence work at the home until all appropriate recruitment checks are carried out including verifying references and obtaining the full enhanced CRB disclosures, for the protection of people living at the home from harm. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 24 Staff training records indicated adequate training in health and safety, moving and handling, adult protection, administration of medication, drug and alcohol awareness and dealing with potentially violent situations. As required at the previous inspection, fire safety training had been provided to all staff members to ensure the safety of staff and residents at the home. However staff files showed that some staff member’s training in first aid and food hygiene was now out of date. This was confirmed by staff spoke to, and a requirement is made accordingly to ensure the safety of people living at the home. Discussion with staff members at previous inspections has shown that they are experienced at working with residents with mental health problems and alcohol or drug dependency and had undertaken some specific training in this area as required previously. They were also knowledgeable about the cultural needs of individual residents. Both regular staff members had registered and commenced training to complete NVQ level 2 in care as required previously, and advised that they were making good progress with the awards. Inspection of staff files and discussion with staff indicated that regular individual staff supervision sessions had been occurring. Annual appraisals had also been undertaken with each staff member, and records of these were available on each staff file and this was confirmed by the relevant staff members. Whittington House DS0000010799.V362634.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Insufficiently rigorous arrangements are in place to manage the home effectively with the needs of residents in mind. Basic quality assurance procedures are in place but these are insufficient to evidence that people’s views are taken into account. Residents would benefit from improvement in a small number of health and safety procedures, to ensure their safety within the home. EVIDENCE: Staff advised that the manager provided adequate support and he was on the rota to work at the home regularly. However relatives and residents spoken to indicated that they did not see him at the home particularly frequently. I was concerned that on the day of the inspection, three relatives were left waiting for the registered manager to arrive for approximately one hour, Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 26 although the meeting had been pre-arranged. The diary for the home did not include details of this meeting, although the registered manager advised that he had been aware of the appointment. I was also concerned that the inspection took place of the London Mayoral Elections, however there was no record in the diary to remind staff about encouraging residents to use their votes. Two residents were about to go out in the early afternoon, and staff had made no mention of the fact that it was an election day. I was under the impression that, had I not mentioned the subject, and encouraged two residents to consider voting, this might well not have been raised with residents at all. I was also concerned that staff records were accessible to other members of the staff team, despite the fact that they contain confidential information such as Criminal Records Bureau (CRB) disclosures, supervision and appraisal records. A requirement is made accordingly regarding the management of the home, to ensure that the rights of residents and their relatives are respected. A rudimentary quality assurance audit had been conducted for the home in the previous year, covering the care planning process, service user welfare and health and safety. Previously the provider had advised that he was working with an independent consultant to complete a quality assurance audit, however no evidence of this was available. The manager advised that a quality assurance audit had not yet been undertaken for the home. There remains inadequate evidence of consultation with people living at the home, visitors and health and social care professionals, to evidence that the views of people living at the home are taken into account. A current Annual Quality Assurance Assessment had not been received for the home. The manager advised that this was due to the form not having been received from the CSCI. I agreed to ensure that a format would be sent out by post and electronically. This must be completed for the home and returned to the CSCI. Regular residents meetings and staff meetings were being undertaken and these covered a range of topics including activities, shopping and independence skills. The home has a selection of policies and procedures, and the manager provided evidence that he had commenced reviewing all of these procedures for the organisation. He was reminded that all relevant policies will also need updating with the current CSCI local office contact details. It is recommended that the use of stickers with the current CSCI London Regional Office contact details be considered in order to save paper. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 27 COSHH materials were stored appropriately within the home. A current gas safety certificate, and water tank maintenance certificates were available as required. There was also evidence of portable appliances testing (PAT) by way of stickers attached to relevant equipment, but it remains required that a portable appliances testing certificate also be obtained. However the most recent electrical installation certificate for the home was unsatisfactory, and a requirement is made accordingly. Following the inspection, a staff member from the home advised that this was due to be re-tested on 12th May 2008. Records indicated that regular fire alarm testing is carried out for the home, and fire drills are also held periodically. However records should specify which fire alarm call point is tested on each occasion. As required previously, an evening fire drill had been carried out within the last year and the frequency of fire drills in the home had increased. Food stored within the refrigerators and freezers, were wrapped and labelled, as required at the previous inspection to ensure the safety of food served at the home for residents. Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 3 X 2 X Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement Timescale for action 04/07/08 2. YA17 16(2ij) 3. YA19 12(1) 4. YA20 13(2) The registered person must ensure that more detailed information is recorded in care plans and updates, particularly in addressing goals and needs agreed at review meetings e.g. sleeping patterns, budgeting and cooking skills, to evidence that these are being addressed appropriately. (Previous timescale of 09/11/07 not fully met). The registered person must 23/05/08 ensure that there is further consultation with people living at the home regarding food purchased and served and that this is recorded, to ensure that their preferences are respected. (Previous timescale of 05/10/07 partially met). The registered person must 23/05/08 ensure that all people living at the home are encouraged to visit the optician at least annually and that this is recorded, to ensure that their health needs are met. The registered person must 09/05/08 ensure that staff do not sign for the administration of medicines DS0000010799.V362634.R01.S.doc Version 5.2 Whittington House Page 30 to any person living at the home, unless they have seen the resident take it. All medicines must be stored in the lockable cabinet and not in other areas of the office. All staff must be made aware that Tippex must not be used on medication administration records. All as and when (PRN) medicines prescribed for people living at the home must be recorded on their current medication administration records. Finally a receptacle needs to be made available for storing and returning loose tablets of prescribed medicines that are not taken by people living at the home, for any reason, to ensure that people’s medicines are administered as safely as possible. The registered person must ensure that a record is available for recording any complaints or concerns raised about the home, to ensure that peoples concerns about the home are taken seriously. The registered person must ensure that the identified unoccupied room is fully cleaned and redecorated to ensure that the odour is eliminated. A new bath mat should be provided in the bathroom, and the old chairs in the lounge should be removed or replaced, for the comfort of people living at the home. The registered person must DS0000010799.V362634.R01.S.doc 5. YA22 22 09/05/08 6. YA24 16(2k) 23(2bd) 06/06/08 7. YA34 19 Sched 01/05/08 Page 31 Whittington House Version 5.2 2(7) ensure that the identified staff member does not work unsupervised within the home at all times, with immediate effect, until appropriate enhanced CRB disclosures and a risk assessment are provided to the local CSCI area office. No new staff member may commence work at the home until all appropriate recruitment checks are carried out including verifying references and obtaining the full enhanced CRB disclosures, for the protection of people living at the home from harm. 8. YA35 18(1ci) 13(4) 16(2j) 24 9. YA37 Immediate Requirement The registered person must ensure that all staff have current training in first aid and food hygiene to ensure the safety of people living at the home. The registered person must ensure that the diary is kept up to date with all appointments to ensure that the home is managed effectively, and that appointments to meet with residents’ relatives are honoured, to ensure that the rights of residents and their relatives are respected. Staff files must also be kept in a manner that protects their confidentiality. The registered person must ensure that he registered person must ensure that the quality assurance system is further developed to incorporate the views of people living at the home, visitors and health and social care professionals, and that evidence is available that DS0000010799.V362634.R01.S.doc 04/07/08 09/05/08 10. YA39 24 04/07/08 Whittington House Version 5.2 Page 32 the views of people living at the home are taken into account. (Previous timescale of 23/11/07 not met). A current Annual Quality Assurance Assessment must also be completed for the home and returned to the CSCI. The registered person must ensure that a satisfactory electrical installation certificate is obtained for the home, a copy of which must be sent to the CSCI. Records of weekly fire alarm testing must include details of which point has been checked each week. A copy of the recent portable appliances testing certificate must also be sent to the CSCI, to ensure the safety of people living and working at the home. 11. YA42 13(4) 23(4cv) 16/05/08 Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 33 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 YA6 Good Practice Recommendations It remains recommended that further evidence be recorded regarding progress made on goals through keyworking sessions with residents, to ensure that they are supported appropriately. It remains recommended that the damage to the rear garden wall continue to be pursued with the owner of the adjoining property, so that residents can have access to this area of the garden once more. It is recommended that all of the home’s policies should be updated to include the current CSCI London Regional Office contact details. Stickers with these details could be used in order to save paper. 2. YA24 3. YA40 Whittington House DS0000010799.V362634.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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