Inspection on 12/10/06 for Whittington House

This inspection was carried out on 12th October 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 13 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 01/05/08

Whittington House 11/09/07

Whittington House 05/04/07

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 Key Unannounced Inspection 12th October 2006 01:45p Whittington House DS0000010799.V304074.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.V304074.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.V304074.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 020 8379 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.V304074.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th April 2006 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 06/04/06 are £670 - £950. 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 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.V304074.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted approximately six hours and was carried out as a routine unannounced visit to the home and in order to check compliance with the requirements made at the previous inspection. Following the previous inspection the inspector arranged a meeting with the registered provider for the home at the local CSCI area office to discuss concerns regarding the home’s poor record of compliance with requirements made. Following this the provider arranged for evidence to be provided to the CSCI showing compliance with the majority of requirements made. There were three residents living in the home and the inspector was able to speak to all of them during the inspection. No new residents had been admitted since the previous inspection. The inspector also observed residents’ relationships with staff and each other, and records maintained at the home in gaining an understanding of their experience at the home. The inspector was assisted throughout by staff members and the manager arrived at the home towards the end of the inspection. The inspector spoke to two staff members during the inspection, conducted a tour of the premises and inspected care records. What the service does well: Feedback from residents indicates that they are 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. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Whilst a number of improvements have been made since the previous inspection, the home has a history of non-compliance with requirements made by the CSCI. There are still serious concerns about residents’ needs being met effectively and health and safety management within the home. Staff must record their input and the progress that residents make in achieving their goals, including the support and guidance provided to one resident in managing their debts. Regular supervised trips should be arranged outside of the home to places of interest to residents, such as trips to the cinema, pub and local cafes/restaurants, and daytrips to more distant destinations. It is recommended that records of food served in the home should specify the types of fruit and vegetables served to show that residents are receiving a nutritionally varied diet. An immediate requirement was made that the manager ensure that there are sufficient stocks of a prescribed medicine for an identified resident so that they receive their medication without interruption. This was met within the timescale set. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 7 It is also required that the manager monitor the administration of medication within the home by regular recorded checks of medication supplies and administration, to ensure that all residents have sufficient stocks of their prescribed medicines and these are administered correctly. It is strongly recommended that staff at the home cease all secondary dispensing of medicines and that a pharmacist carries out this task if it is deemed necessary. A small number of maintenance issues must be addressed within the home to ensure the comfort and safety of staff and residents. At least fifty percent of staff must commence training to NVQ (National Vocational Qualification) level 2 in care. All staff must undertake training in working with people who have mental health problems and working with people with alcohol or drug dependency. It remains recommended that an abbreviated induction format specific to Whittington House, should be available for agency/bank staff members working in the home for the first time. It is recommended that additional arrangements be made for ‘on call’ management, so that the manager is not on call seven days a week. Residents meetings must be used to gather the views of residents about the way the home is run, rather than to discuss their individual progress on goals as this compromises their privacy. The provider must follow advice from the local fire prevention officer regarding their requirement to ensure that emergency exits can be easily opened. It remains required that a current satisfactory electrical installation certificate must be obtained for the home. Failure to comply with this requirement may result in enforcement action being taken against the home. Current gas safety, portable appliances testing and water tank maintenance certificates must also be obtained for 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. Whittington House DS0000010799.V304074.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.V304074.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 and 5. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. An adequate system is in place to assess residents’ needs and goals effectively and ensure that these can be met. Residents’ rights are now protected by contractual arrangements with the home and their local authorities, making them less vulnerable to abuse/exploitation. EVIDENCE: No new residents have been admitted since the previous inspection. Residents’ care plans included assessments of their individual needs, and residents spoken to confirmed that they were consulted about their needs. At the previous inspection it was restated for the fourth time that the content of residents’ statements of terms and conditions with the home be revised to ensure that all necessary information (as specified under Standard 5 of the National Minimum Standards) is included. Evidence that this had been undertaken was sent to the local CSCI area office prior to the current inspection, including details of the room to be occupied, rights and responsibilities, arrangements for reviewing care plans and any limitations to the freedom of each resident. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Residents’ needs and goals are assessed appropriately however there is insufficient evidence that they are responded to adequately, to ensure that they are met. Residents have the opportunity to make decisions about their lives and are encouraged to be independent. However there is not enough support from staff members to ensure that when residents take risks, the dangers are minimised as far as possible. EVIDENCE: Care plans were available for all residents, 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 spoken to confirmed that they were encouraged to be involved in this process. Records indicated that care plans and risk assessments for all residents were being reviewed at least six-monthly as appropriate. As required at previous inspections, appropriate action involving the Court of Protection had been taken to manage the finances of a resident who did not Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 11 have sufficient identity documents to open their own bank account. At the previous inspection it was required that a risk assessment should be undertaken for a resident whose debit card was being kept in the office for safekeeping when not in use, and that records should be maintained of times when the card is with the resident, and when it is returned to the office. It was also required that a more secure storage site for the card be identified to protect the resident and staff members appropriately. Staff and the manager confirmed that no debit or credit cards belonging to residents were being kept in the staff office for safekeeping when not in use, following a review of the risk assessment for the identified resident. The inspector was concerned to note that care plans and daily notes recorded for each resident did not evidence that staff were supporting them appropriately to meet their identified goals. In the case of a resident whose care plan indicated that they required support with budgeting, whilst records indicated that this resident was currently in debt, there was no record of support or guidance provided by staff in managing this issue. Nor were residents spoken to, able to describe support provided by staff in meeting their needs. A requirement is made accordingly. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Although an improvement had been made in the provision of activities to residents, there remains room for improvement in the provision of leisure opportunities to residents 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 and responsibilities are made clear. Dietary needs of residents are catered for with a varied selection of food available that meets their nutritional and cultural needs. EVIDENCE: Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 13 The inspector spoke to all three residents and examined each resident’s care plan, as well as discussing residents’ lifestyle choices with staff members on duty and observing routines within the home. 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, although a requirement is made regarding these meetings under Standard 39. One resident attends day services sporadically according to their wishes. Two residents go out independently using public transport during the day and the other requires greater staff support in participating in meaningful and therapeutic daytime activities. Following support from an occupational therapist, staff have been provided with a selection of therapeutic activities to undertake with this resident, both within and outside of the home. As required previously, there was evidence that staff from the home continue to maintain their own minutes of meetings regarding residents’ welfare, so that action may be taken promptly. Two residents are very able to maintain social contacts independently and both indicated that they did so on a regular basis. The other resident needs far more support in this area, and does not have opportunities of meeting people of their own age or with shared interests. This is an area that remains to be addressed in conjunction with the occupational therapist. Records indicated, and residents and staff members confirmed, that a short break away from the home had been arranged to Brighton over the summer, including an overnight stay. This had been very successful and the manager confirmed that in future it may be possible to arrange a longer break. Other activities included shopping trips, walks in the local park and board and card games within the home; however records indicated that there were few organised leisure activities for residents outside of the home within the last few months. Residents spoken to indicated that they would be interested in participating in more activities outside of the home. Whilst it is appreciated that staff may find it difficult to motivate some residents, it remains required that there be an increase in the number of activities available to residents including occasional meals out, trips to the cinema and daytrips to places of interest. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 14 Records of food served to residents indicated that a varied menu was served and residents spoken to were satisfied with the food available to them including some Caribbean food for residents who request this. The home was stocked with a range of foods including some fresh vegetables, however there was no fresh fruit. Staff advised that they were due to go food shopping the next day and stocks had just run out in the home. Residents confirmed that they did usually have fresh and tinned fruits provided as described on the menus, however they were not specific about the range of fruits provided. One resident returned from an appointment with a dietician on the day of the inspection. The dietician advised that detailed records be maintained of all the foods eaten by this resident and how they were prepared. It is recommended that records of food served in the home to all residents should specify the types of fruit and vegetables served and whether they are fresh, tinned, cooked etc. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 15 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 and 20. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. Residents receive appropriate physical and emotional support and are supported to take their prescribed medicines. However insufficiently rigorous medication procedures within the home may place residents at risk of harm. EVIDENCE: Service user plans, and feedback from residents spoken to indicated that they are treated with respect and that their privacy and dignity are maintained. There was also evidence that residents attended regular healthcare appointments as appropriate. The inspector noted that the recording of health appointments remains significantly improved including details of any treatment or advice given as appropriate. The storage temperature of medicines was recorded daily and was within the specified range, and the medication administration records appeared to be completed appropriately. No residents are self-medicating and records showed medicines received at the home and those returned to the pharmacist in the event of a change in medication being prescribed by a resident’s GP. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 16 However the inspector was concerned to note that medicines had been dispensed into dossett boxes by staff members in the home, and double signed to indicate that these had been checked, whilst there was insufficient of one resident’s prescribed medicine for the day after the inspection. The practice of anyone other than a pharmacist secondarily dispensing medicines into dossett boxes is strongly discouraged due to the increased possibility of human error. The staff member who had dispensed the medicines did not appear to be aware of there being insufficient stocks of this medicine until the inspector brought this to their notice. An immediate requirement was made accordingly. This requirement was met within the timescale set. The home is strongly recommended to cease all secondary dispensing of medicines by staff members and ask a pharmacist to carry out this task if it is deemed necessary for the home. The manager must monitor the administration of medication within the home closely, by regular recorded checks of medication supplies and administration to ensure that all residents have sufficient stocks of their prescribed medicines and these are administered correctly. It is recommended that the social worker of an identified resident who has diabetes be notified that they are refusing to have regular blood sugar monitoring tests. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 17 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 and 23. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints procedure in place to ensure that the concerns of residents are acted upon effectively. Procedures and training are in place to ensure that residents are protected from abuse. EVIDENCE: The home has a complaints procedure, an adult protection procedure and guidance for staff regarding whistle blowing. A copy of the Haringey Adult Protection Policy and Procedure is also available within the home. Evidence was available that all staff at the home had undertaken training in the protection of vulnerable adults as appropriate. No complaints had been recorded since the previous inspection, however residents spoken to advised that they would feel able to express any concerns or complaints to staff, or the manager, if necessary. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 and 30. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. A number of improvements had been made to the environment in which residents live, so that it is homely and comfortable, with adequate private and communal space. Their bedrooms are personalised as appropriate, however there is room for a number of identified improvements to improve the comfort and safety of the environment for residents. 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 of an acceptable standard. A conservatory had been added to the home since the previous inspection and residents told the inspector that they were pleased with this new addition. Cast iron and wood garden furniture is provided within the garden, and residents told the inspector that they enjoyed using this area. The rear garden wall continues to be in a hazardous state, due to pressure applied by the roots of a tree from an adjacent garden. The manager provided evidence that he had been in contact with the local council who own the property in which the Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 19 tree is growing. In the meantime preventative action had been taken by cordoning off the area of the garden that is affected, to protect the safety of staff and residents using the garden as appropriate. It remains required that the issue of this wall be followed up with the local council so that a long-term solution can be found. As required the linoleum flooring in the first floor bathroom had been replaced. The flooring was replaced with flooring tiles instead of linoleum, which improves the décor in the bathroom considerably and is far more practical for the residents accommodated. The most newly admitted resident told the inspector that the carpet in their room was being cleaned regularly as required, and the manager advised that this carpet was due to be replaced this year. One resident who had asked for longer and differently coloured curtains to be provided in their room at the last inspection, had changed their mind about this following the inspection. However during the current inspection they told the inspector again that they would like different curtains. Inspection of the room indicated that the curtains provided were not of sufficient length to fit the windows appropriately, and a requirement is made accordingly. As required at the previous inspection the window restrictor in an identified resident’s room (a resident with high dependency needs) had been secured as appropriate for their protection. The provision of a conservatory at the home meets the previous requirement that the woodwork on the rear exterior of the home be repainted/replaced and that the rear door of the home (which is damaged) be replaced. A small number of new maintenance issues required attention during the current inspection: A panel under the kitchen sink requires repair as it is loose and falls down when the cupboard door below is opened. This is a potential health and safety risk. The front garden path should be retiled or repaved as a number of tiles were missing at the time of the inspection. Finally the hole in an identified resident’s bedroom wall (caused by the door handle) needs to be filled and redecorated. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 20 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 and 35. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Staff have undertaken a range of relevant training to meet the needs of residents safely and effectively. However lack of training or qualifications specific to the client group within the home means that the needs of residents may not be fully met. A recruitment procedure is in place for staff, which adequately protects residents. EVIDENCE: As noted at the previous inspection, satisfactory enhanced CRB disclosures were available for all staff as required, and staff files included the required information. No new staff had commenced work at the home since the previous inspection. There was evidence that staff training had been undertaken in health and safety, moving and handling, first aid, adult protection, administration of medication, drug and alcohol awareness and dealing with potentially violent situations. The inspector observed staff at the home working with a resident who was verbally challenging during the inspection. Staff handled the situation Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 21 appropriately diffusing the situation whilst supporting the resident who was clearly unhappy. One resident told the inspector ‘staff here are very helpful.’ Discussion with staff members indicated that they were experienced at working with residents with mental health problems although they had not had specific training in this area. They were also knowledgeable about the cultural needs of individual residents. It remains recommended that an abbreviated induction format specific to Whittington House, be available for agency/bank staff members working in the home for the first time. This should be separate from inductions for other homes, and include important information about the residents accommodated. At the previous inspection a requirement was made regarding the frequency of staff supervision. Inspection of staff files and discussion with staff indicated that regular individual staff supervision sessions had been occurring. These had been provided by the assistant manager. As required, separate staff meetings (other than house meetings including residents) had also been occurring on a regular basis. However the home has failed to meet the standard of having at least fifty percent of staff being trained to at least NVQ level two in care, and appropriate training must be commenced without delay. Some staff had undertaken training in working with people with alcohol or drug dependency, however this needs to be extended to the remaining staff members. It is also required that all staff working at the home must undertake training in working with people who have mental health problems. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 22 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 and 42. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home is managed with the needs of residents in mind. Basic quality assurance procedures are in place to monitor the standards of care but there is insufficient evidence that resident’s views are taken into account. Health and safety procedures are not adequately protecting residents. EVIDENCE: At the previous inspection the registered person was required to record the hours that he works within the home on a daily basis due to concerns regarding his availability to manage the home on a daily basis. As required, the registered manager was recording the hours that he works in the home on the home’s staffing rota, indicating that he is in the home sufficiently to maintain the role of manager effectively. This was confirmed by staff and residents spoken to. It is recommended that additional arrangements be made for ‘on call’ management, so that the registered person is not on call seven days a week. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 23 At previous inspections it was required that a quality assurance audit be conducted for the home. The provider had advised that he was working with an independent consultant to complete this task and had already circulated questionnaires to residents. He was reminded that he also needed to request feedback from health care professionals and other visitors to the home in addition to an internal audit of how the home is functioning. A copy of the report of the findings of this audit were sent to the local CSCI area office, although they did not include much detail about how the areas identified would be addressed. The inspector was concerned to note, from the minutes of residents meetings at the home, that they did not always appear to be used appropriately by staff. Minutes indicated that these meetings were frequently used to feedback to individual residents regarding the progress that they were making on their goals, which would be far more appropriate in a one-to-one setting. A requirement is made that the way in which residents meetings are used be reviewed to ensure that they are used appropriately to gather the views of residents about the way the home is run. At previous inspections a requirement was made regarding the management of an identified resident’s finances looked after by the home. The manager provided evidence that this was now being managed by the Court of Protection as appropriate to ensure the protection of this resident from financial abuse. COSHH materials (harmful chemicals) were stored in locked facilities as appropriate, and hazard analysis sheets were available for COSHH materials used within the home. Following a fire safety audit undertaken by the local fire prevention officer prior to the previous inspection, a number of requirements were made including the need for fire safety training, easily accessible emergency exits, weekly testing of each fire call point, and monthly emergency lighting testing. Evidence was available from a report of a follow up visit by the fire prevention officer and records maintained at the home, that these areas were now being addressed as appropriate. As required at the previous inspection a fire risk assessment had been undertaken for the home and a copy was sent to the local CSCI area office. However it remains required that the manager obtain and follow advice from the local fire prevention officer with regard to their requirement to ensure that emergency exits can be easily opened. It remains required that a current satisfactory electrical installation certificate must be obtained for the home, and that a copy be sent to the local CSCI area office. Although a certificate was available for a recent electrical installation Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 24 inspection, it was recorded as unsatisfactory and therefore the identified action needs to be undertaken prior to a satisfactory certificate being provided. Failure to comply with this requirement may result in enforcement action being taken against the home. It is also required that current gas safety, portable appliances testing and water tank maintenance certificates be available for the home, as these certificates could not be located at the time of the inspection. Copies must be sent to the local CSCI area office. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 2 X X 1 X Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 26 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 YA9 Regulation 15(2) Requirement The registered person must ensure that evidence regarding progress made on goals through key-working sessions with service users, including support of an identified service user in managing their debts. The registered person must ensure that regular supervised trips are arranged outside of the home to places of interest to service users, such as trips to the cinema, pub and local cafes/restaurants, and day trips to more distant destinations. These must be recorded in service user files. (Previous timescales of 22/10/04, 01/07/05, 23/09/05 and 19/05/06 not met). Immediate Requirement The registered person must contact the GP and/or pharmacist to ensure that there are sufficient stocks of the prescribed medicine specified for the identified service user to ensure that they receive their medication consistently. This requirement was met DS0000010799.V304074.R01.S.doc Timescale for action 22/12/06 2. YA14 16(2mn) 22/12/06 3. YA20 13(2) 13/10/06 Whittington House Version 5.2 Page 27 within the timescale set. 4. YA20 13(2) The registered person must closely monitor the administration of medication within the home by regular recorded audits of medication supplies and administration, to ensure that all service users have sufficient stocks of their prescribed medicines and these are administered correctly. The registered person must ensure that: • the panel under the kitchen sink is repaired, • the front garden path is retiled or repaved, and • the safety issue with regard to the rear garden wall is followed up with the local council. The registered person must ensure that: • longer curtains chosen by the identified service user are provided in their room, and • the hole in the identified service user’s bedroom wall (caused by the door handle) is filled. The registered person must ensure that a minimum of fifty percent of staff are trained to at least NVQ level 2 in care by commencing appropriate training. The registered person must ensure that all staff working at the home have undertaken training in working with people who have mental health problems and working with people with alcohol or drug dependency. The registered person must ensure that service user meetings are used appropriately DS0000010799.V304074.R01.S.doc 10/11/06 5. YA24 13(4a) 23(2d) 08/12/06 6. YA25 23(2d) 24/11/06 7. YA32 19(5) 08/12/06 8. YA35 18(1ci) 09/02/07 9. YA39 24 10/11/06 Whittington House Version 5.2 Page 28 10. YA42 13(4a) 23(4cd) 11. YA42 13(4a) 12. YA42 13(4a) to gather the views of service users about the way the home is run, and not to discuss their individual progress on goals. The registered person must obtain and follow advice from the local fire prevention officer with regard to their requirement to ensure that emergency exits can be easily opened. The registered person must ensure that a current satisfactory electrical installation certificate is obtained for the home, and that a copy is sent to the local CSCI area office. (Previous timescale of 26/05/06 not met). Failure to comply with this requirement may result in enforcement action being taken against the home. The registered person must ensure that current gas safety, portable appliances testing and water tank maintenance certificates are available for the home, and that copies are sent to the local CSCI area office. 08/12/06 24/11/06 08/12/06 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. 2. 3. Refer to Standard YA17 YA19 YA20 Good Practice Recommendations It is recommended that records of food served in the home should specify the types of fruit and vegetables served and whether they are fresh, tinned, cooked etc. It is recommended that the social worker of an identified service user who has diabetes be notified that they are refusing to have regular blood sugar monitoring tests. It is strongly recommended that staff at the home cease all secondary dispensing of medicines and ask a DS0000010799.V304074.R01.S.doc Version 5.2 Page 29 Whittington House 4. YA34 5. YA37 pharmacist to carry out this task if it is deemed necessary for the home. It remains recommended that an abbreviated induction format specific to Whittington House, should be available for agency/bank staff members working in the home for the first time. This should be separate from inductions for other homes, and include important information about the service users accommodated. It is recommended that additional arrangements be made for ‘on call’ management, so that the registered person is not on call seven days a week. Whittington House DS0000010799.V304074.R01.S.doc Version 5.2 Page 30 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. 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