Inspection on 24/10/08 for Whittington House

This inspection was carried out on 24th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Whittington House 01/05/08

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

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Cherry Tree House

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Whittington House 46 Dongola Road London N17 6EE     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Shamash     Date: 0 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Whittington House 46 Dongola Road London N17 6EE 02083769219 02083769219 fgcleland@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Francis Cleland care home 3 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home 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 GBP. 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. 3 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 34 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last inspection on this service was completed on 1st May 2008. The current unannounced inspection lasted approximately six 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. A second visit was required to the home in order to view staff files, as the registered manager had not been available on the first day of the inspection. On the first day one Regulation Inspector (Susan Shamash) visited the home, on the second day the lead inspector was accompanied by Jane Ray another CSCI Regulation Inspector. There were two people living in the home and we were able to speak to both of them. Care Homes for Adults (18-65 years) Page 5 of 34 One resident had moved out of the home and one new resident had been admitted since the previous inspection. On the first day one staff member assisted throughout the visit, and another staff member and the manager were available for the visit on the second day of the inspection. The inspection also included observation of residents relationships with staff and each other, a tour of the premises and inspection of residents and staff files, health and safety records and other records relating to the homes management in order to gain an understanding of peoples experience at the service. What the care home does well: What has improved since the last inspection? What they could do better: Current risk assessments for residents should be kept in the home at all times, and improvements are needed in the recording of healthcare appointments and medication administration and storage. All complaints need to be recorded and addressed appropriately so that people living at the home feel that their views are taken into account. Some minor improvements need to be made to the home environment and regarding the storage of food within the home. An accurate rota needs to be maintained for the home, and staff should be provided with adequate breaks so that they can work effectively with people living at the home. The CSCI must be notified of any incidents affecting the wellbeing of people living at the home and risk assessments must be provided for the building. Finally it remains required that a quality assurance Care Homes for Adults (18-65 years) Page 7 of 34 audit be undertaken for the home at least annually with the results to the CSCI, and evidence must be provided that the home is financially viable. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 34 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of 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 one resident had moved out since the previous inspection, and a new resident had recently moved into the home. We had the opportunity to meet with both people living at the home, and inspected the files relating to both of them. Appropriate assessment information was in place for each person, and both indicated that the home was meeting their needs appropriately. Each persons 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. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: There were records of the support provided to residents, and progress made on working towards their individual goals, although there remains room for 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. Care Homes for Adults (18-65 years) Page 11 of 34 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples 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 we 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. However the risk assessments for one of the residents could not be found on either day of the inspection, and a requirement was made that these be sent to the CSCI area office as soon as possible following the Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: inspection. Resident meeting minutes indicated some consultation about how the home is run, and this was 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 the nature of staff support for individuals with budgeting, hygiene issues and mental health issues as appropriate, however residents would benefit from more frequent contact with keyworkers, and all of these sessions should be recorded. 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. Care Homes for Adults (18-65 years) Page 13 of 34 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Freedom is provided for residents to engage in personal relationships and maintain contact with family members and friends. Their rights are respected, and they are encouraged to develop independent living skills. Peoples dietary needs are catered for with a varied selection of food. However people living at the home do not currently have a range of supported activities offered to them outside of the home, to meet their social and leisure needs. Evidence: We spoke to both people living at the home and examined each persons 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 peoples choices with regard to Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: 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 regular structured activities. Both residents are able to maintain social contacts independently and one indicated that they did so on a regular basis. The other person currently requires more support in this area and tends to spend most of their time in the home. Both resident maintain contacts with family members and friends according to their wishes. At the previous inspection, residents confirmed, that they had enjoyed a short break away from the home in Brighton, and trips to the Bluewater shopping centre and the Beckham Academy. However no further daytrips or breaks had been arranged for residents since that inspection. Activities recorded included supported shopping trips, pub trips, meals out at a local cafe, and card games within the home. Staff and residents spoken to confirmed that they had been involved in these activities, but that there had not been any other activities offered to them since the previous inspection. Records of food served to residents indicated that a varied menu is served including some Caribbean food for residents who request this. Both residents advised that they were happy with the standard of food served at the home. The home was well stocked with a range of foods including some fresh fruit and vegetables, meat and fish. Residents advised that they were receiving support to cook for themselves at home, although they still predominantly relied on staff to cook the meals. Care Homes for Adults (18-65 years) Page 15 of 34 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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 indicated that one person living at the home attended regular healthcare appointments with staff support as appropriate, including an opticians appointment as required at the previoius inspection, and they confirmed this. However it was noted that their toenails were very long on the day of the inspection and therefore required attention either from the resident themself or a chiropodist. Inspection of the newly admitted residents file indicated that there were no clear records of regular healthcare appointments offered to this person. This is required, in the event that a resident chooses not to attend, this also needs to be recorded. The medication administration records (MAR sheets) appeared to be completed Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: appropriately. No residents are self-medicating, and a pharmacist dispenses all possible medicines into weekly dossett boxes. Records indicated that these were being administered appropriately. However one staff member on duty was observed giving medication to a resident without recording this on the relevant MAR sheet. Later when looking through the medicaiton administration records, this was pointed out to the staff member in question, who corrected the mistake. Records were being maintained of medicines received at the home, and those returned to the pharmacist. However medication was being provided to the home in blister packs including a mixture of tablets. Although there was a space for the pharmacy to include a description of each capsule or tablet, these were not being completed for any of the medicines in the blister packs. It would therefore be difficult for staff members to ascertain the content of medicines being signed into the home. It is therefore required that the home ensure that this information is provided from the pharmacy so that staff can accurately sign medication into the home. At the previous inspection we were concerned to note that alhough a medication cabinet was available in the office for storage of medicines, medication for the next week was being stored in a drawer on the desk in the office instead of the medication cabinet. A requirement was made accordingly. At the current inspection the staff member on duty confirmed that no medicines were being stored outside of the medication cabinet. However I was concerned to find medication prescribed to a service user who had left the home approximately two months previously, stored in the cabinet under the photocopier in the office (which is not lockable). Failure to meet this requirement about the storage of medication in the office within the timescale set may result in enforcement action being taken against the home. It is also recommended that the storage of the medication cabinet key should be reviewed to ensure that medications are stored as securely as possible. Care Homes for Adults (18-65 years) Page 17 of 34 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of 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. People appear to be safeguarded by adult protection procedures and staff training. Evidence: The homes complaints procedure and adult protection procedure and guidance for staff regarding whistle blowing remain adequate. The complaints procedure is posted in the home, and although it still had the previous local CSCI area office contact details on the first day of the visit, this had been corrected by the second day of the visit to the home. A copy of the Haringey Adult Protection Policy and Procedure is available within the home. Evidence was available within staff files that staff at the home had undertaken training in the protection of vulnerable adults as appropriate. The manager and records indicated that no complaints had been recorded since the previous inspection. Although the record should include headings to ensure that all relevant information is recorded in the event of a complaint/concern being made. A complaint made to the inspector and the home at the previous inspection, by family members unhappy that the manager had not been available for a meeting, had not been recorded. The manager was reminded that this record is necessary in order to Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: demonstrate that the home is receptive to concerns and complaints made. On the first day of the inspection one resident expressed concerns about staff members leaving them alone at the home whilst they went out for breaks. Discussion with the staff member indicated that they would not leave any person unsupervised within the home. This issue was therefore passed on to the manager of the home to be addressed. Care Homes for Adults (18-65 years) Page 19 of 34 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in which residents live is comfortable and adequately decorated. Peoples bedrooms are personalised, but it is less clear whether communal areas of the home are treated as their space. They are also not fully protected by hygiene procedures within the home, 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 was being used as a staff room in the absence of a third person living at the home. As required at the previous inspection the empty room which had smelled strongly of urine, had been completely cleaned, decorated and refurbished prior to a new resident moving into the home. People spoken to advised that their bedrooms were decorated according to their own choices and both were personalized as appropriate and confirmed that they did not wish to have lampshades in various areas in the home. Prior to the previous inspection new sofas, chairs, carpet and a rug had been provided in the lounge, and new dining Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: room chairs were also provided giving these rooms a smarter appearance. The shower curtain in the bathroom appeared a little worn and marked, but otherwise the bathroom was clean and appropriately decorated. However there were no handdrying facilities provided in this room. A disused water machine and telephone box, needed to be removed from the dining area and a stereo should be provided in this room, or the lounge area of the home. One door to a residents room in the home needed to be oiled, but all doors were safely self-closing as appropriate. The lounge and a cupboard under the stairs contained a significant number of staff members personal belongings including a COSHH (cleaning) material which was removed to the office on the request of the inspector. The kitchen also contained many items of food which the staff member advised belonged to staff members, most of which were not labelled, a requirement is made accordingly under Standard 42. During the visit, a man knocked on the door, and was let in. The staff member advised that he was a personal friend who had come to deliver some photographs from her recent wedding party. The visitor did not not stay long, however an overall picture emerged that staff might be treating the home as if they too lived there, which might be a consequence of the very long shifts that appeared to be being worked. Garden furniture is provided in the rear garden, and residents told me that they had used this area over the summer period. The rear garden wall remains a hazard, due to pressure applied by the roots of a tree from an adjacent garden, but this area remains fenced off as appropriate. The manager has previously provided evidence of communication with the neighbour regarding this issue. It remains recommended that the issue of this wall be followed up with the owner of the relevant property so that a long-term solution can be found. During the current visit, it was noted that one of the dividing walls to the side of the rear garden was cracked in several areas, and the part of the garden adjacent to the house was very uneven, possibly providing a safety hazard to people living and working at the home. By the time of the second days visit to the home, both of these issues had been addressed. Care Homes for Adults (18-65 years) Page 21 of 34 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is unclear whether sufficient staff are available to provide residents with flexible support within and outside of the home. Adequate recruitment procedures are in place, to protect residents from the risk of harm. People are generally protected by a range of relevant training to meet their needs safely. Staff are adequately supported and supervised to ensure that they support residents in line with best practice. Evidence: Examination of the staffing rota showed that three staff members currently work regularly at the home, alongside the manager. However it did not reflect the situation at the time of the inspection, or on the day before or the coming evening. The staff member confirmed that due to unforeseen circumstances, they would have been working at the home without a break for approximately 26 hours by the time the next member of staff took over from them (including a sleep-in shift). Discussion with residents also indicated that staff members might occasionally leave the home unstaffed in order to go out for short breaks. A requirement is made regarding this issue under Standard 22. People living at the home generally felt that there were sufficient staff available to support them in the home, although both felt that they were left to themselves for Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: most of the time. All three regular staff members files were inspected and were found to include satisfactory enhanced CRB (Criminal Records Bureau) disclosures, two references, identity documents, application forms, inductions records, training and supervision records as appropriate. 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 and all staff had current first aid and food hygiene training. Discussion with staff members showed 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. One staff member was working towards an NVQ (National Vocational Qualification) level 3 qualification in care and advised that they had completed their portfolio for this award, another had completed the NVQ level 2 qualification. 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. Amongst files stored in the office relating to the home, a staff file belonging to a staff member who had left working for the home some time ago was found. This file included confidential information about this staff member which should not have been accessible to other staff members working at the home. Requirements had been made at previous inspections regarding the need for all staff files to be locked away. Care Homes for Adults (18-65 years) Page 23 of 34 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes quality assurance procedures do not currently evidence that peoples 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. Residents spoken to confirmed that they had seen the manager recently. Despite a requirement made at the previous inspection no quality assurance audit had been conducted for the home in the last year. The manager advised that he had now delegated this task to a staff member in the home, to be carried out shortly. It is recommended that an independent person might be involved in such an audit, so that a more objective report might be produced. The annual quality assurance audit for the home had been completed as appropriate. However there remains inadequate evidence of consultation with people living at the home, visitors and health and social care professionals, to ensure that the views of people living at the home are taken into account. Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Some residents meetings and staff meetings had been undertaken and these covered a range of topics including activities, shopping and independence skills. I was concerned about the large number of files and papers in the office relating to various services, including several staff members and residents who had long since left the home. The home would benefit from the archiving of papers relating to service users no longer living at the home, or relating to more than two or three years ago. The home has a selection of policies and procedures, and the manager was reminded that all relevant policies needed updating with the current CSCI local office contact details. This had been addressed by the second day of the inspection. Although a COSHH (cleaning chemicals) cupboard was available in the home as appropriate, some cleaning materials belonging to a staff member were found in the cupboard under the stairs. A current satisfactory gas safety certificate, electrical installations certificate and water tank maintenance certificates were available as appropriate. There was also evidence of portable appliances testing as required at the previous inspection. Records indicated that regular fire alarm testing is carried out for the home, and fire drills are also held periodically including an evening fire drill within the last year. Not all foods stored within the refrigerators and freezers were wrapped and labelled, as required. The staff member advised that some of these foods were actually the property of staff members and not for residents use. We also found an opened jar of pasta sauce that had not been kept in the refrigerator as advised by the instrucations recorded on the jar. Again the staff member advised that this was not for use by residents but belonged to another staff member. No current general risk assessments were available for the home, and a requirement is made accordingly. The home has been sustaining a vacancy for over a year and another three-bedded home belonging to the provider has two vacancies. There are therefore some concerns regarding the financial viability of the home and a requirement is made accordingly. Care Homes for Adults (18-65 years) Page 25 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 34 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The registered person must 19/12/2008 ensure that current risk assessments are available within the home for each residents, to ensure that they are supported to take informed risks. Copies of the relevant risk assessments were sent to the CSCI shortly after the inspection. . 2 12 16 The registered person must ensure that a range of supported activities outside of the home are offered to people living in accordance with their preferences. . 19/12/2008 3 19 12 The registered person must 19/12/2008 ensure that all people living at the home are encouraged to attend routine healthcare appointments, and that this is recorded, to ensure that their health needs are met. Should they refuse to attend Care Homes for Adults (18-65 years) Page 27 of 34 appointments offered, this must be recorded. . 4 20 13 The registered person must 28/11/2008 ensure that staff sign for the administration of medicines at the time that they are administered, and medications belonging to a service user no longer resident at the home must be returned to them or disposed of at the pharmacy to ensure that peoples medicines are administered as safely as possible. . 5 20 13 The registered person must 19/12/2008 ensure that the home is provided with descriptions of all medicines provided in mixed blister packs to the home, so that staff can accurately sign medication into the home. . 6 20 13 The registered person must 28/11/2008 ensure that all medicines are stored in the lockable cabinet and not in other areas of the office, to ensure that they are stored safely in the interests of people living at the home. Failure to comply with this requirement may result in enforcement action being taken against the home. Care Homes for Adults (18-65 years) Page 28 of 34 . 7 22 22 The registered person must ensure that the identified concerns expressed by a person living at the home regarding staff leaving the home unstaffed for short periods of time, is investigated and addressed as necessary, with a record made of this as appropriate, and a copy sent to the area CSCI area office. . 8 24 23 The registered person must ensure that more cups and plates and a new microwave oven are provided for the peoples use in the home. This requirement was met by the second day of the inspection. 9 24 23 The registered person must ensure that the water cooler and payphone which are no longer operational, are removed, and a schedule is produced for the redecoration of the dining room. A new shower curtain must be provided in the bathroom and a stereo should be provided for residents use in the lounge. The hinges on the door to the most recently admitted persons room should be oiled, and the letters on all residents bedroom doors 28/11/2008 28/11/2008 19/12/2008 Care Homes for Adults (18-65 years) Page 29 of 34 (relating to previous residents first names) should be removed or replaced, to ensure the comfort of people living at the home. . 10 30 23 The registered person must ensure that more hygienic hand drying facilities are provided in the bathroom, such as a paper towel dispenser or air dryer. Staff should be provided with an area in the home to store their personal items, and must make use of this so that their personal belongings are stored away from communal areas in the home, for the safety and comfort of people living at the home. . 11 32 18 The registered person must 28/11/2008 ensure that the rota of staffing for the home is maintained up to date, and is an accurate reflection of the times that staff and the manager are present in the home on a daily basis, to ensure that the home is staffed appropriately to meet the needs of residents. . 12 32 18 The registered person must ensure that sufficient 28/11/2008 19/12/2008 Care Homes for Adults (18-65 years) Page 30 of 34 staffing cover is provided for the home so that staff members can take reasonable breaks, whilst ensuring that people living at the home are supported appropriately. . 13 39 24 The registered person must ensure that a quality assurance audit is carried out for the home including the views of people living at the home, visitors and health and social care professionals, and that evidence is available that the views of people living at the home are taken into account. (Previous timescales of 23/11/07 and 04/07/08 not met). Failure to comply with this requirement may result in enforcement action being undertaken against the home. . 14 41 37 The registered person must 28/11/2008 ensure that any incident affecting the wellbeing of a person living at the home is reported to the CSCI without delay, to ensure that the wellbeing of people living at the home can be monitored. . 15 42 13 The registered person must ensure that current general risk assessments are 16/01/2009 16/01/2009 Care Homes for Adults (18-65 years) Page 31 of 34 undertaken for the home addressing fire safety, security, kitchen safety, infection control and other relevant areas affecting people living or working at the home. . 16 42 13 The registered person must 28/11/2008 ensure that staff foods are labelled and kept to the same hygienic standards as residents foods stored within the home. Salad creme must be labelled with the date of opening and sauces must be stored within the refrigerator once opened, for the protection of people living in the home. . 17 42 13 The registered person must 28/11/2008 ensure that all COSHH materials are stored safely within the home for the protection of people living at the home. . 18 43 25 The registered person must ensure that written confirmation is provided from the homes accountants that the business is financially viable to ensure that the needs of people living at the home can be met without any constraints. . 09/01/2009 Care Homes for Adults (18-65 years) Page 32 of 34 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 20 It is recommended that the storage of the medication cabinet key should be reviewed to ensure that medications are stored as securely as possible. It is recommended that papers relating to service users no longer living at the home, or relating to more than two or three years ago should be archived, so that current information about people living at the home can be obtained more readily, in the interest of meeting their needs. 2 41 Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). 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