Inspection on 05/04/07 for Whittington House

This inspection was carried out on 5th April 2007.

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 15 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 12/10/06

Whittington House 06/04/06

Whittington House 15/08/05

Whittington House 29/04/05

Whittington House 15/09/04

Whittington House 24/05/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 Whittington House 46 Dongola Road London N17 6EE Lead Inspector Susan Shamash Unannounced Inspection 5th April 2007 12:15 DS0000010799.V333385.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 DS0000010799.V333385.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. DS0000010799.V333385.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Whittington House Address 46 Dongola Road London N17 6EE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8376 9219 F/P 020 8376 9219 Mr Francis Cleland Mr Francis George Cleland Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places DS0000010799.V333385.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 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 05/04/07 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. DS0000010799.V333385.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 five 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. There were three residents living in the home and the inspector was able to speak to two of them in detail, and one briefly 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 two staff members, as the manager was not available at the time of the inspection. The inspector spoke to both staff members during the inspection, conducted a tour of the premises and inspected care records. What the service does well: What has improved since the last inspection? 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. DS0000010799.V333385.R01.S.doc Version 5.2 Page 6 Since the previous inspection, improvements had been made in the administration of medicines to residents at the home. An immediate requirement was met that there be sufficient stocks of a prescribed medicine for an identified resident so that they receive their medication without interruption. As recommended, a pharmacist had been enlisted to dispense residents’ prescribed medicines into dossett boxes to minimise the risk of error as far as possible. A small number of maintenance issues had been addressed for the comfort and safety of staff and residents. One staff member had registered to undertake a relevant NVQ (National Vocational Qualification) and both staff members had undertaken training in working with people who have mental health problems and working with people with alcohol or drug dependency. As recommended, additional arrangements had been made for ‘on call’ management, so that the manager is not on call seven days a week. Residents meetings were being 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 compromised their privacy. The provider had sought and followed the advice from the local fire prevention officer regarding their requirement to ensure that emergency exits can be easily opened. Finally current satisfactory electrical installation, gas safety and water tank maintenance certificates had been obtained for the home. What they could do better: It remains required that evidence regarding progress made on goals through key-working sessions with residents, must be recorded, and that regular supervised trips be arranged outside of the home to places of interest to residents. Adequate stocks of fresh fruit must be provided in the home at all times, and the home must rely less heavily on convenience foods, using freshly cooked alternatives as far as possible. All medicines received at the home or returned to the pharmacist from the home must be recorded, and there should be clear guidelines available for the administration of PRN (as and when) medicines. DS0000010799.V333385.R01.S.doc Version 5.2 Page 7 It remains required that the front garden path be repaved. Matching taps must be fitted on the sink in the bathroom, the bathroom windowsill and radiator, and the banisters on the staircase must be repainted. New furniture must be provided in one resident’s room. Action must be taken to clear weeds and ensure a level surface in the rear garden, and repaint the external window frames of the home. The carpet in the hallway at the top of stairs must be cleaned and paper towels must be provided in the bathroom. The ant problem in the kitchen near to the boiler must be addressed safely. Sufficient staffing must be provided in the home to ensure varied activities for residents outside of the home. It remains required that at least fifty percent of staff must be trained to at least NVQ level 2 in care. Annual appraisals must be carried out with all staff working regularly at the home, and a detailed quality assurance procedure is needed for the home and an audit must be undertaken for the home at least annually. It was of concern to the inspector that no current portable appliances testing certificate covering all relevant items was available for the home. Failure to meet this requirement may result in the CSCI taking enforcement action against the home. The smoke alarm in an iesident’s room must be repaired and at least one evening fire drill must be carried out for the home each year. It is recommended that contact with residents’ social workers be recorded, the medication cabinet in the downstairs office be repaired/replaced and damage to the rear garden wall continue to be pursued with the owner of the property responsible. 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. DS0000010799.V333385.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 DS0000010799.V333385.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 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An adequate system is in place to assess residents’ needs and goals effectively and ensure that these can be met. However there is insufficient evidence that residents can be sure that the home will meet their needs and aspirations. EVIDENCE: No new residents have been admitted since the previous inspection. Each resident’s care plan included assessments of their individual needs, and residents spoken to confirmed that they were consulted about their needs. A requirement is restated under Standard 6 that support provided to residents and progress made on working towards their individual goals must be recorded. The failure to meet this requirement means that it is not possible to verify whether adequate support is provided to residents in meeting their goals. The two residents spoken to were unable to verify support provided to them to meet their needs and goals. DS0000010799.V333385.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, 8 and 9. Quality in this outcome area is adequate This judgement has been made using available evidence including a 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 remains insufficient 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 DS0000010799.V333385.R01.S.doc Version 5.2 Page 11 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. Resident meeting minutes indicated some consultation about how the home is run, and this was confirmed by staff and residents spoken to. However the inspector was concerned to note that care plans and daily notes recorded for each resident still did not evidence that staff were supporting them appropriately to meet their identified goals, despite a requirement made at the previous inspection. 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 still 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. Similar gaps were found in the recording of progress made on goals through key-working sessions with residents, for a resident prone to depressive moments and a resident with a specific hygiene issue as discussed during the inspection. This requirement is restated accordingly. DS0000010799.V333385.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 using available evidence including a visit to this service. 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 although over reliance on convenience foods may mean their nutritional needs are not fully met. EVIDENCE: DS0000010799.V333385.R01.S.doc Version 5.2 Page 13 The inspector spoke to all two residents in detail 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. One resident attends day services sporadically according to their wishes. Two residents go out independently using public transport during the day and the other had recently commenced attending a day centre accompanied by staff from the home, which represents significant progress for them. Residents indicated that they receive staff support in participating in meaningful and therapeutic daytime activities. 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 has less opportunities of meeting people of their own age or with shared interests. This is an area that is being addressed in conjunction with an occupational therapist, and their recent admission to a day centre once weekly represents significant progress in this area. 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 this year 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 for the sixth time, 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. Examination of the staffing rota for the home indicated that there are currently insufficient staff working at the home to provide a varied leisure activity program outside of the home, a requirement is made accordingly under Standard 31. DS0000010799.V333385.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 a heavy reliance on ready made foods such as packaged pies, burgers etc. and 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 were unclear regarding whether fresh fruit was available in this home at all times, with one resident advising that they eat out when possible. It is therefore required that fresh fruit be available in the house at all times and that the home relies less on convenience foods, using freshly cooked alternatives as far as possible. DS0000010799.V333385.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive appropriate physical and emotional support and are supported to take their prescribed medicines. However despite a significant improvement in medication procedures within the home, there is still a need for improved recording to ensure that residents are not placed at risk of harm. EVIDENCE: Resident 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 medication administration records appeared to be completed appropriately. No residents are self-medicating. Since the previous inspection DS0000010799.V333385.R01.S.doc Version 5.2 Page 16 a new system by which the pharmacist dispenses all medicines into weekly dossett boxes, was being used which represents a significant improvement. However recording of medicines received at the home and those returned to the pharmacist, had ceased since the new system was put in place, and this is required to ensure that there is a clear audit trail available for all medicines received into the home. The staff member on duty advised that the social worker of an identified resident who has diabetes, had been notified that they are refusing to have regular blood sugar monitoring tests. However there was no record of this contact with the social worker, and the inspector was unable to verify this. It is recommended that records of any such contact be maintained at the home. Only one resident is prescribed a PRN (as and when) dose of medication to be administered by staff when necessary. However no guidelines were recorded for staff to follow regarding when this medicine should be give. Although records indicated that it is used sparingly, such guidelines are required to ensure that this medicine is administered safely. If possible these guidelines should be approved by a medical practitioner. The staff member on duty advised that the new medication cabinet (which fits the new containers under the new system) was not locking appropriately. Therefore medicines were being stored in the upstairs office. It is recommended that the medication cabinet should be repaired/replaced for easier access to medicines by staff. DS0000010799.V333385.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 using available evidence including a 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. DS0000010799.V333385.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 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Some 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 a need for a number of identified improvements for the comfort, hygiene 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 prior to 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 when it is warm. DS0000010799.V333385.R01.S.doc Version 5.2 Page 19 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 of communication with the local council regarding this issue. In the meantime preventative action had been taken by fencing off the area of the garden that is affected, to protect the safety of staff and residents using the garden as appropriate. It remains recommended that the issue of this wall be followed up so that a long-term solution can be found. 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. As required a panel under the kitchen sink had been repaired, as it was loose and fell down when the cupboard door below was opened, and the hole in an identified resident’s bedroom wall (caused by the door handle) had been filled. However the front garden path had not been retiled or repaved as required at the previous inspection. This requirement is restated. A number of new maintenance issues required attention during the current inspection: Non-matching taps were fitted on the sink in the bathroom, the paint on the bathroom windowsill and radiator was worn and the banisters on the staircase was also in need of repainting. The furniture in one resident’s room was old, institutionalised in feel and in need of replacement. These issues must be addressed without delay. Action must also be taken to clear weeds and ensure a level surface in the rear garden, and a schedule to repaint the external window frames of the home must be provided to the CSCI local area office. The carpet outside an identified resident’s room in the hallway at the top of stairs was stained and must be cleaned and paper towels must be provided in the bathroom for hygiene reasons. The ant problem in the kitchen near to the boiler must also be addressed safely. It is also recommended that the site where the identified resident’s bedroom wall is repeatedly damaged by the door handle, should be fitted with a protective patch to prevent repeated damage. DS0000010799.V333385.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): 31, 32, 34, 35 and 36. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Insufficient staff are available to provide residents with flexible support outside of the home. Staff have undertaken a range of relevant training to meet the needs of residents safely and effectively. However lack of 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: Examination of the staffing rota showed that only two staff members are currently working regularly at the home. 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. However discussion with residents and review of activities DS0000010799.V333385.R01.S.doc Version 5.2 Page 21 records indicated that insufficient staff are available to support residents with a flexible selection of activities outside of the home. A requirement is made accordingly. Staff training records indicated adequate training in health and safety, moving and handling, first aid, adult protection, administration of medication, drug and alcohol awareness and dealing with potentially violent situations. Discussion with staff members indicated that they were experienced at working with residents with mental health problems and had undertaken some specific training in this area as required at the previous inspection. They were also knowledgeable about the cultural needs of individual residents. However the home has not yet achieved 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. Currently only one staff member is about to commence NVQ training. Clearly this will have implications for further staff members recruited to the home. 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. As required, separate staff meetings (other than house meetings including residents) had also been occurring on a regular basis. However there were no records of annual appraisals for staff members and staff spoken to confirmed that they had not yet had appraisals with their manager. Both staff had undertaken training in working with people with alcohol or drug dependency, as required. Although staff files had been seen previously for the two staff members working at the home, and were previously found to include all necessary information, one reference for an identified staff member was found to be missing. It is required that this be addressed. DS0000010799.V333385.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 using available evidence including a visit to this service. Appropriate arrangements are in place to manage the home. 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. Inadequate health and safety procedures continue to place residents at risk. EVIDENCE: As recommended at the previous inspection, additional arrangements be made for ‘on call’ management, so that the registered person is not on call seven days a week. Due to ill health in the last few months, the manager had not been available at the home as frequently at previously, but staff advised that he still provided adequate support by telephoned and still spent time at the home regularly. DS0000010799.V333385.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. It is required that a clear and comprehensive quality assurance system be put in place for the home. At the previous inspection the inspector noted from minutes of resident meetings 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. As required the use of these meetings had been reviewed and appeared to be appropriate. COSHH materials (harmful chemicals) were stored in locked facilities as appropriate, and hazard analysis sheets were available for COSHH materials used within the home. As required at the previous inspection the manager had obtained and followed advice from the local fire prevention officer with regard to their requirement to ensure that emergency exits can be easily opened. A current satisfactory electrical installation certificate for the home, gas safety certificate, and water tank maintenance certificates were sent to the local CSCI office as required. However no portable appliances testing (PAT) certificate was available, as was also required. A week after the inspection a PAT certificate was provided for some of the electrical appliances in the home. However it did not include the electrical items belonging to residents in the home, and therefore this requirement remains outstanding. Failure to comply with this requirement may result in enforcement action being taken against the home. The smoke alarm in one resident’s room was hanging down, and appeared to be in need of repair. It is required that this smoke alarm be repaired and if necessary this should be substituted with an alternative sensor if the resident smokes in their room on a regular basis. Records indicated that regular fire alarm testing is carried out for the home, and fire drills are also held periodically. However at least one evening fire drill must be carried out for the home annually, this may be silent if necessary. DS0000010799.V333385.R01.S.doc Version 5.2 Page 24 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 2 4 X 5 X 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 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 2 32 2 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 1 X DS0000010799.V333385.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 YA9 Regulation 15(2) Requirement The registered person must ensure that evidence regarding progress made on goals through key-working sessions with residents, including support of an identified resident in managing their debts, resident prone to depressive moments and resident with specific hygiene issue discussed during the inspection, to ensure that they are supported appropriately. (Previous timescale of 22/12/06 not met). The registered person must ensure that regular supervised trips are arranged outside of the home to places of interest to residents, such as trips to the cinema, pub and local cafes/restaurants, and day trips to more distant destinations. These must be recorded in resident files, to ensure that they are given adequate leisure opportunities. (Previous timescales of 22/10/04, 01/07/05, 23/09/05, 19/05/06, 22/12/06 not met). The registered person must DS0000010799.V333385.R01.S.doc Timescale for action 25/05/07 2. YA14 16(2mn) 18/05/07 3. YA17 16(2i) 11/05/07 Page 26 Version 5.2 4. YA20 13(2) ensure that adequate stocks of fresh fruit are provided in the home at all times, and that the home relies less on convenience foods, using freshly cooked alternatives as far as possible, to ensure that they have a nutritious diet. The registered person must ensure that all medicines received at the home or returned to the pharmacist from the home are recorded. 04/05/07 5. YA24 13(4a) 23(2d) Clearly recorded guidelines must be available for the administration of PRN (as and when) Diazepam to an identified resident and these should be approved by a medical practitioner, to ensure that each resident’s medication needs are met safely. The registered person must 08/06/07 ensure that: • the front garden path is retiled or repaved, to ensure a pleasant environment for residents. (Previous timescale of 08/12/06 not met). The registered person must ensure that matching taps are fitted on the sink in the bathroom, the bathroom windowsill and radiator are repainted and the banisters on the staircase are repainted. New furniture must be provided in the identified resident’s room. Action must be taken to clear weeds and ensure a level surface in the rear garden, and a schedule to repaint the external window frames of the DS0000010799.V333385.R01.S.doc Version 5.2 Page 27 6. YA24 23(2bd) 08/06/07 7. YA30 23(2d) home must be provided to the CSCI local area office, to ensure that residents live in a comfortable, pleasant and safe environment. The registered person must 25/05/07 ensure that the carpet is cleaned outside an identified resident’s room in the hallway at the top of stairs. Paper towels must be provided in the bathroom. The ant problem in the kitchen near to the boiler must be addressed safely, to ensure that residents live in a hygienic environment. The registered person must ensure that sufficient staff members are provided to ensure adequate flexibility in arranging activities for residents at the home. 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, to ensure that residents are supported by appropriately qualified staff in line with best practice. (Previous timescale of 08/12/06 not met). The registered person must ensure that that references for the identified staff member are maintained on their file at the home, to ensure that residents are safeguarded by appropriate recruitment procedures for the home. The registered person must ensure that annual appraisals are carried out with all staff working regularly at the home, DS0000010799.V333385.R01.S.doc 8. YA31 18(1a) 25/05/07 9. YA32 19(5) 08/06/07 10. YA34 17(2) Schd4(6c) 11/05/07 11. YA36 18(2) 25/06/07 Version 5.2 Page 28 12. YA39 13. YA42 14. YA42 and these are recorded, to ensure that staff are supported appropriately to work with residents in line with best practice. 24 The registered person must 06/07/07 ensure that a detailed quality assurance procedure is available for the home and an audit is undertaken at least annually with details of the procedure and the results sent to the local CSCI area office, to ensure that the standard of care and support provided in the home is monitored and raised with the views of residents in mind. 13(4a) The registered person must 04/05/07 ensure that a current portable appliances testing certificate is available for all relevant appliances in the home, and that a copy is sent to the local CSCI area office, to ensure the safety of staff and residents at the home. (Previous timescale of 08/12/06 not met). 13(4a) The registered person must 11/05/07 23(4c(iv)e) ensure that the identified smoke alarm be repaired and if necessary this should be substituted with an alternative sensor. At least one evening fire drill must be carried out for the home annually, this may be silent if necessary, in order to protect the safety of staff and residents in the home. DS0000010799.V333385.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA19 Good Practice Recommendations It is recommended that records be maintained evidencing that the social worker of an identified resident who has diabetes, has been notified that they are refusing to have regular blood sugar monitoring tests, so that social work input may be obtained for this resident to protect their health as far as possible. It is recommended that the medication cabinet in downstairs office should be repaired/replaced to ensure the safe storage of medicines. It is recommended that the damage to the rear garden wall continue to be pursued with the owner of the adjoining property, so that residents can have access to this area of the garden once more. It is recommended that the damage to the rear garden wall continue to be pursued with the owner of the adjoining property, so that residents can have access to this area of the garden once more. 2. 3. YA20 YA24 4. YA25 DS0000010799.V333385.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: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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