Inspection on 02/07/07 for Wick Road ( 302, Flat 1 & 2)

This inspection was carried out on 2nd July 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wick Road ( 302, Flat 1 & 2) 15/06/06

Wick Road ( 302, Flat 1 & 2) 30/12/05

Wick Road ( 302, Flat 1 & 2) 18/08/05

Wick Road ( 302, Flat 1 & 2) 16/12/04

Wick Road ( 302, Flat 1 & 2) 19/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Wick Road ( 302, Flat 1 & 2) 302 Wick Road Hackney London E9 5DQ Lead Inspector Robert Sobotka Unannounced Inspection 2nd July 2007 09:30 Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.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 Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.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. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Wick Road ( 302, Flat 1 & 2) Address 302 Wick Road Hackney London E9 5DQ 020 8986 4958 020 8502 3543 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) www.heritagecare.co.uk Heritage Care Mrs Teresa Okeke Care Home 8 Category(ies) of Learning disability (8), Physical disability (8), registration, with number Sensory impairment (8) of places Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th June 2006 Brief Description of the Service: The Wick Road project was registered in February 2003. The care home provides personal care, support and accommodation for a maximum of eight service users who have learning disabilities, physical disabilities and/or sensory impairment and are between the ages of 18 and 65 years old. The project is a jointly commissioned venture, via Hackney Primary Care Trust, Heritage Care, North East London Advocacy Project and the Peabody Trust. All current service users were transferred from another residential establishment, managed by NHS. Staff from the former NHS home have also transferred and now work at Wick Road. The purpose built accommodation, is a three storey building based at a very busy intersection in the Victoria Park area of the London Borough of Hackney. The project occupies the first two floors of the building. The third floor is an unregistered space designed for supported living, managed separately from the Wick Road Project. The building has an operating lift and the home is fully accessible to wheelchair users. The home overlooks Victoria Park and has a garden space and a car park to the rear of the building. Local bus services run along the main road, local shops and amenities are short distance away by vehicle. The project owns a van, which is wheelchair accessible. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one day and was unannounced. It was carried out by two inspectors from the Commission for Social Care Inspection, Robert Sobotka, the Lead Inspector and Tim Weller, the Regulation Manager. The inspectors were accompanied by the Commissioner from the Commission for Social Care Inspection, Mr John Knight, who observed the inspection process. As part of this visit, the inspectors spent some time with the registered manager; the deputy manager and they interviewed care staff working in the care home. The inspectors also carried out a tour of the premises and viewed various records. They observed interaction between the people who used the service and members of staff supporting them. Prior to this inspection the home was asked to complete the Annual Quality Assurance Assessment. Some of the information provided in the assessment has been incorporated into this inspection report. The aim of this unannounced inspection was to check the home’s progress towards full compliance with the Care Homes Regulations and the National Minimum Standards for Care Homes for Adults (18-65). The inspectors would like to thank the staff and service users for contributing to this unannounced inspection. What the service does well: The home had a good care planning system in place. The home is managed by a competent and knowledgeable manager. Staff supporting service users have worked with them for a long time and are aware of their needs. The key-workers have learnt to interpret reactions from the service users because they have known them well enough to understand their non-verbal cues. Service users are involved in the staff recruitment interviews. Regular service users’ meetings are organised with the advocate to obtain the views of the service users. The home appropriately supports the service users in meeting their cultural and spiritual needs. Appropriate complaints system was in place. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There were 2 requirements, which remain unmet from the last inspection. These were: - It is required that the responsible person ensures that the individual service user contracts are signed by all relevant parties. - The responsible person must ensure that the service users’ financial affairs are resolved and that they have access to their own finances. Although the organisation was able to demonstrate that some efforts have been made to meet the above requirements, they remain outstanding and must be met without any further delay. In addition the following 11 requirements were made during this inspection visit: - The registered manager must ensure that each service user’s weight is monitored and recorded in accordance with their individual care plans. - The registered manager must ensure that any eyedrops are labelled once opened and that they are stored in line with the manufacturer’s instructions. - The home’s medication administration records must be improved, so that clear administration directions are given in respect of any “as required” (PRN) medication. - The registered manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 7 - The registered manager must ensure that the Commission is informed of any events listed in Regulation 37 of the Care Homes Regulations. - The registered manager must ensure that the clinical waste bin is locked when not in use. - The registered manager must ensure that equipment such as the service users’ walking frames, hoists and any other equipment is discreetly stored when not is use, in order to provide less institutional environment. - The registered manager must ensure that where identified, staff are offered refresher courses in mandatory fields, as well as areas such as sexuality and diversity, in order to ensure that staff possess all necessary skills and knowledge to be able to support all service users appropriately. - The registered manager must ensure that no staff are employed in the home unless all the information listed in Schedule 2 of the Care Homes Regulations has been obtained, in order to protect the people who use the service. - The registered manager must ensure that all staff working in the home receive regular supervision sessions. - The registered manager must ensure that all substances hazardous to health are securely locked away when not in use, in order to comply with the Control of Substances Hazardous to Health (COSHH) Regulations 1999. The following 5 good practice recommendations were also made during this inspection visit: - It is recommended that the Criminal Records Bureau checks be undertaken every 3 years. - It is recommended that a monthly audit of all “as required” medication be carried out. - The registered manager should seen further input from the advocacy team before a decision is made as to what kind of material should be used for flooring in the service users’ bedrooms. - It recommended that the registered manager liaise with the local Primary Care Trust team to ensure that any specialist equipment is supplied by the local Primary Care Trust, instead of being purchased by individual service users. - It is recommended that bedside lighting be purchased for the service users’ rooms. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 9 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 Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate information about the home was in place for potential service users. The home was meeting the needs of those who use the service. Further work is required to ensure that the service users’ contracts are signed by their representatives/relatives. EVIDENCE: The home had an up-to-date statement of purpose and the service users guide. The statement of purpose has recently been updated to reflect a recent change of the service manager within Heritage Care. There have not been any admissions to the service since the home opened in 2003. The registered manager stated that if there were any admissions in future, she would ensure that proper assessment of needs is carried out before agreeing any admission. The service will carefully consider the needs of the person and ensure the capacity of the home to meet the assessed needs. Heritage Care has a referral and admissions criteria to guide the service. Standards relating to the home assessment and admissions systems could not therefore be fully assessed and will be reviewed when any new admissions have taken place. It was noted however that all service users who are currently living in the home have been appropriately assessed prior to moving to Wick Road. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 11 Following the review of documentation, such as care plans and risk assessments, direct and indirect observation of staff interaction with the service users and discussion with care staff, the inspectors were satisfied that the needs of those accommodated in the home were being appropriately met. Since the last inspection, staff working in the home have worked hard to ensure that care plans for each person who used the service were updated and kept up-to-date. Each service user had a written costed contract in place, however they remain unsigned. The inspectors have been informed that as the service users living in the home were unable to sign the documents, no other person has been prepared to sign contracts on their behalf. This required improvement. The inspectors remain concerned that this is a repeated requirements and it must be met without any further delay. Further non-compliance will result in the Commission issuing an enforcement notice against the provider. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home had a good care planning system in place. Risks were appropriately managed. Confidentiality was being maintained. EVIDENCE: During the course of this visit, the inspectors reviewed care plans of 4 service users, which were chosen at random. All service users had pictorial care plans in place. Since the last inspection, the home has introduced a Person Centred Planning and all Health Action Plans have also been rewritten in a more accessible format for all the service users. The registered manager stated that the service works hard to ensure that the staff empower those who use the service to have control of their lives. Care plans viewed were very thorough and included useful and detailed information about how to support each service user and what their likes and dislikes were. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 13 There has been a vast improvement in the quality of care plans for each service user since the last inspection. The inspectors were satisfied that the previous requirement in relation to the home’s care planning systems has now been met. The service holds service users’ meetings, which are facilitated by an advocate, minutes from which were available for inspection. The home has also developed a range of objects of reference to promote choice making for the service user who have limited verbal communication. The registered manager recognised that the home could make the Person Centred Planning more active and make better and more effective use of the role of the advocate. She also stated that there were plans over the next 12 months to start using multimedia materials for the Person Centred Planning purposes, as this would be far more effective and have more impact on the service users. Appropriate risk management systems were in place. The registered manager stated that the home recognised that risk taking is an important part of life, which enables people to learn and develop their skills and overcome difficulties and as a result continue to make choices. The service therefore regards responsible risk taking as part of everyday life and service users are not prevented from taking part in certain activities only because there is an element of risk. In this regard, for example, one of the service users who has high needs, and had never flown or travelled outside the United Kingdom has been supported to achieve a lifetime ambition of flying to Antigua for 12 days to visit her parents. Two other service users have also been able to go abroad on a holiday. The risks were assessed and actions were taken to minimise any effects of the identified risks. All activities are risk assessed before those who live in the home start their activities. The requirement from the last inspection that risk assessments are to be drawn up for those service users who use cot sides has now been met. Confidentiality was maintained. All confidential documents were kept in the staff room and locked when not in use. Information kept on computers was password protected. Each member of staff was assigned with a password to access relevant information on computers. Information was shared with the inspectors on a need-to-know basis. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a good range of activities offered by the home and are supported with personal development and maintaining personal friendships/relationships. Appropriate food arrangements were in place. EVIDENCE: The home ensures that the day service links, which have educational links are kept active and alive. The service ensures that despite profound learning and physical disabilities people who use the service continue to enjoy the life opportunities that they experience. People who use the service are engaged in meaningful activities and are supported to participate and be part of the their local community. Service users are supported by staff to attend local places of worship and visit local pubs. They also make use of the transport facilities available to access the wider community. People who use the service are supported to go Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 15 swimming and to attend clubs for people with learning disabilities, and are engaged in other activities as detailed in their ideal and activity plan/person centred plans. Those who live in the home are supported to maintain contact with their families/friends. They are encouraged to forge friendships both with the people who live with them and well as with people outside the home. Families are invited for barbeques and parties. Although those who use the service are not able to communicate verbally, staff working in the home maintain telephone contact with the service users’ relatives. The registered manager stated that the service users’ rights are maintained and respected at all times based on best practice, which meets the contract requirements. Service users are encouraged to choose what happens in the home and are involved in a decision making as far as it is practicable and possible. Those who use the service have unrestricted access to all communal parts of the home. Staff working in the home adequately support and encourage service users to be as fully involved as possible, despite their limited capacity. Service users are for example involved in some domestic tasks and as of part of developing or maintaining self-help skills in areas such as cooking, laundry, shopping and menu planning. The service offers an individualised and healthy diet, which meets the cultural needs and preferences of the service users. The registered manager stated that those who use the service are involved in the menu planning, shopping as well as food preparation, with staff support. The health and dietary needs of the service users are assessed and reviewed/monitored on a regular basis. This is done in order to minimise risks facing some people who have problem gaining and maintaining weight, as well as those who are prone to obesity. The home works closely with the Dietician and the Speech and Language Therapist. Staff working with the service users are patient and ensure that people who use the service finish their meals at their own pace. There were adequate food supplies in the home on the day of this inspection visit. Fridge/freezer temperatures were being recorded on a regular basis. Since the last inspection the home has improved its pictorial food menu. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall, the service was appropriately meeting personal and healthcare needs of the people accommodated in the home. Medication systems required improvement. EVIDENCE: All of the people who were using the service required support and assistance with their personal care. Each care plan viewed contained very detailed information about how personal care should be delivered to each person and it included their preferences and likes and dislikes. The registered manager stated that the service users are supported with close attention given to respecting individual needs and maintaining dignity at all times. Personal care is given at flexible times. The home maintain good relationships with the Learning Disabilities Team and have a lot of input from the Physiotherapists, Occupational Therapists and Speech and Language Therapists. Staff ensure that care is person led and person centred and as such is very flexible. Each person who used the service had an up-to-date and accessible Health Action Plan in place and there was evidence that regular heath checks from the Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 17 General Practitioner/Nurse were taking place and that any other healthcare facilities were being utilised. During the review of the service users’ health files, the inspectors noted that the weight of the people who use the service was not always recorded, as it appeared that the home was having problems with its weighing scales. The registered manager explained to the inspectors that the weighing scales were frequently out of order and staff members were unable to monitor service users’ weight. This required improvement. None of the people who used the service were able to administer their own medication. As part of this visit, the home’s medication systems were checked. During checking of the medication cabinet, the inspector found some eyedrops, which have been opened, however they were not stored in the fridge, as instructed by the manufacturer. In addition the drops were not dated when opened. All medication administration sheets are usually printed by the local dispensing pharmacist. At the time of this visit, the sheets did not contain full directions as to how the “as required” (PRN) medication was to be administered. This required improvement. The inspector also found some homely remedies for staff, which were kept in the home’s medication cabinet without being clearly labelled that they were for staff use. It is recommended that a monthly audit of all “as required” medication be carried out. All medication was securely locked. Medication stocks were checked and found correct. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home had a good complaints system in place. Some improvements were required in relation to the service user’s financial matters. The home did not always inform the Commission of significant events in the home. EVIDENCE: The home had both complaints and a compliments policy in place and both documents were in different accessible formats and languages. The registered manager stated that the home works with families of the service users and the service is aware of the need to welcome/listen to any comments, concerns and suggestions the service users or their families may have and of the need to use them positively to improve the service. The home works with an advocate, who lends a voice to the service users to ensure that they are heard and listened to at all times. The home has not received any complaints in the past 12 months and had no allegations and incidents of abuse. Some compliments were noted in the home’s compliments book. As part of this visit, the inspectors checked financial records kept on behalf of the service users. As those who use the service are unable to make any decisions in relation to their financial affairs, all purchases on behalf of the service users are made by staff supporting them. The home kept a small amount of money for each person who used the service. Whilst checking the receipt, the inspectors were concerned to note that some staff have used the loyalty cards when making purchases on behalf of the service users, even though those loyalty cards were not registered in the name’s of the service users. This practice in unacceptable and must be stopped. The inspectors have Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 19 raised their concerns in relation to this matter to the registered manager, as using loyalty cards other than those that belong to the service users should be considered as theft and disciplinary procedures should be invoked. The registered manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. During the tour of the premises, it was noted that a part of the ceiling in one of the service users’ bedrooms was missing as a result of the leak. The inspectors felt that this incident affected the wellbeing of the service user and should have been reported to the Commission in line with the Regulation 37 as the “event in the care home which adversely affects the wellbeing or safety of the service user”. The registered manager must ensure that the Commission is informed of any events listed in Regulation 37 of the Care Homes Regulations. Appropriate records of incidents/accidents were maintained and these were being monitored by the registered manager. Staff working in the home have attended adult protection training, however the inspectors felt that one member of staff who was interviewed during this inspection visit would benefit from further training, as their knowledge of various types of abuse was limited. The requirement in relation to the service users not being able to access their own finances remains unresolved and must be addressed as a matter of urgency. This is a repeated requirement and must be met without delay. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those living at Wick Road benefit from an adequate and suitable environment; however further work should be undertaken in order to make the premises more homely. EVIDENCE: Wick Road is located in a purpose built building and is suitable for its stated purpose and aims. The home is wheelchair accessible and has an operating lift. The project occupies the ground floor and first floor of the building. Since the last inspection, all communal premises have been repainted, as previously required. The inspectors and the Commissioner carried out a tour of the premises. They viewed all communal areas and the majority of bedrooms. Bedrooms were personalised and reflected interests and cultural identity of the service users. It was noted, however that some parts of the home, especially bathrooms appeared to be very clinical and would benefit from being some personalisation. In addition, some of the equipment, such as service users’ Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 21 walking frames and hoists were being stored in bathrooms, when not in use. The inspectors felt that this equipment could be stored in discreet areas, such as walk in cupboards, in order to make the premises less institutional. The majority of the premises had laminated flooring. During the course of this inspection, the inspectors were informed that the remainder of the carpets would be replaced with laminated flooring, as some of the existing carpets were stained and in need of replacement. A discussion took place during this inspection visit between the registered manager and the inspectors about the way the decision was made in relation to the choice whether the service users would prefer carpets or laminated flooring in their bedrooms. The inspectors felt that further input was needed from the advocacy team before a decision is made as to what kind of material should be used for flooring in the service users’ bedrooms. The inspectors also felt that some of the service users would benefit from bedside lamps, rather than having to use overhead/main lighting. The home has six WC’s, four bathrooms and five showering facilities. All areas were spacious and clean. Specialist equipment was installed (such as Arjo baths, power chairs, tracking hoists and changing benches), to meet the assessed needs of the service users. In addition grabrails were installed throughout the house. The home had 3 mobile hoists, which service users can use in the home and when they are going on holidays. All bedrooms contain power beds. During this inspection visit, a discussion took place about the availability of specialist equipment for the service users. The inspectors were informed that in some cases service users have been expected to purchase some of the specialist equipment. This equipment should be paid for or supplied on a loan from the local Primary Care Trust. It recommended that the registered manager liaise with the local Primary Care Trust team to ensure that any specialist equipment is supplied by the local Primary Care Trust, instead of being purchased by individual service users. The home was found to be hygienic and free from offensive odours. At the time of this inspection, the home’s clinical waste was kept in the wheelie bins in the rear garden and those bins were not locked. The registered manager must ensure that the clinical waste bins are locked to prevent any spread of infections. In the Annual Quality Assurance Assessment supplied to the Commission prior to this inspection, the registered manager stated that there were plans on the way to install a macerator for the disposal of incontinence pads to replace the use of clinical waste and yellow bags. Laundry facilities were clean and well maintained. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Appropriate staffing levels were in place. Further training was required for staff working in the home. Recruitment practices required minor improvements. EVIDENCE: Copies of the duty rosters were maintained in the home. Staff who spoke with the inspectors felt that the current staffing levels were satisfactory to meet the needs of the service user accommodated in the home. Members of staff were observed to work in a professional and courteous manner and treated service users with dignity and respect. The registered manager informed the inspectors that one of the challenges facing the home was the retention of staff, due to the heavy physical workload linked to the high level of physical needs of the people who use the service. Overall a good level of training was offered to staff working in the home, however an interview with one of the staff working in the home highlighted a need for further training in relation to the Protection of Vulnerable Adults, Fire Safety Training and issues around sexuality and diversity. The registered manager must ensure that where identified, staff are offered refresher courses in mandatory fields, as well as areas such as sexuality and diversity, in order Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 23 to ensure that staff possess all the necessary skills and knowledge to be able to support all service users appropriately. At the time of this inspection more than 80 of the staff working in the home had the National Vocational Qualification in Care Level 2 or above. As part of this visit, the inspectors checked several staff personnel files. The inspectors were informed that each employee’s main file was kept in the organisation’s head office. Copy of the person’s file was also kept in the home. Some of the files viewed did not contain proof that a member of staff was entitled to work in the United Kingdom. Another file contained only one reference. Another staff file did contain both references, although the references received contained information that was inconsistent with the information supplied by a member of staff and there was no evidence that the references had been verified. This required improvement. Criminal Records Bureau Disclosures were not checked during this inspection visit, as they were being stored in the Heritage Care head office in Loughton. Pro-forma sheets were kept in the home, which evidenced that each person received a Criminal Records Bureau checks. It was noted however that in some cases, the Criminal Records Bureau disclosures were more than 3 years old. The recommendation that the Criminal Records Bureau checks are carried out every 3 years has therefore been repeated. The frequency of supervision sessions required improvement, as at the time of this inspection visit it fell short of the required National Minimum Standard. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a competent manager. Good quality assurance systems were in place. Health and safety was generally well-maintained, although improvements are required to the storage of any substances hazardous to health. EVIDENCE: The home is well run by a competent and qualified manager, who is experienced to work with the service user group. She had worked in the field with people with similar needs for over 10 years and has been registered with the Local Authority Inspection and Registration Unit since 2001 and with the Commission for Social Care Inspection since 2005. The registered manager has the NVQ Level 4 in Management, NVQ in Care Level 3, NVQ in Care Level 4 and a Bachelor of Arts (Hon) Degree in French. She has also recently enrolled for the NVQ Level 4 Registered Managers Award and undertakes regular training Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 25 and development to maintain and update her knowledge, skills and competence while managing the home for the benefit of the service users. Throughout the course of this inspection, the manager was able to demonstrate her good understanding of the service users’ individual needs and knowledge of the relevant legislations. Appropriate quality assurance systems were in place. There has been a change in the service manager since the last inspection. The new service manager visits the service one a regular basis. Staff who spoke with the inspectors felt that the new service manager was very supportive. Reports from her monthlyunannounced visits to the home were available for inspection. They were also being forwarded to the Commission on a regular basis. The majority of health and safety checks were in place, however it was noted that at the time of this inspection some cleaning materials were not kept locked. The registered manager must ensure that all substances hazardous to health are securely locked away when not in use, in order to comply with the Control of Substances Hazardous to Health (COSHH) Regulations 1999. As previously mentioned, the home’s clinical waste bin should be locked when not in use. The home was appropriately insured for its purpose. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 26 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 3 2 x 3 3 4 x 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 2 27 3 28 3 29 3 30 2 STAFFING Standard No Score 31 x 32 3 33 3 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 2 x Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 17 Requirement Timescale for action 01/10/07 2. YA23 20 3. YA19 12(1) 4. YA20 13(2) It is required that the responsible person ensures that the individual service user contracts are signed by all relevant parties. (Previous timescales of 01/11/05, 01/03/06 and 01/09/06 were not met.) The responsible person 01/10/07 must ensure that the service users financial affairs are resolved and that they have access to their own finances. (Previous timescales of 15/11/05 01/03/06 and 01/09/06 were not met.) The registered manager 01/09/07 must ensure that each service user’s weight is monitored and recorded in accordance with their individual care plans. The registered manager 15/08/07 must ensure that any eyedrops are labelled once opened and that they are stored in line with the manufacturer’s instructions. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 28 5. YA20 13(2) 6. YA23 13(6) 7. YA23 37 8. YA30 16(2)(k) 9. YA29 23(2)(m) 10 YA35 18(1)(c)(i) The home’s medication administration records must be improved, so that clear administration directions are given in respect of any “as required” (PRN) medication. The registered manager must ensure no loyalty cards are used when making purchases on behalf of a service user, unless the cards are in the service user’s name, in order to protect the service user from financial abuse. The registered manager must ensure that the Commission is informed of any events listed in Regulation 37 of the Care Homes Regulations. The registered manager must ensure that the clinical waste bin is locked when not in use. The registered manager must ensure that equipment such as the service users’ walking frames, hoists and any other equipment is discreetly stored when not is use, in order to provide less institutional environment. The registered manager must ensure that where identified, staff are offered refresher courses in mandatory fields, as well as areas such as sexuality and diversity, in order to ensure that staff possess all necessary skills and knowledge to be able to support all service users appropriately. 15/08/07 15/08/07 15/08/07 15/08/07 15/08/07 01/10/07 Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 29 11. YA34 19(1) 12. YA36 18(2) 13. YA42 13(4)(c) The registered manager 15/08/07 must ensure that no staff are employed in the home unless all information listed in Schedule 2 of the Care Homes Regulations has been obtained, in order to protect the people who use the service. The registered manager 15/09/07 must ensure that all staff working in the home receive regular supervision sessions. The registered manager 01/08/07 must ensure that all substances hazardous to health are securely locked away when not in use, in order to comply with the Control of Substances Hazardous to Health (COSHH) Regulations 1999. Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA34 YA20 YA26 Good Practice Recommendations It is recommended that the Criminal Records Bureau checks be undertaken every 3 years. It is recommended that a monthly audit of all “as required” medication be carried out. The registered manager should seen further input from the advocacy team before a decision is made as to what kind of material should be used for flooring in the service users’ bedrooms. It recommended that the registered manager liaise with the local Primary Care Trust team to ensure that any specialist equipment is supplied by the local Primary Care Trust, instead of being purchased by individual service users. It is recommended that bedside lighting be purchased for the service users’ rooms. 4. YA29 5. YA26 Wick Road ( 302, Flat 1 & 2) DS0000039313.V340898.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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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