Care Home: 100 Whitehall Street

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What the care home does well There continues to be a welcoming and cheerful atmosphere at the home, and people living at the home are very positive about the support provided to them. Bedrooms are personalised reflecting the choices of the individual people living at the home. Those living at the home are satisfied with the quality and variety of food served including cultural alternatives. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 There is a high level of satisfaction in respect of the staff support provided to individual people living at the home. A range of activities are provided for people living at the home according to their choices. People living at the home are encouraged to be independent and to make their own choices. Residents are consulted about their care plans as far as possible. The home successfully provides sensitive individual support to people with a range of different needs, characters and interests. Staff members are knowledgeable about their role and responsibilities within the home. People are supported to have holidays, at least annually, away from the home, with staff support. What has improved since the last inspection? Several improvements had been made to the environment including landscaping of the front driveway of the home making it more accessible to people with mobility problems, replacement of carpets in the dining area and corridors on the ground floor, more regular maintenance of the rear garden, and improved signposting to the home`s front door. There had been improvements in the provision of staff training in fire safety, first aid, manual handling, health and safety and food hygiene to ensure that the needs of people living at the home are met safely. The frequency of individual staff supervision sessions had also been increased to ensure that they work in line with best practice to meet the needs of people living at the home. A registered manager had been put in place for the home, although this is on an interim basis, following a recruitment process being undertaken at the time of this inspection. Regular monthly monitoring visits were being undertaken to the home, and improvements had been made to the quality assurance procedures for the home, to ensure that people living at the home receive a high quality of care. Improvements were also made to health and safety procedures within the home, so that there is now a high standard of practice in this area. What the care home could do better: 100 Whitehall StreetDS0000010755.V375505.R01.S.doc Version 5.2 Some minor improvements are needed within the home environment for the comfort of people living at the home. Procedures for supporting people with their monies should be made more rigorous, to ensure that they are fully protected from financial abuse. Improved monitoring records for recording concerns about the home, should be put in place to ensure that people`s concerns are taken seriously, and a training plan for the home is needed to ensure that any gaps in training profiles are addressed. Shortly following this inspection visit, the management advised that steps had already been taken to meet these requirements. It is recommended that more goals be developed with people living at the home, and that a more comprehensive quality assurance system be put in place to ensure that high standards of care and support remain in place within the home. Key inspection report CARE HOME ADULTS 18-65 100 Whitehall Street Tottenham London N17 8BP Lead Inspector Susan Shamash Unannounced Inspection 22nd June - 2nd July 2009 3:00 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 100 Whitehall Street Address Tottenham London N17 8BP 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 8801 2930 020 8365 0097 john.campbell@haringey.gov.uk London Borough of Haringey Adam Ismail Care Home 18 Category(ies) of Learning disability (18) registration, with number of places 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 18 30th June 2008 Date of last inspection Brief Description of the Service: 100 Whitehall Street is situated in an area just off of White Hart Lane. The home provides residential care for up to eighteen people with learning disabilities. The provider is Haringey Local Authority. The home is large and purpose built over three floors that are accessed by two staircases and a lift. There are a number of shared lounges, dining areas and kitchens and a rear garden with various patio areas. There are eighteen single bedrooms. There are no en-suite facilities but there are a generous number of bathrooms and toilets. The home was closed for major refurbishments for approximately one year in 2006. The statement of purpose states that the homes service is based on ordinary life principles and people living at the home are encouraged to access activities in the community. The home provides support with all aspects of personal care and daily living. The home provides three main meals per day and people living at the home have facilities to make themselves drinks and light snacks whenever required. Home fees are from £618 per week as at July 2009. Copies of the most recent inspection reports can be obtained from the office at the home or the CQC website www.cqc.org.uk 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 5 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The first day of this inspection was not announced to the home, and took place on a Monday evening. It took place to check on how people were being supported at the home. A second day’s visit to the home (which was announced) was arranged in order to access staff records and financial records, for which the presence of a manager were necessary. Overall the inspection lasted approximately eight hours. I was assisted by deputy managers, team leaders and support workers on each floor of the home, in addition to support from the registered manager, and the Head of Supported Living Services. I also spoke to four people staying on the respite unit, four people living on the first floor, and spent time with five people living on the ground floor of the home, and seven staff members in all. The majority of people living at the home were out at day activities at the start of the inspection, however all returned during the afternoon, and all residents on the ground floor of the home went out on the evening of the first day of the inspection. There were five people living on the ground floor and five on the first floor. The residents on the ground floor currently have a higher level of needs to those on the first floor and the home is staffed accordingly. I conducted a tour of the building and I sampled staff and resident individual records as well as health and safety records and those regarding the general running of the home. Information provided in the Annual Quality Assurance Assessment was also taken into account as part of this inspection. At the time of the inspection staff were being consulted about changes in the way that the home is being run and managed, and there was some anxiety expressed by staff members about the ramifications of some of these proposed changes for people living at the home. What the service does well: There continues to be a welcoming and cheerful atmosphere at the home, and people living at the home are very positive about the support provided to them. Bedrooms are personalised reflecting the choices of the individual people living at the home. Those living at the home are satisfied with the quality and variety of food served including cultural alternatives. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 7 There is a high level of satisfaction in respect of the staff support provided to individual people living at the home. A range of activities are provided for people living at the home according to their choices. People living at the home are encouraged to be independent and to make their own choices. Residents are consulted about their care plans as far as possible. The home successfully provides sensitive individual support to people with a range of different needs, characters and interests. Staff members are knowledgeable about their role and responsibilities within the home. People are supported to have holidays, at least annually, away from the home, with staff support. What has improved since the last inspection? What they could do better: 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 8 Some minor improvements are needed within the home environment for the comfort of people living at the home. Procedures for supporting people with their monies should be made more rigorous, to ensure that they are fully protected from financial abuse. Improved monitoring records for recording concerns about the home, should be put in place to ensure that people’s concerns are taken seriously, and a training plan for the home is needed to ensure that any gaps in training profiles are addressed. Shortly following this inspection visit, the management advised that steps had already been taken to meet these requirements. It is recommended that more goals be developed with people living at the home, and that a more comprehensive quality assurance system be put in place to ensure that high standards of care and support remain in place within the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. 100 Whitehall Street DS0000010755.V375505.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 100 Whitehall Street DS0000010755.V375505.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Appropriate information is available to assist people in making a decision about whether to move in, and detailed assessment procedures are in place to ensure that people’s needs and goals are met effectively. People’s rights are protected through contractual arrangements with the home. EVIDENCE: 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 11 At the time of the inspection five people were accommodated on the ground floor, and five were living on the first floor. The second floor respite service had four people staying overnight on the first day of the inspection. One new person had been admitted to the home since the previous inspection, and appropriate assessments, and care planning guidelines were in place for this person as appropriate. Assessments were in place for all the people living or staying in the home on a respite basis, including information regarding their cultural, and lifestyle preferences and risk assessments. I spent time with people living on all floors of the home, confirming that they felt their needs were being met as appropriate. A statement of purpose is in place for the home including all the information required under Schedule 1 of the Care Homes Regulations 2001 as appropriate. A pictorial version of the service users guide for the home was also available. Completed contracts were available for people living at the home, between social services and the home to protect people’s rights within the home. As recommended, these now included the rooms to be occupied by people living at the home to further protect residents’ rights as far as possible. 100 Whitehall Street DS0000010755.V375505.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s needs and goals are assessed and responded to, in consultation with them, to ensure that these are met effectively. Risks are recorded appropriately with strategies in place to ensure that people are protected, whilst being encouraged to develop independence skills. EVIDENCE: 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 13 I examined seven care plans for people living in (or staying at) different areas of the home. High quality care planning systems were in place and these had all been reviewed within the last six months as appropriate. Care plans included information regarding people’s cultural needs and lifestyle choices as appropriate. Detailed risk assessments had been produced for people living on the ground and first floors as appropriate, and these had been reviewed within the last six months as required at the previous inspection. Work had been undertaken to develop person centered plans for people living on the ground and first floors of the home including pictures and formats to make these as accessible as possible. However it is recommended that more varied goals should be identified with people living at the home (particularly those living on the first floor of the home) to provide increased support with developing independence skills, and making individual choices about their lives. Signatures indicated that people living at the home are consulted regarding the care plans and risk assessments as appropriate. The people that I spoke to indicated that they were given opportunities to be involved in choosing their own activities and helping out in the day to day running of the home. Observation of staff and resident interactions on all floors also confirmed that people are encouraged to make choices about their activities and that these are respected. Minutes of resident meetings for all floors indicated that these are held regularly and are used to disseminate information and provide people with an opportunity to make choices about home life. These meetings are held approximately weekly on each floor, with any people staying at the respite service on the second floor, and with those living on the other floors as appropriate. Use of audio and video formats to disseminate information continues to be used in some of these meetings. Records indicated that people living at the home had had at least annual social services reviews as appropriate. 100 Whitehall Street DS0000010755.V375505.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): This is what people staying in this care home experience: 12, 13, 14, 15, 16 and 17. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the service have fulfilling lifestyles with access to meaningful activities both in the community and in the home. They are supported to maintain links with their friends and families, encouraged to be involved in the running of the home according to their abilities and to develop independent living skills as far as possible. A balanced and varied selection of food meets their nutritional needs. EVIDENCE: Inspection of peoples’ care plans, discussion with staff and discussion and observation of residents indicated that they have varied day activities including attendance at college and day centres. Staff advised that there had been a further improvement in the provision of leisure activities to people on the 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 15 ground and first floors of the home, in the evenings, due to having a more flexible rota, so that sufficient staff members were scheduled to work on particular shifts when people wanted to go out e.g. on one day of the inspection, all of the people from the ground floor attended a social club near the home. People living on all floors of the home had day activities available to them outside of the home, including attending day centres, college and structured activities within the local community. A wide range of leisure activities were available to those living on the ground floor of the home including pub lunches, music therapy, shopping trips, horse riding, cinema and theatre trips. Two residents had recently been to see the Lion King at a West End theatre, with staff support. One service user continues to be supported to attend a Turkish centre in accordance with their cultural preferences, others continue to attend a local cycling club for people with disabilities. People on the first floor of the home had significantly increased the frequency of their leisure activities including recent trips to local parks, Buckingham Palace, Clarence House, swimming and cinema trips, Wood Green, Enfield Town, Alexandra Palace, Tower Bridge, Planet X, and drives in the countryside. Those staying at the respite service on the second floor had the highest number of activities available to them including recent trips to Paradise, Stanborough, Golders Hill, Broxbourne and Crews Hill Fish Farm parks. There had also been trips to the West End, Southend on Sea, Alexandra Palace, Hatfield Galleria, cinema trips, and various drives and walks. Team leaders advised that holidays were being planned for people living on different floors of the home, including a trip to Centre Parks for one person on the first floor. Other residents told me that they were hoping to go on holiday to Ireland, Paris, and one person had recently been on holiday in Wales. Following consultation with occupational therapists, multi-sensory equipment had been purchased for the home, particularly for the use of people living on the ground floor. Items available include hedgehog balls, indoor skittles, a ‘bell ball,’ ‘tipping targets’ and mats. However it continues to be noted, and confirmed by staff members, that there is no designated space available for use of this equipment, other than within the resident’s lounge, so that few items purchased were being used. It remains recommended that this issue be addressed in order to provide appropriate stimulation for people living at the home. Care plans and discussion with staff and people living on each floor of the home indicated that they have varied lifestyles according to their choices, with access to a range of social, cultural, educational and leisure activities both in the community and in the home. People from all floors are supported to attend church on Sundays if they wish to, and there is also a regular Mass service held at the home for residents who wish to attend. People attend day centres, college or supported employment according to their choices, and a 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 16 musician entertainer visits the ground and first floors of the home on a weekly basis. Other activities undertaken regularly include gentle exercise, beauty therapy, music, puzzles, karaoke, and parties held at the home. Approximately five staff members are able to drive the minibus, making regular trips out possible. Records for people living on all floors, alongside the visitors book, discussion staff and residents confirmed that staff support people to maintain links with friends and families. One person had been supported to go on a train trip in accordance with their wishes, with a staff member and relative supporting them. Residents on all floors, but particularly the first floor of the home, are very involved in helping to lay the table for meals and clear up, as well as undertaking their own laundry and keeping their rooms clean. Observation of residents on all floors of the home during mealtimes indicated that they enjoyed the food served. Menus for each floor included a variety of choices and were nutritionally balanced as appropriate. People spoken to indicated that they were satisfied with the food served at the home. Cultural alternatives were available to people including Ackee and Saltfish with dumplings and rice for a Caribbean resident, and black pudding for a resident who requested this. Staff spoken to were aware of the food preferences, and allergies of each person living in the home. On the second floor a chart with each person’s dietary needs and allergies was kept in the kitchen to remind staff of the needs of different people coming to stay at the home. Use of pictorial cards was also helpful in assisting people to make menu choices particularly on the ground and second floors of the home. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical and emotional needs of people living at the home are met appropriately, and their medication needs are addressed safely to protect people’s health as far as possible. EVIDENCE: All of the people living on the ground floor and the majority of people living on the first floor need some physical support with personal care and their care plans outline their support needs accordingly. Arrangements were detailed in care plans ensuring that the broad range of their health and personal care needs are addressed. Less contact with health care professionals is undertaken for people staying at the respite service, but relevant and up to date health care information was available in their files as appropriate. Due to the communication difficulties of people living on the ground floor it is important that they are weighed regularly, and appropriate equipment was available for this, and records indicated that people were being weighed 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 18 regularly as appropriate. Records on all floors indicated that people attend regular health care appointments and discussion with staff and residents confirmed this. People spoken to advised that they were satisfied with the support provided to them by staff at the home. However no gaps were found in this area, some floors had clearer healthcare appointment monitoring records than others, and it is recommended that there should be consistency in recording in this area. Inspection of medication storage facilities and records of medicines brought into the home, administered and disposed of, indicated that satisfactory procedures are in place to protect people living on the each floor of the home. No residents are currently self-medicating. A monitored dosage system was being used on the ground and first floors, to reduce the risk of staff error. No gaps were found in administration records or blister packs, indicating that medicines are signed for at the time of administration as appropriate. Medicines were being signed in and out of the home, so that a clear audit trail was available regarding all medicines was available. Information about side effects of each medicine prescribed to people living at the home, was also being kept as appropriate. A new system of monthly medication audits had also been introduced for the home. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has an appropriate complaints procedure, and complaints and concerns from people living at the home and their representatives are acted upon effectively. Procedures and training are in place to ensure the protection of people living at the home from abuse. EVIDENCE: The home has a clear and accessible complaints procedure, a safeguarding adults procedure and guidance for staff regarding whistle blowing. Records were available of all concerns or complaints received about the home, and people spoken to, advised that they would feel able to speak up about issues that concerned them. However, there is room for improvement in the recording of concerns raised about the home. Although I saw evidence that people’s concerns had been addressed, there is no clear record which provides all of this information, including the dates and times of each concern raised, detailed information regarding how these complaints were addressed and timescales by which a response was given to the complainants. It is therefore recommended that the recording systems be upgraded so that there is a clear record of how each concern raised is dealt with and timescales for action. Shortly after the 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 20 inspection the management confirmed that an improved recording format for tracking concerns had been put in place. Records indicated that almost all staff members at the home had undertaken recent training in safeguarding adults, with those remaining identified and booked to undertake this training shortly. Appropriate policies and procedures are available regarding action to be taken in the event of an allegation, disclosure or suspicion of abuse, including a whistle blowing policy. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, and 30. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is furnished, decorated, and laid out to a sufficiently high standard to meet people’s needs comfortably. A high standard of cleanliness ensures a hygienic environment for people living at the home. EVIDENCE: The home is currently divided into three separate units, so that residents live in smaller groups rather than a large less personal setting. There is a lift between floors as well as two stairways, and domestic style kitchens are available on each floor. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 22 People living at, or staying at the home, advised that they were generally satisfied with the facilities available to them. Bedrooms had been personalised and were furnished and decorated so that they were comfortable and inviting. One person’s room included a number of multi-sensory decorations in line with the needs and preferences of that resident. Bathrooms were fitted with handrails as appropriate for the needs of people living at the home. Staff and residents advised that bath and shower equipment was functioning well, with a ‘whirlpool’ setting also available on some of the baths. Communal areas were generally decorated appropriately, and the home was clean, tidy and free from unpleasant odours. There had been significant improvements to the driveway at the front of the home, allowing easier access for the minibus. Improvements had been made to the garden area since the previous inspection, with regular garden maintenance being undertaken to ensure that it is accessible to people living at the home. Staff and residents spoken to, confirmed that they were now using the garden areas in good weather. Future plans remain in place for completely overhauling the garden areas, so that they are more stimulating and accessible to people living at the home, as researched by one of the team leaders (to include a water feature, and sensory areas) however they are dependent on a sufficient budget being available. As recommended at previous inspections, there was clear labelling throughout the building and improved signposting for the home’s main entrance. As noted in the previous section, I was concerned to note that there was not a suitable room available for people living at the home to use multi-sensory equipment. It is recommended that a room be made available for this purpose. Since the previous inspection, the carpet in the dining area and corridors on the ground floor had been replaced, to aid easier cleaning. The management were aware that the ceiling in room 3 was in need of redecoration, and that a crack in the glass on the door of room 6 needed to be repaired. The walls in the shower room on the ground floor were also in need of redecoration, in addition to some areas of the ground floor lounge walls where the paint had worn away, and the bench in the rear garden which was not inviting to use. Discussion with staff and residents indicated that people on the first floor were in need of a new hi fi system for their lounge, and a new mattress was needed for the ground floor sleeping in room. It is recommended that a shed be provided in the rear garden area, and that an additional sofa (for residents 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 23 wishing to lie down) be provided in the ground floor lounge. Introduction of environmental controls for lighting, heating, windows etc. should also be considered to increase people’s independence and comfort. Shortly after the inspection the management confirmed that a new mattress had been ordered for the sleeping in room as specified above, the redecoration issues had been included in the home’s maintenance programme, and the need for repair of the glass panel had been prioritised as urgent. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately staffed to meet peoples’ needs, and staff are appropriately experienced, trained, and supervised to support people effectively. There are appropriate recruitment practices in place to protect people living at the home from harm. EVIDENCE: I looked at staff files for people working on all floors of the home. Seven staff files were inspected in all, including those for new staff employed since the previous inspection. They included two written references and application forms, and evidence that enhanced Criminal Records Bureau disclosures had been undertaken, as appropriate. Staff spoken to, and the rota for the home confirmed that at least two staff members are scheduled to work on each floor at all times of the day with more staff being available at busier times of the day on the ground floor. Observation of practices in the home indicated that people receive sufficient staff support to meet their needs at the home effectively. As required 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 25 previously staff advised that, as required at the previous inspection, sufficient staff are now made available on the ground floor, so that people can attend activities of their choices in the evenings e.g. a social club on Mondays, and I was able to observe that this was the case on both days of the inspection. However female staff working on the ground floor told me that they experienced some difficulties due to having only one male resident, and four female residents, and male staff not carrying out personal care on female residents, so that there had been some difficulties in sharing the workload amongst staff, with male staff taking on more of a role in arranging activities. Records were available to evidence that staff had received appropriate induction training. Staff spoken to advised that they had received a corporate induction, and a detailed induction specific to the home is also in place. More than the required number of staff members working on all floors, are undertaking or have completed NVQ level 2 or 3 in care as appropriate, and the home is commended for this practice. Staff spoken to confirmed that they had undertaken training in communication with people who have learning disabilities, addressing challenging behaviour, understanding autism, and safeguarding adults. Profiles of staff training undertaken on each floor of the home had been completed to ensure that all staff are appropriately trained, and highlight any gaps in training. However although the profiles were available, they had not as yet been translated into a clear training plan for the home to address any gaps in current staff training, including briefings on the Mental Capacity Act 2005 and its relevance to work with specific individuals living at the home. I was able to crosscheck some of these profiles against certificates available within staff files, indicating that as required at the previous inspection, the majority of staff had undertaken current fire safety training. Training updates had also been provided in first aid, manual handling, health and safety and food hygiene. Records indicated that all staff members including team leaders were being provided with regular supervision sessions. This was confirmed by staff spoken to. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is managed appropriately with the needs of residents in mind, with quality assurance procedures in place to ensure that people receive a consistently high standard of care. A high standard of health and safety checks within the home protect people living and working in the home from harm. However people could be better protected from financial abuse by improving procedures for supporting them with their finances. EVIDENCE: Each floor of the home is being managed by a deputy manager and team leaders, and appeared to have an open, positive and inclusive atmosphere. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 27 Since the previous inspection, the manager had successfully applied with the CSCI. However I was advised that this post had only been filled on an interim basis, and that the provider organisation was currently recruiting for a full time manager who will then need to register with the CQC unless they are the present holder of the post. I was also informed about proposed changes to the management of the home which were currently under consultation, and might lead to the home being run as one unit, rather than three separate units, in order to cut the costs of running the service. Staff members spoken to were understandably concerned about the ramifications of these changes for themselves, and people living at the home. Residents had not yet been informed about the possible changes under consultation. Records indicated that there are regular resident meetings held on all floors of the home and regular staff meetings held on each floor covering a wide range of topics relevant to the home. Staff advised that where possible residents had chosen the colours of paintwork, carpets, duvets and curtains for their rooms, and records showed that they had recently been involved in choosing menus, activities and holiday destinations. Records in the home indicated that regular unannounced monitoring visits were being undertaken to the home by the provider organisation, as required at the previous inspection. The Annual Quality Assurance Assessment for the home was completed shortly after the inspection visit, and provided clear information about areas for development within the service. Monthly medication audits had been introduced for the home. There was also an annual development plan for the service, and satisfaction surveys regarding the respite unit were due to go out the week after the inspection. Staff surveys had also been sent out regarding the service. However there is room for improvement in the quality assurance procedures for the home to ensure that the views of all stakeholders are taken into account, and that people living at the home are assured continued high standards of care and support. All residents living at the home require support to manage their finances, although family members take on the bulk of this responsibility for some people living at the home. I checked two records for people living on each floor of the home. Clear records are being maintained of support provided to people living at the home who need help managing their finances as appropriate. A record was in place detailing all valuables kept on behalf of people living at the home (including building society books, passports etc) however I was concerned to learn that the management had access to some people’s pin numbers for accessing bank/building society accounts. This places staff and residents at unnecessary risk, and the management were advised that this practice should cease as soon as possible. Shortly after the inspection, the management confirmed that requests for new pin numbers had been made for all relevant service users, advising that and upon their arrival these would be shredded unopened, with a witness, so that no one would have access to these numbers. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 28 In addition I advised that properties kept for safekeeping on behalf of residents (such as bank books/cards or passports) should be signed in and out of the safe, for the further protection of staff and service users should there be any implication of financial abuse. Shortly after the inspection the management confirmed that this format had now been put in place. Satisfactory fire extinguisher and fire alarm servicing certificates were available, alongside current satisfactory gas safety, electrical wiring and portable appliances testing certificates as appropriate. Fire alarm testing was being undertaken on a weekly basis, and fire drills were also being arranged regularly including a fire drill at night to ensure that staff are fully aware of their responsibilities at this time. A fire risk assessment was available for the home, and there was evidence that requirements made at the most recent local fire authority inspection had been met. The fire risk assessment for the home had been reviewed within the last six months. Records of weekly fire alarm testing was now being undertaken in a clear sequence, so that each fire call points was being tested on a regular basis as recommended at the previous inspection. Appropriate food hygiene procedures appeared to be in place across the home including recording of fridge/freezer temperatures, cooking temperatures, and disposal of foods prior to their best before dates. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 29 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 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X 2 3 X Version 5.2 Page 30 100 Whitehall Street DS0000010755.V375505.R01.S.doc Are there any outstanding requirements from the last inspection? NO 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 YA22 Regulation 22 Requirement The registered persons must ensure that clear and complete records are maintained for every concern received about the home, including timescales and details of how each issue is addressed, to evidence that people’s concerns about the service are taken into account. The registered persons must ensure that the ceiling in room 3 is redecorated, the crack in the glass on the door of room 6 is repaired, the walls in the shower room on the ground floor are repainted, alongside areas of the ground floor lounge walls, and the bench in the rear garden. A new hi fi system should be provided within the first floor lounge, and a new mattress should be provided in the ground floor sleeping in room, for the comfort and safety of people living and working at the home. The registered persons must ensure that a clear training plan is available for the home to DS0000010755.V375505.R01.S.doc Timescale for action 22/08/09 2. YA24 23(4) 04/09/09 3. YA35 18(1ci) 18/09/09 100 Whitehall Street Version 5.2 Page 31 4. YA41 16(2l) 17(2) Sched 4:9 address any gaps in current staff training, including briefings on the Mental Capacity Act 2005 and its relevance to work with specific individuals living at the home. The registered persons must ensure that no staff members have access to pin numbers for accessing resident’s bank/building society accounts, and that properties kept for safekeeping on behalf of residents (such as bank books/cards or passports) are signed in and out of the safe, with appropriate recording in place to protect people from financial abuse as far as possible. 07/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations It is recommended that more varied goals are identified with people living at the home, to provide increased support with developing independence skills, and making individual choices about their lifestyles. It is recommended that a shed be provided in the rear garden area, an additional sofa (for residents wishing to lie down) be provided in the ground floor lounge, and that the possibility of providing accessible environmental controls for lighting, heating, windows etc. be researched to increase the independence and comfort of people living at the home. It is recommended that a room be made available for the use of sensory equipment, for the comfort and stimulation of people living at the home. It is recommended that the quality assurance procedures for the home be upgraded to ensure that the views of all stakeholders are taken into account, and that people living DS0000010755.V375505.R01.S.doc Version 5.2 Page 32 2. YA24 3. 4. YA24 YA39 100 Whitehall Street at the home are assured continued high standards of care and support. 100 Whitehall Street DS0000010755.V375505.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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