Care Home: Bedford Road 7

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What the care home does well New people`s needs are assessed in detail before their admission to ensure that they can be met by the home. Comprehensive care plans and risk assessments are in place and these are reviewed regularly to ensure that people`s needs are met. A key working system is in place at the home, and monthly summaries of care needs and activities are recorded, to ensure that responsive care and support is provided. The home is commended for a high standard of practice in supporting residents to achieve their goals. People live in a generally well maintained and pleasant environment and can access all communal areas. Their health needs are closely monitored and arrangements and they are generally supported to see appropriate health professionals. The complaints procedures and the policies in relation to the protection of vulnerable adults from abuse are appropriate. The food provided is of good quality and meets the nutritional and cultural needs and preferences of people living at the home.The home is active in supporting people to access a variety of leisure, educational and other day activities according to their choices. An annual holiday away from the home, is arranged for residents, with staff support to ensure that they can be involved in activities of their choice. What has improved since the last inspection? There had been an improvement in the recording and review of residents` goals ensuring that they are supported to achieve goals appropriately. More regular activities were being provided to people living at the home, as a result of improved staffing numbers available to support them. Clearer records were being maintained of meals served to individual people living at the home, to evidence that their cultural and nutritional needs are met. More rigorous recording of people`s weights was being undertaken, to ensure that the health needs of people living at the home are addressed appropriately. Recording of medicines brought into the home was being undertaken to ensure that people`s medication needs are met safely.Improvements had been made in staff training in food hygiene, fire safety and first aid, to ensure that people living at the home are protected from harm. A new manager had been recruited to the home as required, ans some improvements to the home environment had been undertaken including action to ensure no further disruptions to the supply of hot water and central heating for people living at the home. Improvements in the number of staff working in the home and their supervision, ensure that they work in line with best practice and can support people with activities outside of the home and address unforeseen emergencies without risk. The current Annual Quality Assurance Assessment had been completed for the home and a regular quality assurance audit was being undertaken for the home, to ensure that the home is run in the best interests of people living at the home. Weekly fire alarm tests were being carried out without gaps and there was an improvement in arrangements for the storage and disposal of clinical waste within the home hygienically. What the care home could do better: Improvements are needed in the recording of dentist and optician appointments offered to people living at the home to ensure that their healthcare needs are fully met. Gaps in staff training must be identified and addressed, and all staff should be trained in the Mental Capacity Act 2005 and its implications for people living at the home. Monthly unannounced visits must be undertaken on behalf of the provider organisation to monitor the quality of care and support provided by the home. It is recommended that all person centred plans be dated to ensure that these are current documents, that a barbeque be provided within the home and that issues raised on the electrical installation certificate for the home be addressed to ensure the comfort and safety of people living at the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Bedford Road 7 7 Bedford Road London London N15 4HA The quality rating for this care home is: two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Susan Shamash Date: 0 8 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Inspection report CSCI Page 2 of 33 Care Homes for Adults (18-65 years) Audience Further copies from Copyright General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 33 Information about the care home Name of care home: Address: Bedford Road 7 7 Bedford Road London London N15 4HA 02088002864 02088002864 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): HAIL (Haringey Association for Independent Living Limited) Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 6 6 0 0 learning disability physical disability Additional conditions: The Registered Person may provide the following categories 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: Learning Disability - Code LD Physical Disability - Code PD The maximum number of service users who can be accommodated is: 6 Date of last inspection Care Homes for Adults (18-65 years) Page 4 of 33 A bit about the care home Bedford Road is a home registered to provide residential care to six people who may have learning disability or physical disability. The building is provided by Circle 33 Housing Association and the services are provided by Haringey Association for Independent Living (HAIL). The home is located in a residential area close to the Seven Sisters Underground and shopping facilities. There are six single bedrooms, three bathrooms/showers and three toilets. There is a lounge, a kitchen, a dining room and a large garden at the rear of the building. The ground floor of the home is wheelchair accessible even though the current people living at the home do not require this. The home has stated objectives of enabling people to live as independently as possible, with the same range of choices as any other citizen, mixing as equals with others and being members of their own community. Information about the home is including in the homes brochure and the CSCI inspection reports are available from the home by contacting the provider or from the CSCI website - www.csci.org.uk. The weekly fees of the home depend on peoples assessed needs, but the average weekly fee is 1053.44GBP as of June 2009. Care Homes for Adults (18-65 years) Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home Care Homes for Adults (18-65 years) Page 6 of 33 How we did our inspection: This is what the inspector did when they were at the care home This unannounced inspection was carried out as a routine key standards inspection of the home and lasted approximately five and a half hours on a Tuesday evening. I was assisted by three staff members on duty, and the new manager of the unit also came in to assist me towards the end of the inspection visit. All people who live at the home were out during the day, at the start of the inspection visit, but returned to the home later during the inspection. I had the opportunity to talk with and spend time with all people living at the home and spoke to three staff members independently. The inspection also included a tour of the building, assessment of three peoples care files, three staff files and seven training files, health and safety records, financial records for people supported in this area by the home, rotas and menus and medication administration records. Information provided in the current Annual Quality Assurance Assessment for the home was also taken into account as part of this inspection. Care Homes for Adults (18-65 years) Page 7 of 33 What the care home does well New peoples needs are assessed in detail before their admission to ensure that they can be met by the home. Comprehensive care plans and risk assessments are in place and these are reviewed regularly to ensure that peoples needs are met. A key working system is in place at the home, and monthly summaries of care needs and activities are recorded, to ensure that responsive care and support is provided. The home is commended for a high standard of practice in supporting residents to achieve their goals. People live in a generally well maintained and pleasant environment and can access all communal areas. Their health needs are closely monitored and arrangements and they are generally supported to see appropriate health professionals. The complaints procedures and the policies in relation to the protection of vulnerable adults from abuse are appropriate. The food provided is of good quality and meets the nutritional and cultural needs and preferences of people living at the home. Care Homes for Adults (18-65 years) Page 8 of 33 The home is active in supporting people to access a variety of leisure, educational and other day activities according to their choices. An annual holiday away from the home, is arranged for residents, with staff support to ensure that they can be involved in activities of their choice. What has got better from the last inspection There had been an improvement in the recording and review of residents goals ensuring that they are supported to achieve goals appropriately. More regular activities were being provided to people living at the home, as a result of improved staffing numbers available to support them. Clearer records were being maintained of meals served to individual people living at the home, to evidence that their cultural and nutritional needs are met. More rigorous recording of peoples weights was being undertaken, to ensure that the health needs of people living at the home are addressed appropriately. Recording of medicines brought into the home was being undertaken to ensure that peoples medication needs are met safely. Care Homes for Adults (18-65 years) Page 9 of 33 Improvements had been made in staff training in food hygiene, fire safety and first aid, to ensure that people living at the home are protected from harm. A new manager had been recruited to the home as required, ans some improvements to the home environment had been undertaken including action to ensure no further disruptions to the supply of hot water and central heating for people living at the home. Improvements in the number of staff working in the home and their supervision, ensure that they work in line with best practice and can support people with activities outside of the home and address unforeseen emergencies without risk. The current Annual Quality Assurance Assessment had been completed for the home and a regular quality assurance audit was being undertaken for the home, to ensure that the home is run in the best interests of people living at the home. Weekly fire alarm tests were being carried out without gaps and there was an improvement in arrangements for the storage and disposal of clinical waste within the home hygienically. Care Homes for Adults (18-65 years) Page 10 of 33 What the care home could do better If you want to read the full report of our inspection please ask the person in charge of the care home Care Homes for Adults (18-65 years) Page 11 of 33 If you want to speak to the inspector please contact Susan Shamash 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 0870 240 7535 Care Homes for Adults (18-65 years) Page 12 of 33 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 13 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . New residents can be confident that their needs are assessed by the home prior to their admission to ensure that they can be met. Evidence: No new people had been admitted to the home since the previous inspection. All residents files that were inspected continue to include detailed assessments of their needs by the home as well as assessment information from their social workers and healthcare professionals. Assessments carried out by staff included details of the physical, emotional, personal care, cultural, dietary and social needs of each person, including observations of their opinions of prospective residents compatibility with existing people who live at the home. Staff confirmed that they were provided with sufficient assessment information about all the people living at the home. Care Homes for Adults (18-65 years) Page 14 of 33 Evidence: Care Homes for Adults (18-65 years) Page 15 of 33 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home can be confident that their needs will be addressed appropriately and responsively. They are supported to make decisions about their lives and to take informed risks to maximise their independence. Evidence: Three peoples care files were inspected in detail and person centred plans for all residents were also inspected. Signatures indicated that care plans and risk assessments had been reviewed at least six-monthly and that there continues to be some consultation with families and representatives regarding support provided. The home operates a key working system and discussions with the staff and an examination of the files indicated that each key worker writes a monthly summary of significant events and activities for people living at the home. An appropriate level of detail was included in care plans and risk assessments for the three people whose files I inspected. These took account of cultural needs and lifestyle choices indicating how these needs were being met. Care Homes for Adults (18-65 years) Page 16 of 33 Evidence: As required previously, any restrictions placed on people living at the home were now clearly outlined in peoples care plans alongside the signed agreement of relevant parties. For example, for safety reasons one persons belongings are stored outside of their room. Discussion with staff members made it clear that the home encourages people to realise their potential by adopting suitable methods to support each person. Risk assessments, observations and discussion with staff and residents indicated that people continue to be supported to take some risks as part of developing their independent living skills. Observations of staff interacting with people living at the home confirmed that they treat people with respect, maintaining their privacy, dignity and respecting their cultural and lifestyle choices whilst supporting them with personal, social and emotional care. Care Homes for Adults (18-65 years) Page 17 of 33 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who live at the home have a choice of activities organised and facilitated by the home including educational and recreational activities both inside the home and within the local community. People are supported to maintain contacts with friends and family and also enjoy an annual holiday away from the home with support from the staff team. The food provided at the home is of good quality and appears to meet peoples dietary needs and preferences. Evidence: All people who live at the home currently attend day services on the majority of weekdays, and one person. Some residents also attend college courses on a regular basis. Daytime activities include chair aerobics, aromatherapy, baking, visits to places Care Homes for Adults (18-65 years) Page 18 of 33 Evidence: of interest, shopping, music groups, a mens group and a film group. From their personal files and documents it was evident that the home continues to liaise with day centres, and that staff support people to attend other activities within the local community. Staff advised that people at the home continue to be involved in a wide range of activities during the day. Observation of interactions with people living at the home indicated that they were generally supported to be involved in activities of their choices both inside and outside of the home and this was confirmed in daily notes recorded. Residents had been on a holiday in the last year and photographs were available from this and other leisure activities undertaken. The key worker of one resident advised that they were looking into the possibility of a holiday in Spain according to their wishes. Other activities recorded in residents files included regular reflexology massages, bowling, playing football in the park, trips to the coast, local places of interest, parks, pub and restaurant meals, picnics and shopping trips. Clear and achievable goals were recorded for each resident. For one person these included trips to classical music concers, museums, the cinema, support to cook breakfast independently. Reviews of these goals indicated that all were being addressed regularly, and the home is commended for a high standard of practice in this area of supporting residents to achieve their goals. Discusssion with staff members indicated that there had been an improvement in the staffing numbers within the home, allowing more activities to be undertaken with residents on a regular basis including weekend and evening activities. Discussions with members of the staff team and an examination of care plans indicated that no people living at the home currently choose to attend a place of worship, although this option is available to them. It was also evident from peoples files and discussions with the staff that people living at the home enjoy visits by and to family and friends. My observations of people living at the home showed that they were very relaxed and comfortable within the home accessing communal areas as they wished. I was impressed to see staff encouraging residents to be as independent as possible, e.g. one person washed up their own plate following the evening meal, even though this took an extended period of time. Staff showed patience and awareness of peoples abilities and preferences throughout the shift. All people living at the home require support with financial management. There are appropriate systems in place to safeguard peoples money being looked after by the home, and at the end of each shift staff check the money and records and handover to the staff on the next shift. Receipts are kept for all transactions with peoples monies and the homes petty cash. The home has a four weekly rotating menu. The menu is displayed in the dining room. The staff spoken to explained how they support people to choose meals with the use of Care Homes for Adults (18-65 years) Page 19 of 33 Evidence: pictorial symbols. I noted that people appeared to enjoy the evening meal on the day of the inspection, and that the mealtime atmosphere was pleasant and unrushed. The home was well stocked with food including fresh fruit and vegetables, and people living at the home indicated that they enjoyed the food provided. Staff explained peoples preferences to me, including cultural alternatives such as curries and West Indian foods, and these options were recorded within records of meals served to people living at the home. Care Homes for Adults (18-65 years) Page 20 of 33 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples personal and health care needs are met by experienced staff, however there is room for improvement in provision of support to attend dentist and opticians appointments to ensure that all healthcare needs are addressed. Improvements in the recording of medication administration and peoples weights, have ensured that people living at the home are protected from harm as far as possible. Evidence: I observed all residents being treated with respect by staff members, and it was clear that trusting relationships remain in place between staff and residents. There was a good deal of interaction between residents and staff members during the evening of my visit, I witnessed staff supporting people with musical activities and puzzles, whilst ensuring that their physical needs were met appropriately. The home has a procedure for regularly updating peoples assessments and care plans and works closely with health professionals and day centre officers. It was clear from discussion with staff and an assessment of the homes diary and peoples files that that people living at the home are supported to see their general practitioners, and chiropodists on a regular basis. However there was insufficient recording of opticians and dentist appointments to evidence that people receive the appropriate support to Care Homes for Adults (18-65 years) Page 21 of 33 Evidence: attend appointments with these healthcare professionals. As required previously there were records of regular weight checks for people living in the home, with attention given to any significant weight loss of gain as appropriate. The home monitors and records the temperature of the area where medicines are kept on a daily basis to ensure that this remains below 25 degrees Celsius as appropriate. Clear directions were recorded for administering medication, and medication administration records were complete with no gaps indicating that people had been receiving their medicines appropriately. I observed medicines being administered to one resident, in an appropriate manner. Records were available for all medicines received at the home, and those sent back to the pharmacist, and a file including known side effects of all medicines prescribed to people living at the home, was also available within the office. Care Homes for Adults (18-65 years) Page 22 of 33 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience 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 satisfactory policies and procedures to ensure that people are protected from abuse and that their concerns and complaints are listened to and dealt with. Evidence: The complaints procedure is written with pictorial illustrations for use by non-verbal people living at the home. A copy of the procedure is included in the homes brochure and the statement of purpose. Complaints recorded since the last inspection had been dealt with appropriately. Copies of staff training certificates in the Protection of Vulnerable Adults were available in the staff files inspected. Staff spoken to confirmed that they had undertaken this training and were aware of action to be taken in the event of a disclosure or suspicion of abuse. They confirmed that they have read the homes policies including the whistle blowing policy, and were aware of things to look out for in the behaviour of non-verbal residents that might indicate cause for concern. There is also a copy of the placing authoritys adult protection policy and procedure within the home. Care Homes for Adults (18-65 years) Page 23 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People generally live in a comfortably furnished and decorated environment. The home is generally clean and hygienic, for the comfort and protection of people living at the home. Evidence: A number of improvements had been made to the home over recent inspection visits, with repairs and some new furniture provided in several residents rooms and the carpet on the first floor hallway had been replaced. It had already been changed once due to a faulty batch being supplied, and the manager of the home remains in contact with the supplier due to problems with the most recently laid carpet. The home has a relatively new oven and cooker and staff advised that all kitchen facilities are in good working order. Hand-drying facilities were installed in the toilet rooms and hand-towel dispensers were stocked appropriately on the day of the current inspection. As required previously, an infection control audit had been undertaken for the home, and appropriate action had been taken to ensure more hygienic disposal and storage of clinical waste. The premises were clean and bright and there were no offensive odours. There are Care Homes for Adults (18-65 years) Page 24 of 33 Evidence: handrails in the corridors, adaptations in bathrooms, toilets, and shower rooms and the radiators are guarded. As required at the previous inspection, action had been taken to address problems with the supply of hot water, and central heating systems within the home. Staff members confirmed that these issues had been addressed with the housing association, and this was confirmed in the maintenance records for the home. The rear garden was generally maintained appropriately, with a new shed provided. Staff advised of plans to trim back the trees overshadowing the garden. It was suggested that residents might benefit from having a barbeque for the home. Care Homes for Adults (18-65 years) Page 25 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at the home are protected from abuse by rigorous recruitment procedures for the home. They can be sure that the staff team are suitably experienced and supervised to meet their needs appropriately. However some gaps in staff training may mean that their needs are not always met in line with best practice. Evidence: I spoke to three staff members during the visit, and observed staff interacting sensitively with people living at the home. Discussion with them indicated that they are very aware of peoples needs and that there had been an improvement in the provision of appropriate staffing numbers to enable residents to be provided with the stimulation that they need. Three staff recruitment files were inspected, alongside the training undertaken by a further three staff members. All staff members had satisfactory Criminal Records Bureau (CRB) checks from the current employer. The home had also obtained two written references for each member of staff. There was also evidence of identity documents checked and some induction training. Files for the bank (as and when) staff are kept at the head office and therefore it was not possible to check if they have all necessary items in their files. Training files for seven staff members were inspected indicating that a wide range of Care Homes for Adults (18-65 years) Page 26 of 33 Evidence: training had been undertaken including relevant Learning Disabilities training, protection of vulnerable adults, medication, health and safety, manual handling, risk assessment and communication awareness. A large proportion of staff had undertaken or were undertaking relevant NVQ qualifications. As required previously all staff had been trained in fire safety, however although there had been a significant improvement in staff training in these areas, I noted a small number of gaps in some staff members training particularly for current food hygiene, and first aid. A requirement is made accordingly. Staff advised that they attend regular meetings, and this was confirmed by records maintained. The new manager had commenced supervision sessions with members of the team, and these were recorded as appropriate. Staff members spoken to advised that they generally felt well supported, and that there had been an improvement in the provision of sufficient staffing numbers within the home. Care Homes for Adults (18-65 years) Page 27 of 33 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Effective management arrangements are in place, for the smooth running of the home. Quality assurance procedures are in place for the home, however there is room for improvement to ensure that there are no gaps which may compromise standards of care and support provided. Appropriate health and safety procedures are in place for the protection of people living and working at the home from harm. Evidence: A new manager had commenced work within the home, and she was available for part of the inspection. The previous deputy manager (who had been covering the mangement of the home) had since left the project. Discussion with staff, and inspection of the home indicated that the new manager had been effective in managing the staff team at a time of change, had formed good relationships with people living at the home, and was beginning to make some improvements within the home. She is due to register with CQC as manager of the home. another manager from within the provider organisation were covering management of the home. Care Homes for Adults (18-65 years) Page 28 of 33 Evidence: Records maintained at the home indicated that unannounced visits undertaken on behalf of the provider organisation were being undertaken sporadically and not monthly as required at previous inspections. The last visit had been undertaken in May 2009, but prior to that visits were undertaken in January 2009, and September 2008. Discussion with the responsible individual confirmed that they were aware of gaps in this area due to staffing issues, and would be taking appropriate action to remedy the situation. A current Annual Quality Assurance Assessment had been completed for the home, and there was evidence that the provider organisation was undertaking quality assurance audits including feedback from people living at the home and other stakeholders. Most recently an audit had been undertaken in March 2009. The home had been awarded a 5 star (excellent) rating at the most recent food hygiene inspection by Haringey Environmental Health. Gas safety certificates, and portable appliances testing certificates were available for the home as appropriate. However although all code 1 faults recorded on the electrical installation certificate had been addressed, no action had been taken to address code 2 faults. It is recommended that this issue be addressed with the housing association responsible, for the safety of people living and working at the home. The most recent Legionella testing showed that the homes water supply is clear. Records showed that weekly fire alarm testing is being undertaken as appropriate, however there had been few fire drills in recent months, with the most recent drill held in December 2008. The manager advised that a drill had been booked to be undertaken in the next few days. Drills should be undertaken at least quarterly, and be held at different times of the day. All issues addressed by the most recent fire brigade visit had been addressed, and appropriate risk assessments regarding the building were in place for the home. Detailed records were being maintained of all accidents and incidents occuring within the home as appropriate. Care Homes for Adults (18-65 years) Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 33 Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 19 12 The registered person must 28/08/2009 ensure that all people living at the home are supported to attend regular opticians and dentist appointments and that this is recorded, to ensure that their healthcare needs are fully met. . 2 35 18 The registered person must 25/09/2009 ensure that gaps in staff training are identified and addressed, and that all staff are provided with training in the Mental Capacity Act 2005 and its relevance to people living at the home. . 3 39 26 The registered person must ensure that there are no gaps in the monthly unannounced visits to the 31/07/2009 Care Homes for Adults (18-65 years) Page 31 of 33 project by a representative of the provider organisation, to ensure that a high standard of quality care and support continues to be provided within the home. . Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 6 It is recommended that person centred plans for each person living at the home should include the date of the last review to ensure that these are kept up to date in their interests. It is recommended that a barbeque be purchased for the home, for the enjoyment of people living at the home over the summer period. It is recommended that the code 2 faults noted on the current electrical installation certificate should be addressed without delay, for the safety of people living and working at the home, and that more regular fire drills should be undertaken. 2 24 3 42 Care Homes for Adults (18-65 years) Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone : or 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) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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