Care Home: Carlingford Road, 181

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What the care home does well The manager of the service has worked hard over the last year to develop the service provided to the residents, all of whom have complex needs, including some with significant communication needs. This has included developing a range of key documentation in accessible format, ensuring that information recorded on care plans and risk assessments is reviewed and up to date and by implementing robust quality monitoring systems to further develop the service. Staff presented as being competent, committed to the residents well being and had access to a range of training and development opportunities. Residents are encouraged to take part in a wide range of activities, both within the home and in the wider community. What has improved since the last inspection? At the last key inspection five requirements were made and we were pleased to see that all of these had been complied with. These requirements were in the following areas: to make sure that risk assessments are up to date to maximise protection for residents; to make sure that suitable arrangements are in place for obtaining informed consent when decisions are made regarding residents health and welfare; to make sure that the ground floor shower was working properly for the benefit of residents; to review the number of staff on duty to keep residents safe and for an application to be made for the manager of the home to be registered with the Commission. Two good practice recommendations were also made and these had been acted upon. These were for the reports from the provider organisation`s monthly monitoring visits to the home to include progress made with regard to requirements made by the Commission and for the latest provider organisation`s policies and procedures to be available at the home. What the care home could do better: Two requirements are made at this inspection: to make sure that the Commission is notified without delay of any safeguarding issues in order to maximise protection to residents as well as to comply with government regulations regarding care homes; and, to make sure that the two bathrooms in the home have further work undertaken so that they maximise protection to residents and to make these facilities more pleasant to use. Key inspection report Care homes for adults (18-65 years) Name: Address: Carlingford Road, 181 181 Carlingford Road South Tottenham London N15 3ET     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Peter Illes     Date: 0 3 0 7 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 32 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 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 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. 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 Care Homes for Adults (18-65 years) Page 3 of 32 Information about the care home Name of care home: Address: Carlingford Road, 181 181 Carlingford Road South Tottenham London N15 3ET 02088888916 02082994818 choicesupport@choicesupport.org.uk www.choicesupport.org.uk Choice Support care home 4 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 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: Learning Disability - Code LD Date of last inspection Brief description of the care home 181 Carlingford Road is a residential care home registered to provide personal care to up to four people over the age of eighteen and who have a learning disability. The home is situated in a residential area of Tottenham in North London, with good public transport links and close to Wood Green shopping and leisure facilities. The home is a converted mid-terrace house, arranged over three storeys, with four bedrooms, two bathrooms, a garden, lounge and kitchen. On the 1st April 2004, Choice Support took over the registration of the home, and Sanctuary Housing Association provides the housing support. Choice Support is a charitable organisation that has been in business for 20 years supporting people with learning disabilities in the community. The home provides 24 hour care and the stated aim is to provide the people living there with a Care Homes for Adults (18-65 years) Page 4 of 32 Over 65 0 4 Brief description of the care home secure, relaxed and homely environment in which their care, well being and comfort is of the prime importance. The current weekly cost of a placement is from £1155 p.w. depending on the persons assessed needs, however, all four places are currently block purchased by L.B. of Haringey. The provider makes information available about the service, including inspection reports, to people living in the home and to other stakeholders. Care Homes for Adults (18-65 years) Page 5 of 32 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection of this service took place on 2nd July 2008. This key inspection took approximately eight hours over two days, 2nd and 3rd July 2009 and was undertaken by the lead inspector. However, terms such as we, our and us are used where appropriate within this report to indicate that the inspection activity was undertaken by the Commission. A new manager, Ms Olympia Kapoula, has been appointed since that last inspection and was available to assist throughout this inspection. Four residents were living in the home, all of whom have lived at the home for a number of years. The inspection activity included: meeting and speaking to all of the residents present, although conversation was limited due to their communication needs: observation of residents and staff interaction; detailed discussion with the manager; discussions with care staff on duty over the two days, three of them independently; an independent Care Homes for Adults (18-65 years) Page 6 of 32 discussion by telephone with a social worker from L.B. of Haringeys Community Learning Disability Team and an independent telephone discussion with a commissioning officer from L.B. of Haringey. Further information was obtained from a tour of the building and documentation kept in the home. The home also sent us an Annual Quality Assurance Assessment (AQAA) when we asked for it. Care Homes for Adults (18-65 years) Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Adults (18-65 years) Page 8 of 32 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 32 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. The home has detailed and accessible information to assist prospective residents and their representatives make an informed choice about living at the home. The home also has a clear admissions policy to assist in making sure that the home can meet the needs of new people when they are referred. All residents needs and wishes are regularly reviewed to make sure staff are aware of any changing needs and residents benefit from written contracts that explain their rights and responsibilities while living at the home. Evidence: The homes annual quality assurance assessment, AQAA, states; We have clear policies and procedures in place to ensure that all parties have the relevant information to make an informed decision prior to admission. It goes on to state; All information is available to service users such as statement of purpose, service user guide and code of conduct including terms and conditions. We sampled the above documentation and found it to be accessible through the use of pictures and illustrations, detailed and up to date. We saw that the service user guide had just been updated and we were told the new versions were to be gone through with Care Homes for Adults (18-65 years) Page 10 of 32 Evidence: residents and people that are important to them before replacing the previous ones kept in their files. No new residents have been admitted to the home for a number of years but we saw that the home had a clear admissions procedure that we were told would be implemented if a new referral is made to the home. Evidence was seen on the files of all four residents that their needs are reviewed on a regular basis to ensure that staff were aware of peoples changing needs. This included records of regular key worker sessions with the person, monthly key worker reports and regular reviews, including reviews attended by the persons placing authority. Key workers spoken to were able to describe peoples needs and how these were being addressed. We also spoke independently by telephone to a social worker from from L.B. of Haringeys community learning disability team (CLDT) who had recently undertaken placement reviews on two of the residents. The social worker told us, There have been vast improvements (in the service) in the last year. We spoke independently by telephone to a social worker from L.B. of Haringeys Community Learning Disability Team who had recently attended placement reviews on two of the four residents. This social worker stated that she was very pleased with the placement of the two residents and that in her opinion the care at the home had improved significantly since the current manager has been in post. Each residents file contained a tenancy agreement with Sanctuary Housing Association, the organisation that provides the accommodation and a care contract that specified the care and support each person would receive. Both of these had been signed on behalf of the home and by the resident or their representative. Care Homes for Adults (18-65 years) Page 11 of 32 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. Residents needs and preferences are well recorded on their support plans to assist staff in meeting these effectively. Residents are encouraged to make as many decisions for themselves to increase their day to day independence. They are also encouraged to take appropriate risks in their day to day lives to assist them to safely achieve their aspirations. Evidence: The homes annual quality assurance assessment, AQAA, states; We provide effective support planning that uses measurable outcomes based upon the needs and preferences of service users. Service users are encouraged to participate in the assessment process and reviews of their support plans. We looked at the support plans for all the four residents and found these to be very detailed, up to date and supported by a range of current assessment information, including risk assessments. One residents support plan was inspected in detail. This included a range of individual needs, preferences and clear guidance to staff on how to meet these. The plan was supported by a cultural needs assessment form, a health action plan and a Care Homes for Adults (18-65 years) Page 12 of 32 Evidence: communication passport. The plan also contained clear guidance regarding the persons sexuality. This person has complex needs and behaviour that sometimes challenges the service; evidence was seen that guidance to staff is updated regularly to address the persons changing needs and preferences. All of the residents have limited verbal communication and we spent some time observing staff and residents interacting, including tasks such as assisting residents with the preparation of meals of their choice and general interaction both before and after residents attended their day services. Staff were seen to relate to residents in a supportive way, including when one resident became agitated on occasion. A number of limitations are in place for residents, including how they access the community and what support they need to do this. There was evidence of how these had been agreed and are being implemented in the individuals support plan. At the last key inspection a requirement was made that one persons risk assessment was updated as their staffing support needs were not recorded correctly on the risk assessment at that time. Evidence was seen that this requirement had been complied with. It was noted that a lot of multi-disciplinary work had been undertaken with one resident over the last year to help them minimise behaviour that challenges the service. This included by increasing staffing at night and by the placing authority agreeing additional funding for one to one hours during the day. We looked at detailed risk assessments and records of the episodes of challenging behaviour and they showed us that this behaviour had significantly decreased over the past six months. However, it is our judgement that the current additional resources need to be kept in place for the foreseeable future to assist the home to maintain this improvement and to ensure that the persons needs can continue to be safely met. All risk assessments sampled were up to date and included identified risks and guidance to staff on how to minimise these. Risk assessments varied for each resident and included individual risks including relating to epilepsy, the risk of sexual exploitation and how to minimise risk from challenging behaviour. There is a form kept with each persons risk assessments for staff to sign to indicate they had read the latest version. Care Homes for Adults (18-65 years) Page 13 of 32 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. Residents are supported to enjoy a wide range of activities, both in the home and in the wider community. They also enjoy contact with relatives and people that are important to them to the extent that they wish. Peoples rights and responsibilities are respected and promoted within their daily lives. People are also supported to enjoy healthy and nutritious meals of their choice. Evidence: The homes annual quality assurance assessment. AQAA, states; The service offers a range of activities both within their home and the wider community. Evidence was seen that all four residents attend external day service five days a week, including specialist day services, which meet their needs. Communication between the day services and the home is helped by the use of individual communication books, which were seen to include details of how the person has been at the home and at the day service prior to travelling between each service. The provider organisation runs Care Homes for Adults (18-65 years) Page 14 of 32 Evidence: employment training and work experience opportunities for people they supported in the London region. A one to one coordinator from the provider organisation visited the home during the inspection to meet the residents and staff to explore whether these opportunities could be of value to the residents at this time. We were pleased to learn from this coordinator that the employment training and work experience opportunities could potentially be taken up by people with a range of needs and dependencies. Residents are also supported to attend recreational, leisure and social activities in the community. Evidence was seen that this included attending a local leisure centre and social clubs. One resident we met belongs to a drama group and was due to take part in a performance on the Friday and Saturday of the week of this inspection, which they were clearly enthusiastic about. We were informed by the manager after the inspection that the play was brilliant and dynamic (the residents) performance was great, all the other residents attended with our staff and everybody loved it! We were told that last year residents went on holiday to Leeds and enjoyed the 41st Leeds carnival that included Caribbean music and food. We also saw pictorial information for residents about going on holiday to Center Parcs this year, which one resident spoken to was keen to show us. Residents are from different cultural backgrounds including Asian, Black British and White European. Evidence was seen that the home is working hard to practically promote equality and diversity within the service. Each resident had a cultural needs assessment form on their files that included a range of relevant information including: peoples needs and preference regarding how they wish to be supported with their religious needs; their personal care, including skin and hair care and their sexuality. These, and other documentation seen, recorded peoples needs and wishes regarding their sexuality, including sexual expression and how to minimise the risk of sexual exploitation in the community. Evidence was seen that residents are supported to maintain contact with relatives and other people that are important to them. It was also noted that a number of relatives had regular contact with the home, including attending review meetings. We also saw evidence that one relative had formally complimented the home on identified improvements to the support it provided their resident over the past year. The home operates a seven week menu and the manager has introduced pictorial menus to help residents plan and choose their meals as well as being aware of what is on the menu for that day. We were told that none of the residents needed a special diet although the home encouraged healthy eating, e.g. by encouraging minimising fat Care Homes for Adults (18-65 years) Page 15 of 32 Evidence: and salt intake. The menu contained a range of ethnic meals that residents liked. Examples of these included: Afro-Caribbean dishes such as Jamaican oxtail, fried plantain and ackee and saltfish; Asian dishes such as korma, tikka masala and coconut curry and English dishes such as traditional roast dinner and fish and chips. Residents were observed being supported by staff to choose what they wanted for breakfast from a range of cereals and toast with the option of a cooked breakfast. This was seen to be undertaken in a relaxed manner and appropriately friendly manner. Records were sampled of the meals that each resident had eaten, which were satisfactory, and it was noted that sufficient food was appropriately stored in the home. Care Homes for Adults (18-65 years) Page 16 of 32 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. People living in the home benefit from being sensitively supported with their personal care needs. They also benefit from their health care needs being well met, including through referrals to a range of community based health professionals. People are protected by the homes medication policies and procedures. People and their families can also be assured that the home knows their wishes in the event of an unexpected death. Evidence: All residents have specific support needs regarding their personal care. These are clearly set out in their support plans, which were seen to contain detailed guidance for staff on how to meet both the persons needs and wishes in this area. Staff spoken to were able to describe how they supported people with their personal care, including how their cultural and other preferences were addressed. The homes annual quality assurance assessment, AQAA, states; We enable service users access to health care services and assist them in exercising a degree of choice in accessing health care services of their choice. All service users health is monitored and any potential complications and problems are identified and dealt with at an early Care Homes for Adults (18-65 years) Page 17 of 32 Evidence: stage. Each resident had an up to date health action plan that provided detailed information about the individuals health needs and the ways these should be addressed. Evidence was seen that residents that suffer from particular conditions such as epilepsy have these carefully monitored to assist staff in meeting the persons needs in such areas. Each resident has a health appointment record sheet in their file and these were inspected. The record for each appointment showed which healthcare professional the appointment was with, the outcome of the appointment and any notes or directions for staff following the appointment. The home also endeavours to obtain a written report from the health care professional regarding the appointment and the outcome. Evidence was seen from these records that residents are registered with a GP and had access to a dental services, optician, chiropodist, general hospital out-patient appointments and health prevention screening where appropriate. One resident was supported by a staff member to attend a local dentist for a check up during the inspection. Evidence was seen that the home had a current medication policy and procedures. We saw records for medication received into the home and medication disposed of, which were up to date. The medication administration record (MAR) chart and medication for two residents were inspected and indicated that residents were being administered their medication safely. Each residents medication file contained a photograph to aid safe administration and included information about the medication prescribed, including any possible side effects. Evidence was also seen on the MAR charts inspected that the manager undertakes weekly audits to assist the monitoring of safe administration. One person is prescribed PRN medication, which means staff are to administer it when required. There were clear guidelines on the persons file for administering this PRN medication. None of the residents were prescribed controlled medication and all the medication was properly and safely stored. Evidence was seen that staff that administer medication had been trained to do so and staff spoken to confirmed this. Each persons file inspected had a record of the person, and/ or their families wishes, in the event of their death. This was called What I want to happen to me when I die. We were told that these records were in the process of being reviewed. Care Homes for Adults (18-65 years) Page 18 of 32 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. Residents are protected by the homes policies and procedures on dealing with complaints and on safeguarding people from abuse. However, the home must make sure that the Commission is notified of any safeguarding issue to maximise this protection. Evidence: The homes annual quality assurance assessment, AQAA, states;We have arrangements in place to deal with complaints and keep service users safe. Complaints are monitored by the Choice Support Quality Assurance and Protection Committees. These are sub groups of our board of trustees and service users are represented on both committees. All staff are regularly updated about the outcomes of the meetings. The home has an accessible complaints procedure that was seen displayed in the home and a copy kept in the signing in book for the attention of all visitors. The complaints log was inspected and showed one complaint had been recorded since the last inspection; the record showed that this had been dealt with properly. It was also noted that five compliments had been received by the home during that period. We also saw evidence that the provider organisation evaluates complaints and compliments and writes a regular report on this as part of its quality monitoring processes. The home has a satisfactory and up to date safeguarding adults policy and procedures that were seen and that properly emphasised that any allegation or disclosure of Care Homes for Adults (18-65 years) Page 19 of 32 Evidence: abuse must be referred to the local authority to coordinate any investigation. One safeguarding referral had been made by the home to L.B. of Haringey following an incident between two of the residents. Records showed that this had been properly investigated and appropriate strategies put in place to minimise the identified risk to people living at the home. However, the Commission has no record of receiving a notification of this safeguarding referral at the time, as is required under the current regulations. The manager told us that it is the provider organisations policy that such notifications to the Commission are made by the providers regional office rather than the individual home and she was not clear whether this had been done or not. A requirement is made regarding this. Evidence was seen that staff have received training on dealing with safeguarding allegations or disclosures and staff spoken to were able to tell us the actions they would need to take should a disclosure or allegation come to their attention. At the last inspection a requirement was made that arrangements are made for assessing residents capacity/ ability to give informed consent, so that their best interests are safeguarded. Evidence was seen that this requirement was being complied with. Records showed a number of areas where a multi-disciplinary meeting had considered how best to deal with identified areas relating to consent. An example of this was seen with regard to consent to treatment for dental care. We were also told that staff are due to attend further training on the Mental Capacity Act, including the Deprivation of Liberty safeguards (DOLS) that came into force in April 2009. Care Homes for Adults (18-65 years) Page 20 of 32 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. The home is generally well decorated and maintained and provides a domestic type environment that meets residents needs and which they are happy to live in. However, further work is needed on the two bathrooms to fully protect residents and to provide a pleasant environment for them to use. The home was clean and tidy creating a pleasant environment for all. Evidence: The homes annual quality assurance assessment, AQAA, states; The building has good accessibility, it is comfortably furnished and of a size that is adequate to the number of service users. Individual rooms are personalised and the general quality of the homes furniture, decor and hygiene meets the minimum standards. Accommodation at the home is provided on three floors. The ground floor contains the lounge, kitchen/diner, laundry and shower/bath/toilet. There is a ramp to the front door to facilitate access although the building is not fully accessible and thus not suitable for people who use wheelchairs. There is a pleasant well kept garden to the rear of the house that contains good quality garden furniture. The first floor contains two residents bedrooms, a bathroom/ toilet, the managers office and an adjoining sleeping-in room. The second floor contains an additional two residents bedrooms. During a tour of the building it was noted that all the residents bedrooms had been Care Homes for Adults (18-65 years) Page 21 of 32 Evidence: personalised and included photographs, a notice board with relevant information such as their personal pictorial daily activities guide, a television and lockable cupboard. All the bedrooms were suitably decorated and residents have had new beds and mattresses in the past year. Each room had a pleasant and individual feel that reflected the residents preferences. One resident is talented as an artist and their pictures were displayed in the persons room as well as other communal areas in the home. At the last inspection the ground floor shower was broken and a requirement was made that it was repaired so that residents could use it. This requirement had been complied with. It was also noted that new flooring had been laid in both the ground floor and first floor bathrooms and we were informed that both of these rooms had been refurbished in the last year. However, both bathrooms need further attention to maximise infection control and present a more pleasant environment for residents to use. The area surrounding the shower tray in the ground floor bath/shower room is porous and showing significant signs of water damage, including mould on damaged surfaces. This is creating a hazard to health and safety by not promoting infection control. Similarly there are significant porous surfaces around the toilet and bath in the first floor bathroom which also present a health and safety hazard by not promoting infection control. A requirement is made about both rooms. All the residents have complex needs and do not have en-suite facilities in their rooms; it is therefore all the more important for them to have access to pleasant and safe bath/ shower and toilet facilities. We were told that redecoration and refurbishment was undertaken by Sanctuary Housing Association but the current regulations make it the registered persons responsibility to ensure that residents live in a safe and pleasant environment. The other communal areas in the home, including the kitchen/ diner and lounge, were well decorated and equipped providing a pleasant environment for people living and working there. The sofas and chairs in the lounge had been replaced in the past year and both the kitchen/ diner and lounge were well decorated and equipped. The home had an appropriately equipped laundry room which was clean and hygienic. There are a range of environmental risk assessments in place and evidence that regular health and safety checks are undertaken on the physical environment of the home. The home was clean and appropriately tidy throughout the inspection. Care Homes for Adults (18-65 years) Page 22 of 32 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. Staff employed in the home have a range of relevant qualifications and competencies and are deployed in sufficient numbers to properly support people living in the home. The homes recruitment policy assists in protecting people living in the home. People are also supported by staff who have access to appropriate training, formal supervision and an annual appraisal to assist in further meeting the needs of people living in the home and in the staffs own development. Evidence: The homes annual quality assurance assessment, AQAA, states; The service has a well trained and competent staff team who are equipped to meet the specific needs and preferences of service users. At the time of this inspection the home was employing a manager, six full time support workers and two part time support workers. Of the eight support workers three had completed the national vocational qualification (NVQ) level 2 in care and two of those were working toward NVQ level 3 in care. Two others were working towards NVQ 2 in care and the remaining three were due to start NVQ later during the year. The homes rota showed that there were a minimum of two support workers on duty on the morning and afternoon shifts and one waking and one sleeping-in support worker on duty at night. We were informed that additional staff could be bought on Care Homes for Adults (18-65 years) Page 23 of 32 Evidence: duty if that was needed and also that the home occasionally uses bank or agency staff who would be familiar with the needs of the residents. In addition the manager is often on duty in addition to the support staff although works some shifts to keep familiar with the residents routines outside of office hours. The rota showed that when the manager was not on duty one staff member was designated to lead the shift. Support staff spoken to independently stated that the shift leader worked well and that the provider organisation provided an on-call management system for advice and guidance, which also worked well. The staff on duty matched the rota during the two days of the inspection. We were pleased to note that a pictorial version of the rota for each day was displayed in the home to help residents know which staff would be working that day. At the last inspection a requirement was made that a risk assessment was undertaken to determine whether there should be a male staff member on duty at all times to support residents needs and preferences. This had been complied with. As outlined in the Individual Needs and Choices section of this report staffing has been reviewed and increased during the past year and this had significantly assisted reduce the amount of challenging behaviour staff had to deal with. However, staff still face some episodes of challenging behaviour, one of which we witnessed, so it is important that the home continues to ensure that there is enough staff on duty to meet peoples needs at all times. It is also important that staff continue to receive appropriate support, both during and after any episodes of challenging behaviour, and the manager is aware of this. One member of support staff had been recruited since the last inspection and this persons file was inspected. This showed evidence of a safe recruitment procedure and the file contained evidence of a criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check obtained by the provider organisation prior to the staff member starting work, a clear application form, two references and proof of identity. Staff receive regular training and a staff training matrix was seen to assist evidence this. Recent staff training has included core areas such as moving and handling; fire safety; safeguarding adults; food hygiene; safe administration of medication; health and safety and first aid. Staff also confirmed that they received specialist training in areas such as person centred planning, meeting the needs of people with autism, meeting the needs of people with epilepsy and communication training including makaton sign language. Staff were generally positive about the quality of training the provider organisation makes available. Care Homes for Adults (18-65 years) Page 24 of 32 Evidence: We were informed that all staff were supervised every six to eight weeks and both documents sampled and staff spoken to evidenced this. We also saw evidence that the manager has undertaken a staff appraisal with each member of staff during the past year. Care Homes for Adults (18-65 years) Page 25 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home and staff benefit from competent and effective management support. They also benefit from the meaningful implementation of the provider organisations quality assurance systems to assist the service to continue to improve. The home has effective health and safety procedures in place to protect people living there and others that work or visit the home. Evidence: At the last inspection a requirement was restated that the provider organisation ensures that a manager applies to the Commission to be registered. We were subsequently informed by the provider organisation that a new manager, Ms Olympia Kapoula, took up post at the home on 17th July 2008 and that she would be starting the registration process shortly after that. At this inspection we saw a copy of the new managers Criminal Records Bureau clearance taken out through the Commission as part of her application process. We also saw a copy of the receipt she obtained from the Commission for her application form and the accompanying cheque. However, there has been a significant delay by the Commission in processing this application that is outside of the control of the manager or the provider organisation. We will Care Homes for Adults (18-65 years) Page 26 of 32 Evidence: follow this up outside of this inspection process and our judgement is that this requirement has been complied with. The manager presented as being very competent, both regarding knowledge of the needs of people with a learning disability and in the management of the service. We were impressed with the work the manager has undertaken since taking up post including: sending us a very comprehensive annual quality assurance assessment, (AQAA); reviewing key documentation and making this accessible and the introduction of a range of robust management systems to ensure that the provider organisations policies and procedures are implemented at the home in a positive and meaningful way. We spoke to a social worker from L.B. of Haringey who had recently reviewed two of the four residents at the home. She stated that in her opinion the home had improved greatly over the past year since the new manager has been in post. We also spoke to a commissioning officer from L.B. of Haringey who stated that the Borough was satisfied with the service provided by the home. Feedback about the managers management style from staff was positive and our judgement is that she has made significant improvements in the running of the home since she took up post. We saw evidence that the home and the provider organisation have comprehensive systems for monitoring the quality of the service and implementing ongoing improvements. These included: by commissioning an independent organisation, Values into Action, to undertake a survey of residents views; by the manager writing a quarterly report on the quality of the service, the report for January to March 2009 was seen and was very detailed; by an annual service audit; and, by the provider organisation having a coherent national operational business plan that was meaningfully cascaded to regional level and then to individual services. We saw the homes business and development plan for 2008/ 09 and were told that the 2009/ 10 plan was in the process of being introduced. The provider organisation has also introduced a system called quality checkers that includes the manager and residents visiting other services and representatives from other services visiting Carlingford Road. In addition we saw evidence of an effective key worker system, the introduction of regular residents meetings and reports from monthly monitoring visits by the provider organisations regional manager. At the last inspection two good practice recommendations were made; to show evidence of monitoring the Commissions requirements in the monthly monitoring visits and that the home made sure all its policies and procedures were up to date. We saw evidence that both of these recommendations had been acted on. A range of satisfactory health and safety documentation was seen. This included; a gas safety certificate, portable appliance test certificate, an electrical installation Care Homes for Adults (18-65 years) Page 27 of 32 Evidence: certificate and evidence of action being undertaken to minimise the risk of legionella. The homes fire log was inspected and contained satisfactory evidence of a fire risk assessment, fire fighting equipment being serviced and fire drills being undertaken. Care Homes for Adults (18-65 years) Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 37 The registered person must ensure that the Commission is informed without delay of any event which adversely affects the well-being or safety of any service user. This includes any allegation or disclosure of abuse. This requirement is made to maximise protection to service users and to comply with the Care homes regulations 2001 03/08/2009 2 27 13 The registered person must 30/10/2009 ensure that all parts of the home are as far as reasonably practicable free from hazards to their safety. This must include that both the ground floor and the first floor bathrooms promote infection control by having non porous surfaces in identified areas (described in the main body of the Care Homes for Adults (18-65 years) Page 30 of 32 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action report). under Environment. This requirement is made to maximise protection to residents and provide a pleasant and safe environment for them to use. 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 Care Homes for Adults (18-65 years) Page 31 of 32 Helpline: 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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