Care Home: Cumberland Gardens (7)

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What the care home does well Service users` needs assessment, care planning and review systems are comprehensively written, given a holistic picture of individual service users. Staff support service users by encouraging and supporting them to learn and develop independent lifestyles that would enable them to live more independent lifestyles. Where possible people are able to move and to resettle in the community or take advantage of community amenities.The home benefits from good leadership and direction from a staff team that demonstrate an understanding of their roles and responsibilities and which ensures good relationship between service users and staff. What has improved since the last inspection? There has been a refurbishment of the care home have contributed to the home looking clean, fresh and welcoming. There have been improvements to the care plans and medication administration. What the care home could do better: Further improvements are necessary to the administration of medication. The medication charts had gaps and there was no evidence that confirmed that the person had received the medication. People living in the care home are confident to raise concerns. However the outcomes of investigations into complaints is not always recorded CARE HOME ADULTS 18-65 Cumberland Gardens (7) 7 Cumberland Gardens Off Great Perce Street Islington London WC1X 9AG Lead Inspector Pippa Canter Unannounced Inspection 15th August 2008 14:30 Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Gardens (7) Address 7 Cumberland Gardens Off Great Perce Street Islington London WC1X 9AG 020 7278 4421 020 7837 9591 lorna.williams@candi.nhs.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Camden & Islington Mental Health & Social Care NHS Trust Miss Lorna May Williams Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2006 Brief Description of the Service: The Clerkenwell Project provides residential support for up to five service users who have mental health needs. Camden and Islington Mental Health and Social Care Trust operate the service. The project is run along a communal living framework with service users sharing the homes day-to-day activities. The staff team work within a multi agency team to provide individual support for each service user to live as independently as their abilities will allow. The home links in with day centres, colleges, clubs and other community resources so that service users have the opportunity to become involved in the local community. The project is situated within a quiet residential area that is also a conservation area. There is easy access to transport links, shops and other local amenities. Accommodation for service users is provided over four floors. There is no shaft lift and service users must be mobile. There is a large kitchen/diner and a laundry at basement level. There is a lounge at ground floor level and the single rooms for service users are spread over all remaining floors. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people using this service experience good quality outcomes. This unannounced key inspection was completed over one afternoon and early evening. A total of 4.5 hours were spent in the care home altogether. Prior to the inspection, we reviewed the information that the Commission for Social Care Inspection had about the home. This included the Annual Quality Assurance Assessment (AQAA), which was completed and returned by the registered manager. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. We reviewed and summarised the incident reports supplied by the home. Postal questionnaires were circulated for people living in the home, as well as health and social care professionals. Staff returned two surveys. We have looked at the information collected from the previous inspection and relevant information from other organisations. During the visit we looked at the premises. People living in the service and staff were spoken to and representatives of the management team were also available. Staff were observed going about their duties and interacting with residents. We followed the care for two who are currently living in the care home. The care plans were compared with the care being given. The choice of care plans reflected people’s gender, specific mental health and physical care conditions and cultural needs. The inspection focused on aspects of care, daily activities, staffing levels, supervision, complaints and adult protection. Staff recruitment and training records were looked at as well. Samples of health and safety records were seen. All those who have contributed to the inspection process are thanked for their input. What the service does well: Service users’ needs assessment, care planning and review systems are comprehensively written, given a holistic picture of individual service users. Staff support service users by encouraging and supporting them to learn and develop independent lifestyles that would enable them to live more independent lifestyles. Where possible people are able to move and to resettle in the community or take advantage of community amenities. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 6 The home benefits from good leadership and direction from a staff team that demonstrate an understanding of their roles and responsibilities and which ensures good relationship between service users and staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed and trial periods take place before a placement is made permanent. Active choices are made by service users about whether to move into the home. EVIDENCE: The files of two service users were examined, both of which contained an assessment of needs comprehensively drawn up, an up to date care plan and risk assessment used in conjunction with the individuals’ plans of care. Admission process is designed as a considered approach to support the new referral. Following admission there is an induction process for the new person which includes setting up visits to community resources, registering with the local GP and drawing up the care plan with the assigned key worker. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users changing needs and personal goals are reflected in the care plans. Service users are consulted and supported about all aspects of life at the home and to take risks relative to independent living. EVIDENCE: All service users benefit from having a care plan. This has been developed from the ongoing assessment process and with the involvement of the service user and the key worker. A holistic view is taken. Individuals’ goals are identified and included in the care plans. Service users spoken to confirmed their involvement in the process. Each person is entitled to have a copy of their current care plan, which is kept in their bedroom. Service users are encouraged and supported to make their own decisions as necessary. For example, a service user recently admitted to the home talked to the inspector about his induction process and how he was helped to get to Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 10 know the area. The manager affirmed that the staff group would support the service users to follow social, educational and leisure pursuits. Appropriate risk assessments are in place for all service users, with risks clearly identified in the care plan. These are updated as necessary. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users participate in lifestyle choices that enables them to develop interests as well as to develop relationships and to maintain family contacts. People living in the care home are supported to have a healthy diet, which they enjoy. EVIDENCE: Key working sessions are used to ascertain service users individual goals, likes and interest. Attempts are made by staff to support service users to take part in age appropriate and cultural activities. Service users have the opportunity to use local community resources. From looking at the records and talking to residents and staff, it is clear that residents are supported to have a meaningful lifestyle. A visitors’ policy is available and provided to visitors. One service user is supported to regularly visit relatives living abroad. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 12 The meals are chosen by service users on a weekly basis and they also participate in planning, preparation and the cooking of meals. There is clear evidence that the dietary needs of service users are well catered for with a choice of meals and a balanced and varied selection of food is encouraged that meets service users’ satisfaction. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health and personal care needs are met using the comprehensive care planning and review systems in place. The arrangements for the administration of medication need improving. EVIDENCE: Staff do not provide personal intimate care Service users are supported to do as much for themselves as possible as part of the recovery model of care. There is evidence seen on two service users files to show that staff are supporting individual service users appropriately regarding their physical, psychological and emotional well being. All service users are registered with a local GP surgery. New admissions are registered on a temporary basis until the end of the six-week trial period. Staff liaise with other health care professionals effectively. The systems for the administration of medication are good with clear and comprehensive. Although arrangements are in place to ensure service users medication needs are met, an inspection of the medication administration Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 14 charts (MARS) showed that there were gaps in recording the administration of medication. Three MARS charts were looked and from a period between 12.07.08 and 01.08.08, there were 20 gaps across the three charts when there was no signature of code used. Therefore it was unclear whether medication had been taken by the resident or not. A requirement has been set. This is requirement 1. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are protected by the home’s practices. Policies and procedures are in place to underpin practice. EVIDENCE: There is no evidence of complaints being made directly to the Commission for Social Care Inspection regarding this service. Each new service user to the home is given a copy of the complaints procedure outlining how to complain and how the process works. This forms part of their induction into the service. Of the service users spoken to, they all confirmed awareness and knowledge of whom they should approach if they had a complaint. Service users are able to make comments during the house meetings and key working sessions. There are two ways in which complaints are recorded. Residents are able to complete the suggestions and complaints log, which they can access as it is kept in the lounge. External complaints from neighbours, people in the community and visitors are recorded in a book kept on the office. However it is not always clear about outcomes, as these have not always been recorded. A requirement has been set. Please requirement 2 The service has a robust policy and procedure relating to safeguarding adults. Staff attend training. A whistle blowing policy is also in place and staff have a good understanding of what constitutes abuse and what action should be taken if they suspect any form of abuse. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 16 Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a pleasant and comfortable place for service users to live. Maintaining a safe environment is important, and is an ongoing challenge for staff. The home was clean and hygienic on the day of the visit. EVIDENCE: A tour of the premises was made. The home is now at the end of a refurbishment programme. The upgrade is to meet the low priority requirement to the Disability Discrimination Act 1995 and recommendation from an Infection Control Audit. Communal areas and bedrooms have been upgraded and residents have participated in choosing colour schemes. As part of the refurbishment a residents’ room has become an office; the sleeping in room has become a residents’ bedroom and the previous office is now the sleeping in room. Bathrooms and toilets have all been updated and improved. The improvements have extended to the laundry and the kitchen. Completion of a refurbishment programme have contributed to the home looking clean, fresh and welcoming, with improvement to residents bedrooms and laundry Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 18 room. A cleaning schedule is in operation, for domestic staff and support workers. Staff attended training on Update infection Control Skills and knowledge on 15th January 2007. There is a revised 2007 copy on Infection Control policy situated in the office. A handwashing basin is now situated in the laundry room, as part of the upgrade to the building. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by staff that are competent, qualified and vetted by the home’s recruitment policies and practices; service users individual and joint needs are met by trained staff. EVIDENCE: The care home has a history of a thorough and robust recruitment and selection process. Up to 99 of permanent staff hold the NVQ Level3 and this had been achieved as long ago as 2005. The staff team have knowledge of the code of conduct published by the General Social Care Council. Staff confirmed that they have regular support and supervision with the manager. Supervision contracts were seen and individual sessions are recorded and are signed by the staff member. There has been a recent assimilation of a bank worker into a fulltime permanent post, from the existing 2.5 support worker vacancy. Staff traning and development is given priority. The service has facilitated a staff member to undertake nurse training by reducing her working hours thus Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 20 enabling her to study for a nurse qualification. Other staff have commented that it is not always easy to get support from the organisation for external development courses; however they affirmed that training in availabe which keeps them up-to-date and enables them to meet the needs of the service user. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a consistent way. Service users are canvassed for their views and their health, security and welfare are protected. EVIDENCE: The home is managed and led by a manager who is competent, qualified and experienced to run the home. Service users are canvassed for their views about the service and any developments in both formal and informal ways. The service has comprehensively written policies and procedures, which underpin the care practice in the home. The service supports people in meeting their equality and diversity needs taking account their age, sexuality, gender and cultural background. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 22 Residents are supported and safeguarded in respect of handling their own finances. Where individual financial accounts are kept these show a clear audit trail. A sample of health and safety documents was inspected. The records, observations and the operational practice seen ensured that service users and staff health, safety and welfare are promoted and protected. Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered person must make sure that when medication administration records are not signed this is fully investigated and the action taken recorded. The registered person must make sure that when complaints are investigated the outcome is recorded in the complaint’s record. Timescale for action 30/09/08 2. YA22 22(3) 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Cumberland Gardens (7) DS0000061532.V369417.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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