Care Home: DRS Annexe Care Home

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What the care home does well The home is kept clean and tidy for residents. They are supported to lead the lifestyle they want to and to use facilities in the community. People living at this home are provided with a healthy varied diet and a staff team who are being trained to support them. Care plans and risk assessments are comprehensive so that residents` needs are known and met. What has improved since the last inspection? The manager reported in the home`s self assessment document (known as an AQAA) that improvements have been made by refurbishing the home, providing televisions to each resident and developing an ongoing plan for improving the service provided. What the care home could do better: A requirement is made in this report for the staff to stop wedging fire doors open as this practice could cause any possible fire to spread. A requirement is made to ensure people`s needs are assessed and confirmation provided to them that the home can meet their assessed needs before they move in. The reason for this requirement is that there was inadequate information available for inspection regarding the assessed needs of a person living at the home. A requirement is also made to improve recruitment practice in the home. It was found that two of the four staff whose files were inspected had been allowed to start work in the home before all the checks on their suitability had been received. This is unacceptable practice as it may put residents at risk of being cared for by unsuitable people. These checks were all in place by the time of the inspection so there were no current risk to residents. CARE HOME ADULTS 18-65 DRS Annexe Care Home 2 New Villas Baronet Road Tottenham London N17 0LT Lead Inspector Jackie Izzard Unannounced Inspection 12th and 19 September 2008 12:20 th DRS Annexe Care Home DS0000068762.V372180.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 DRS Annexe Care Home DS0000068762.V372180.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. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service DRS Annexe Care Home Address 2 New Villas Baronet Road Tottenham London N17 0LT 020 8885 0758 020 8203 0430 raniedatoo@btinternet.com 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) DRS Care Homes Limited Marshall Gore Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12/09/06 Brief Description of the Service: DRS Care Homes Limited are registered to provide a service to four people with mental health problems and/or learning disabilities at this home. The home is situated in a residential area in Tottenham, providing access to shops and local public transport links. The home is terraced and joined to two other care homes at 3 and 4 New Villas, also owned by DRS Care Homes Ltd. The bedrooms all have en-suite facilities. The shared areas include a kitchen, separate laundry room, a lounge/diner and a paved garden. The home has a registered manager, Mr Marshall Gore, who also manages the adjacent care home. There are at least two care staff working at the home during early and late shifts. Night shifts are covered by a waking night staff. Information about the home including service users’ guide and the CSCI Inspection reports are available from the home by contacting the providers. The weekly fees of the home depend on the assessed needs of residents. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 5 DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for the service is two star. This means the people who use this service experience good quality outcomes. This inspection took place over two days; 12 and 19 September 2008. One inspector visited on 12 September and two visited on 19 September. The inspection consisted of a tour of all the rooms in the home, inspection of residents’ records to assess whether their needs were known and met, inspection of staff records to assess recruitment and training in the home, and inspection of a selection of other records such as medication records, food records and health and safety documents. We also spent time talking with the manager, Marshall Gore, two staff members and the responsible person on behalf of DRS Care Homes Ltd; Mrs Datoo. We met the four residents and were able to speak briefly with two of them on the second visit. We also used the monthly reports on the conduct of the home completed by DRS Care Homes Ltd, our Annual Service Review completed earlier in 2008 and the manager’s self assessment of the home, completed in November 2007 to help with this inspection. Following this inspection it was established that a fifth person was receiving care at this service and that this person was accommodated in an extension to the home. The provider informed CSCI that this person was not receiving personal care, but supported living, not regulated by CSCI. What the service does well: What has improved since the last inspection? The manager reported in the home’s self assessment document (known as an AQAA) that improvements have been made by refurbishing the home, DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 7 providing televisions to each resident and developing an ongoing plan for improving the service provided. 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. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 8 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 DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 9 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. People living at the home can be assured that their needs have been assessed before they were offered a place and are known by staff providing a service to them. EVIDENCE: The assessments were checked for two residents. One was reported by the manager to be the person mostly recently admitted to the home. The assessments by the placing authority and by the home were in place, and were of a good standard detailing the resident’s needs. We also looked at the assessment for a resident who was reported to be more able than the others. Again, the assessment was comprehensive and detailed the person’s needs. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 10 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. Most residents can be assured that that their needs are known, recorded and addressed by staff. EVIDENCE: We checked the care plan and risk assessments for one male and one female resident. Both care plans were comprehensive and addressed their needs in various areas of their lives. Both plans were regularly reviewed by staff to ensure they were up to date. Risk assessments were detailed and included strategies for managing risk. There were detailed risk assessments for a recent holiday that both residents had been on with staff. These documents showed that staff promoted residents’ safety while allowing them to take risks where appropriate. Individualised missing person procedures were in the two files so that staff could act promptly if they were to go missing from the home. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 11 Examination of the daily records made on these two residents showed that their care needs were known by staff and met and that they were enabled to make decisions for themselves about their day to day lives. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 12 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, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at this home are supported to go out into the community and follow their interests. They are provided with a choice of activities and supported to maintain their relationships with friends, partners and families. A healthy balanced diet , meeting the preferences of people from differing cultural backgrounds is enjoyed. EVIDENCE: Residents were all out during the inspection so lifestyle was discussed with the manager and with a staff member, and records relating to activities and food inspected. Activities recorded as taking place regularly included games, cooking and meals out. The provider books sole use of a cinema for the residents of the five care homes on a monthly basis if they wish to go. All four residents were out during the first day of the inspection and records showed DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 13 they all attend daycentres or drop in centres for people with similar needs to them. Two of the four residents have completed college courses. Staff support people to go out into the community and use amenities. One resident attends church when s/he wishes to. All residents went on holiday to Brighton recently where a house was rented for them. The manager said he is planning to make a photographic record of the holiday for the residents. We saw photographs of residents out on a previous holiday. One resident is doing work experience at a drop in centre and the manager said that this resident will move on to supported housing in the future. This is evidence that residents are encouraged to progress and become more independent. A staff member said that she goes with residents to local parks and shops on a regular basis. The manager said that residents all have contact with friends and/or family outside the home , one stays with family for a weekend every month and another has a partner who visits regularly. The menu seen indicated that a balanced diet is served which includes foods from different cultures. Four meals are provided as there is a supper as well as breakfast, lunch and dinner. The manager said that one person eats Halal meat. One resident cooks for herself and all have the opportunity to take part in a community meal where they are encouraged to cook once week. The kitchen was stocked with a variety of foods. On the second day of the inspection, residents came home from day services and were having a takeaway meal together. We spoke with one resident on the second day of the inspection who said, “I love it here. I get to do everything I want and they help me a lot.” The other residents were not able to give their views on whether the home was meeting their needs but residents were observed to be relaxed and enjoying staff company while waiting for a takeaway meal. Records of residents meetings showed that residents are asked for their views on decisions affecting their lifestyle, for example about their recent holiday. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 14 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. People living at this home have their health needs met and are protected by the home’s practices with medication. EVIDENCE: The manager said that two residents have a mental health diagnosis and the others have a learning disability and this was confirmed by reading their assessments. Records showed they have access to services specifically for their needs. We looked at the health records of one person with learning disability and one with mental illness. There were clear records of health needs and medical appointments for both. Staff keep detailed records of residents’ appointments with healthcare professionals and the outcome of these appointments so that all staff involved are aware of the health needs of the residents. Records showed that both residents’ health needs were known by the home and met. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 15 One care plan stated that the resident needs the support of two staff to attend health appointments and there was written evidence that staff provide the support needed. The home’s medication is stored securely and delivered in a monitored dosage system by the local pharmacist. A sample of one week’s medication charts and medication for two residents were compared. The MAR sheets were completed fully showing that medication has been given and recorded. This indicates proper safe procedures being followed. All the residents were seen briefly during the second day of the inspection and no concerns were noted about their physical appearance. Their personal care needs appeared to be met . One resident said, “they help me a lot.” Daily records for all five people living at the home were seen for five days in September 2008 and these indicated that all had received support and/or supervision with their personal care. The provider said that the fifth person was not being provided with personal care. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are protected by clear procedures for making complaints and dealing with safeguarding issues. They are protected by staff trained in recognising and responding to abuse. EVIDENCE: The complaints book showed that since the last inspection of this home there have been three complaints recorded. All were seen to have been recorded and dealt with appropriately. We saw the complaints procedure displayed in the home for residents and/or their visitors. The manager said a new format which is easier for people with learning difficulties to understand will shortly be produced. We spoke with one staff member who confirmed that she had attended training in safeguarding and understood the procedures. The manager advised that all staff members have attended basic “POVA” training which covered safeguarding procedures to be followed. The home had a copy of the up to date safeguarding adults procedures used by the local authority. DRS Annexe Care Home DS0000068762.V372180.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. Residents are provided with the space and facilities to meet their needs and they benefit from a clean and homely environment. EVIDENCE: All rooms in the home were inspected as part of this inspection. The bedrooms all have ensuite shower, sink and toilet. The home was well maintained and cleanliness throughout was seen to be of a high standard. Fire doors onto the kitchen were wedged open. A requirement was made to cease wedging fire doors open as this increases risk of a fire spreading. Residents’ bedrooms are provided with televisions by the company and are cleaned by staff to a high standard. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 18 There is an open plan lounge-diner and a paved garden with seating and a water feature. Residents were seen to be enjoying sitting in the garden during the inspection. There are suitable laundry facilities where people wash their clothes with support from the staff. There was an open “lean to” structure where there was a desk and board games. The manager said that this used to be the smoking area but was now a “games room.” Attached to this was an extension to the property. The manager said this was a training flat used for residents who were planning to move into supported living. DRS Annexe Care Home DS0000068762.V372180.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. Residents benefit from staff being provided with training suited to the needs of the residents but they are not always protected by the home’s recruitment practices which could put them at risk. EVIDENCE: We checked recruitment records to see if the newly appointed staff had been properly vetted before starting work in the home. Two staff members’ files showed that they both started on 1/2/08. Their POVA first checks were both received on 25/1/08 which is good practice as this shows they are not on the list held nationally of people unsuitable to work with vulnerable adults. Both started before the home had received two references as required. Their second references were dated 9/5/08 and 22/5/08 respectively. This indicates recruitment practice which does not protect safety of residents. A requirement was made to ensure safe recruitment practice is adhered to at all times. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 20 The manager reported that all staff have or are working towards an NVQ qualification. Both new staff had records on file that they were enrolled on NVQ training and were being supervised regularly. This is good as neither had any prior experience of this work. We met privately with one staff member who said that since she was employed in April 2008 she has attended training in medication, health and safety, fire safety, POVA, first aid, food safety and the mental capacity act. The manager showed that staff have individual training and development plans to record their training needs. Staff rotas showed two staff on duty during the day and one awake at night. There are six staff employed plus the manager. There was one staff on duty with the manager at the time of this inspection. This was because there were no residents at home all day so this is satisfactory. We were able to speak with three staff members who all showed a positive attitude towards the residents of the home. DRS Annexe Care Home DS0000068762.V372180.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. Residents benefit from a well run home where their views are listened to and their health and safety generally promoted. EVIDENCE: We checked a sample of health and safety records to see if the home was well maintained and safe for residents. We saw that electrical and gas inspection certificates were within required date (October 2005 and November 2007) and safe to use. The portable electrical appliances were checked in September 2007 and the manager said that these were booked to be inspected on 17 September 2008 and showed written confirmation of this. DRS Annexe Care Home DS0000068762.V372180.R01.S.doc Version 5.2 Page 22 The home had insurance in place which was within date. There were no health and safety concerns noted in the home. However, there was no documentation available regarding the safety of a fifth room which is structurally attached to the home. An inspection by LFEPA in the week of this inspection indicated that more fire precautions were needed for the safety of a person sleeping in that room. Some fire doors in the home were seen to be wedged open and a requirement is made to cease this practice. Records of staff and resident meetings showed evidence that consultation takes place regularly. Minutes of residents meetings dated 2 September 2008 and June 2008 were read during the inspection and showed evidence that people living in the home were encouraged to make decisions about their lives in the home. Information provided in the AQAA self assessment completed by the manager states that “We have regular consultation on a monthly basis with our service users via Residents Meetings. This gives us a platform to hear their views on a regular basis. Our Annual Quality Assurance surveys also give residents an opportunity to express their views via anonymous questionnaires. The results of these surveys are analysed thoroughly and the important information collected is used to improve our service.” The manager was able to give examples of improvements made as a result of listening to residents’ views. The manager is registered to manage this home and an adjacent home and has an office in both. He does not hold the registered manager’s award but does have relevant qualifications in management and mental health and is experienced at managing services. DRS Annexe Care Home DS0000068762.V372180.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 3 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 2 35 3 36 x 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 4 13 3 14 4 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 2 x DRS Annexe Care Home DS0000068762.V372180.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 YA34 Regulation Requirement Timescale for action 30/11/08 19 The registered persons must schedule 2 ensure that no person starts work at the care home until all the checks on their suitability to do so have been received. This is so that residents are protected from the risk of unsuitable people being employed. 23(2)(c)(i) The registered persons must ensure that the practice of wedging fire doors open is ceased. This is to improve fire safety precautions in the home. 2 YA42 17/10/08 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 DRS Annexe Care Home DS0000068762.V372180.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 DRS Annexe Care Home DS0000068762.V372180.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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