Inspection on 08/04/09 for 3-5 High Worple

This is the latest available inspection report for this service, carried out on 8th April 2009.

CQC found this care home to be providing an Excellent service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3-5 High Worple 13/01/06

3-5 High Worple 22/07/05

3-5 High Worple 04/01/05

3-5 High Worple 02/06/04

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: 3-5 High Worple Rayners Lane Harrow Middlesex HA2 9SJ     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: Ram Sooriah     Date: 0 9 0 4 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 31 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 31 Information about the care home Name of care home: Address: 3-5 High Worple Rayners Lane Harrow Middlesex HA2 9SJ 02088662867 F/P02088662867 dina.devshi@lha-asra.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: ASRA Greater London Housing Association Limited care home 5 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: 5 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 3-5 High Worple is a care home providing personal care and accommodation for up to 5 people who have learning disabilities. The home specialises in the care of Asian people from various cultural and religious backgrounds. The home is owned by ASRA Greater London Housing Association, which is a registered housing association, with charitable status. The organisations head office, based in SE1, provides senior management support to the staff and manager of the home. The home was opened in 1998. It consists of two semi-detached houses that are linked Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 5 Brief description of the care home on the ground and on the first floors and has been suitably adapted to provide accommodation for the residents. The home is located within a residential area of Rayners Lane, in the London Borough of Harrow. It is around the corner from shops, pubs, and public transport links, including Rayners Lane Underground station, and is close to a large park. The home has shared-driveway parking on each side. Parking restrictions apply on the road outside the home, but there are car parks and parking meters within close proximity of the home. All the homes bedrooms are single, fully furnished and with wash hand basins. The home has a bathroom, and two shower rooms, all of which have toilets. Access to the first floor is by stairs. The homes kitchen/diner and lounge afford it sufficient communal living space. The home has a reasonable-sized garden, with overlooking patio area that is easily accessible, and well maintained. The care home was full at the time of the inspection and the charges in March 2009, were 806 pounds weekly for each resident. There was an expectation that fees would be increased from April 2009, depending on the Local Authority fees policy. Care Homes for Adults (18-65 years) Page 5 of 31 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 key unannounced inspection took place on Wednesday 8th April from 11:05-17:00 and continued on Thursday 9th April from 11:00 to 15:30.During the inspection we talked to four residents, two members of staff, toured the premises, looked at a sample of records and inspected a sample of medicines. The manager completed an Annual Quality Assurance Assessment (AQAA) that has been used where possible to inform this report. The home was rated an excellent service during the key inspection that took place on the 25th May 2007. There was an Annual Service Review on the 7th July 2008. In the period between the inspections, we monitored the home from notifications that are sent to us by the home and from feedback from people who contacted us, including social and health care professionals. Care Homes for Adults (18-65 years) Page 6 of 31 We would like to thank the residents for their feedback during the inspection and the manager and all her staff for their cooperation during the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: This report contains one requirement but has a number of recommendations to promote good practice. The requirement is about window restrainers. The window restrainers that were in use Care Homes for Adults (18-65 years) Page 8 of 31 in the home, were of a type that can easily be disabled. These should be reviewed by the home to make sure that window restrainers are of a type that can only be disabled with a special key or tool. All residents receive a contract that is on the whole comprehensive. However, the part about the fees do not clarify that residents pay a personal contribution and that the local authority that placed the resident is responsible for paying the bulk of the fees. The contract seems to suggest that it is the resident that pays the fees. There should be paper towel dispensers wherever there is a need for it, to make sure that these are easily available when needed. The home has in the main a satisfactory quality management system. A report is normally available after the group of homes have been audited, addressing the group performance. It would be helpful if there was a specific report for High Worple, to give specific feedback about its performance. 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 9 of 31 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 10 of 31 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 all the necessary information to provide to any prospective resident or to their representatives, in a format suitable to their needs, for them to decide if the home is suitable for them. The home has sufficiently qualified staff to assess the needs of prospective residents to make sure that the home will be able to meet the needs of the prospective residents. Evidence: We discussed the service users guide (SUG) and the statement of purpose (SoP) with the manager. All residents have a copy of the SUG in their care records and we also noted that these have been reviewed in 2008. These were comprehensive and contained all the necessary information as required by legislation. We also noted that these have been produced in a pictorial format. The manager clarified that the SUG and the SoP can be produced in other languages and formats if required. There have not been any new residents in the home since the last inspection so we have not been able to see an up to date preadmission assessment. However, the home has all the necessary documents and the manager has run the home for about 4 Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: years and is qualified to carry out a preadmission assessment of a new resident if that is required in the future. She states in the AQAA that If we do have a vacancy we will ensure that service users are fully involved as before to ensure that the placement is of their choice. She also clarified that the organisation and she were committed to the implementation of the Valuing People strategy of the Government that has been drawn up to improve the life of people with a learning disability. The home provides all residents with a contract. This is on the whole comprehensive and addresses all the points as required by legislation. The section for weekly charge, says that The Resident will pay on the commencement date the weekly charge for the period beginning on the commencement date and ending on the next date for payment . It seems that the contract makes the resident responsible to pay the fees although the bulk of the fees is paid by the local authority that placed the resident in the home and the resident only pays a contribution towards their stay in the care home. There was also some indication in our conversation with the manager that the resident pays the rent part of the placement and that the local authority pays the care and support part of the placement. If that is the case then the contract should also make this clear. We found, as part of our inspection that the home is well able to meet the needs of the residents that live there. Staff have the knowledge and are competent enough to understand the needs of the residents and to prepare appropriate care plans to meet the needs of the residents. Those residents who spoke to us said that the care home is their home. We also observed the residents in the home and we noted that their demeanour suggested that they were very comfortable living in the home and that they knew the other residents who live in the home and the members of staff, quite well. Care Homes for Adults (18-65 years) Page 12 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of residents are appropriately addressed in individual care plans which are drawn up with the residents or their representatives. Risk assessments are in place to address areas of risk taking, as part of an independent lifestyle. Evidence: Each resident has a person centred plan and an individual care plan. The person centred plan is written in a person centred format and addresses the things that are important to the resident such as, their family and people close to them, their healthcare needs and the things that the resident likes and dislikes. This is produced in an easy to read format with signs and pictures. The manager stated that the individual care plan is the tool that is used by staff to deliver the care that residents require. The individual plan contains short and long term goals of residents such as areas where the resident wishes to develop independent skills. Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: The promotion of independence and the development of individual living skills is a central theme of the care plans. These are identified following review meetings or with discussions between a resident and their key worker and may include attending particular courses or finding a job. The individual care plan contains a useful section that is prepared for the review of the needs of residents. This section contains information about what has worked very well from the last care plan, and what has not worked so well. This then enables to review the action plan and to change it, if required to make sure that the needs of residents would be met. The cultural and spiritual needs of each resident are addressed in the care plans and action is identified about meeting these needs according to the individual wishes of the residents. Risk assessment is noted to be an integral part of the care plans. This is specific to each resident according to their individual needs. We noted that risk assessments were in place not to restrict the freedom of the residents, but rather to promote their independence while maintaining their safety. All of the residents are encouraged to lead as normal a life, as possible. They are all able to go out of the home on their own and to use public transport. They are all encouraged to cook and to take part in domestic tasks. We noted that the care plans and risk assessments were kept up dated and reviewed at least every six months or when required. In cases where new risks were identified we noted that these were addressed in the care records. Care Homes for Adults (18-65 years) Page 14 of 31 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff to lead a fulfilling lifestyle both, inside the home and in the local community, according to their choices. Evidence: The social and recreational needs of residents are identified in the person centred care plan and the individual care plan of residents. A section in the care plan addresses the wishes of residents and areas where they would like to develop social and independent living skills. They are then supported by the home and their key worker to reach their objectives. This section is comprehensive and includes the involvement of family and friends in the lives of the residents. As mentioned in the previous section, the spiritual needs of each resident is addressed in their individual care plan. During the inspection we noted that staff were supporting a resident with regards to their spiritual needs and the approaching Easter. The Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: manager stated that all residents are supported when required with their spiritual needs by the home or by the relatives of the residents. The assessment of the needs of residents contains information about the educational courses that residents were involved in as well as courses to enable them find and maintain paid employment. Some of the courses are entitled Moving on and Ready to go to work. There has been some success in this area as one resident has managed to find paid employment and another resident was involved in acquiring work experience. We noted during the inspection that a resident was being supported with completing an application form to find employment. All residents were assisted to complete a CV that is kept updated and that is used where required to assist residents in finding employment. Staff in the home make use of the various facilities in the community to support disabled people in finding employment such as Pathways, Remploy and Mencap Disability Employment. Residents have the option to attend day centres and to take part in a variety of activities according to their wishes. Some learn new skills and others concentrate on the opportunities to take part in community activities. The home also support residents in maintaining and in identifying new opportunities for recreation. For example some residents regularly go to the swimming pool, two residents play football and some are involved in other sports such as darts throwing. Residents are encouraged to maintain relations with their relatives and friends. The home has an open visiting policy and residents are able to visit their relatives during weekends. Many of the current residents choose this opportunity and visit their relatives every weekend. In addition to that residents have the opportunity to maintain current friendship and to make new friends. They are able to attend many clubs such as the Tanglewood Club and the Ashiana Club. The home is close to shopping links and we were informed that residents help with the shopping. We noted how two residents accompanied a member of staff when the latter went to the local shops. In addition to this residents go out in the local community independently and also use public transport independently. There are no restrictions on the movement of residents and they are free to go out when they want to. We were informed that they all have a key to the front door and to their bedrooms. We indeed noted that all the bedrooms of residents were locked and that they used their keys all the time. During the inspection we noted that a number of residents were helping in the kitchen to prepare supper and that they all had made decisions about their meals. We were told that residents clean their bedrooms during Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: the weekend with the support of staff. They also do their own laundry and are supported where required. From looking at the menu and the records of meals that are cooked in the home, and from the conversation with staff and residents, we concluded that residents are able to cook and have the meals that they want. We noted that the menu forms a regular item of the agenda of residents meetings. During the inspection one resident chose to cook himself lunch and another resident who wanted a particular supper was given the opportunity to prepare this supper. The kitchen is divided in two sections: a meat section and a vegetarian section. This includes separate fridge/freezer, pots and pans and oven. We discussed the provision of Asian meals in the home and the manager explained that residents are able to choose the food that they want to eat according to their cultural preferences and tastes and that the home would provide the ingredients that are required to prepare the meals. The kitchen was clean and tidy. All records were kept as required including fridge/freezer temperatures and the expiry dates of food that were kept in the fridge and freezers. The home was awarded a four star rating from the Local Environmental Health Team when they inspected the kitchen. Care Homes for Adults (18-65 years) Page 17 of 31 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. Residents are supported by the manager and her staff in a sensitive manner to maintain their personal and healthcare needs as required. The management of medicines is of a good standard to ensure the safety of residents. Evidence: We were informed that all the residents were independent with personal care and that encouragement and support was provided to residents as required with regards to maintaining a high standard of hygiene. The type of support required was identified in the individual care plans of residents. All residents that we saw, presented with a good standard of hygiene and we noted that they were all appropriately dressed. The healthcare needs of residents were identified in the care plans of residents and support to residents was provided where required. In some cases monitoring of residents condition was required and we noted that this was being carried with feedback being provided during review meetings. Residents were supported to attend their GP and other healthcare professionals when required and records were kept about the outcomes of these visits. Where a particular action was required, this was included in the care plans of residents. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: Medicines management in the home was inspected. None of the residents administered their medicines and staff were responsible to administer all medicines. We were informed that all members of staff have had medicines training. The medicines reference book in the home was dated March 2004 and therefore we recommend that a more up to date medicines reference book be provided to staff. All medicines are stored in a medicines cupboard in the managers office/sleep in room. We noted that the amount of all medicines was recorded when received in the home and that the majority of spaces were signed when medicines were administered and that a code was used when the medicines were not administered. The home uses the Boots Monitored Dosage System to manage medicines. Staff were familiar with the indications and uses of the medicines and the possible side effects to observe for. Care plans of residents address to some extent the future of residents in terms of whether they would like to continue living in the home or live on their own in the near future. There was however no information about longer term aims, about ageing and about dying. We discussed this with the manager and she agreed that this would be a useful addition to care plans. The home has a policy on death and dying and the manager stated that they would refer to this policy if this was required. We also discussed the future of the residents in the home as they grow older and if their needs change. The manager clarified that residents would be able to stay in the home as long as their needs were met in the home. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home takes complaints and allegations and suspicions of abuse seriously and makes sure that these are appropriately addressed. Evidence: The complaints procedure was present in the care records of residents. It was provided in an easy to read format. A copy of the complaints procedure was available in the office but not in the foyer/reception area of the home to enable access to other parties that may wish to complain about the service. The home divides complaints into informal and formal complaints. There were records of two informal complaints in the complaints register and these were appropriately addressed as per the complaints policy of the home. There have not been any safeguarding issues in the home prior to the inspection but we discussed the procedure to follow with the manager and a member of staff. They were both clear of the action to take if there were allegations or suspicions of abuse. We looked at the whistleblowing procedure. None was available on notice boards but a copy was in the policies and procedures folder. We noted that it said that senior management should be informed if staff had any concerns such as about the standard of care. The procedure however did not say which person should be informed and did not provide the contact details of that person. Staff said that they would contact the Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: head of care if they had any concerns and that they would take the contact number from the notice board. Care Homes for Adults (18-65 years) Page 21 of 31 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 maintained and is appropriately decorated to provide an appropriate standard of accommodation for residents. Evidence: The grounds of the home were on the whole maintained but would require some tidying up, as the weather improved. There were many pots that needed replanting or disposed of as they were empty or in poor condition. The outside of the building was in a generally good state of repair. The home is made up of two semi-detached properties that have been joined on the ground and on the first floors. It was on the whole clean and warm and we did not find any odours. The communal areas are located on the ground floor. There is a large kitchen with a dining area with enough seating for all the residents. The kitchen was well equipped with a range of appliances and with a range of base and wall kitchen units. The lounge area is found next to the kitchen and was appropriately furnished. There is a TV with digital channels and facility to access Asian channels. There are four bathrooms/showers in the home. These were in an acceptable state of decoration. There was liquid soap and paper towels to use for hand washing but we noted that paper towels dispensers were not available in all the bathrooms/toilets. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: There were some grabrails in the bathrooms/toilets and handrails along the stairs, but apart from that the home did not have any other disability equipment. We were informed that these were not required at the current time. The home was on the whole in an appropriate state of decor and we were informed that redecoration normally occurs every five years on a rolling programme. A redecoration plan was not available but we were told that the redecoration is part of the business plan of the home. We were also informed that residents have the opportunity to choose the colour scheme of their rooms and of the communal areas. We were able to see the bedroom of one resident. We noted that the bedroom was appropriately decorated and maintained. The bedroom was personalised with the residents possessions, including pictures and items of decoration. The manager stated that all staff have done the NVQ level 2 in infection control. Current practices in the kitchen and in the home in general, suggest good standards of infection control. Care Homes for Adults (18-65 years) Page 23 of 31 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. Residents are cared for and supported by sufficiently skilled and competent members of staff that are provided in adequate numbers. Evidence: There are normally one member of staff on duty in the home. At night there is one sleep in member of staff. The manager works from 09:00 to 16:00 and is mostly supernumerary, but is in the home and is available if required to help and support residents. At busy times of the day there are at times two members of staff to ensure that residents are appropriately supported and supervised. Examples are when residents are back from the day centres or when many or all residents take part in a range of activities. The staff team in the home consists of four care staff and the manager. At the time of the inspection the home had a vacancy of one member of staff, as a result of one member of staff having been internally promoted. The manager stated that at times agency staff are used and that they tend to use the same people for continuity of care. She reported that the home also make checks to ensure that all the employment checks have been completed for the agency workers. As the home has not had any new employees since the last inspection, we did not look Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: at the recruitment practices of the home. We were informed that the home complies fully with the employment procedure of the organisation. The entire homes staff are trained to NVQ level 2 or above. There was also evidence that the have all had the mandatory training to include manual handling, fire, health and safety and food hygiene training. Discussion with the manager and her staff suggests that staff have at least one supervision session every month. There are also minutes of regular staff meetings. This suggest that staff are appropriately supported for them to care and support residents. Care Homes for Adults (18-65 years) Page 25 of 31 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. The manager runs the home in an open and inclusive manner. Health and safety issues in the home are appropriately addressed to ensure the safety of all people that use the premises. Evidence: The manager has a degree in Psychology and has an NVQ level 4 in management. She has been running the home since 2003. From our conversation with her and from her responses we are of the view that she is fully aware of her responsibilities with regards to the care homes legislation and national minimum standards. She has also been keeping herself updated with regards to mandatory training as well as other training. Feedback about the manager from staff and residents was positive. We noted during the inspection that the manager was approachable to both staff and residents and that residents would approach the manager if they had any issues to discuss with her. She was also fully aware of each residents needs. Minutes of monthly staffs meetings and of residents meetings were available for inspection. Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: The home has a quality assurance procedure and a quality management system that consists of a yearly customer survey and annual audits. Results of the customer survey were available for inspection and areas of weaknesses and strengths were summarised in a report. Yearly audits are carried out but the audits look at the performance of a group of care homes. The report that is produced, also addresses the performance of the group of homes against standards that have been set up by the organisation. There is not a specific report about the performance of High Worple and while there is some feedback about the performance of the home, it would have been useful to the home, if there was more detailed feedback about its performance. The home carries out weekly fire detector tests, emergency lights tests and water temperature checks in the bedrooms of residents. Fire drills are held monthly with records kept. The home had an up to date portable appliances test certificate, electrical wiring certificate and a gas safety certificate. There was evidence that the fire detection system and fire fighting equipment were maintained as required. There was a fire risk assessment and a health and safety risk assessment available for inspection. The home did not have an emergency fire plan as per the Regulatory Reform (Fire Safety) Order 2005, although some of the information was available in different places but not in one plan. The manager provided a fire emergency plan a week after the inspection. Windows in the home had restrainers but we observed that a resident was able to disable the restrainers on a window, and fully open the window. We discussed the usefulness of the restrainers if they can be easily disabled, according to the HSE publication: Falls from windows in Health and Social Care (HSE, (2007). Falls from windows in Health and social Care. www.hse.org.uk). The HSE recommends that restrainers should only be disabled by a special key or tool to ensure that these cannot be easily disabled and therefore putting residents at risk of falls. Care Homes for Adults (18-65 years) Page 27 of 31 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 28 of 31 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 42 13 The home must review all the window restrainers in place in the home to make sure that these are not easily disabled by residents. 13/07/2009 To ensure the safety of residents Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 5 We recommend that the contract be reviewed to contain clearer information about the fees that are to be paid, since the local authority pays the bulk of the fees and the resident pays a personal contribution. That care plans address the future of residents, including issues about the end of life care of residents. The whistleblowing procedure should be clear about the person to contact and should provide the contact details of the person, in cases where staff have concerns about the service or any other issue that affect the safety of residents or other people. 2 3 21 23 Care Homes for Adults (18-65 years) Page 29 of 31 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 4 5 30 39 There must be paper serviettes dispensers in all areas where this is likely to be required. That following the yearly audit, a specific report be produced for High Worple, to provide more detailed feedback about its performance, rather than a report to address the group performance. Care Homes for Adults (18-65 years) Page 30 of 31 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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