Inspection on 28/05/09 for Belmont House Care Home

This is the latest available inspection report for this service, carried out on 28th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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Extracts from inspection reports are licensed from CQC, this page was updated on 18/02/2010.

Key inspection report CARE HOME ADULTS 18-65 Belmont House Care Home Belmont House 41, Blemont Road South Tottenham London N15 3LS Lead Inspector Tony Brennan Unannounced Inspection 28th May 2009 11:00 Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 1 This report is a review of the 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. 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 home adults 18-65 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. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 2 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 Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belmont House Care Home Address Belmont House 41, Blemont Road South Tottenham London N15 3LS 07521138801 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) Pratima Rambojun Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9) of places Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category/ies 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: 2. Mental Disorder - Code MD The maximum number of service users who can be accommodated is: 9 New service. Date of last inspection Brief Description of the Service: Belmont House is owned and managed by Mrs Pratima Rambojun. Mrs Pratima Rambojun is the owner of another home in north London. Mrs Pratima Rambojun has recently purchase Belmont House from the previous providers. Belmont House is a care home registered to provide accommodation for up to 9 people with mental disorder, excluding learning disability or dementia. The home is a three-storey end of terrace property situated off West Green Road in north London. The area is close to the Turnpike and Wood Green underground stations and shopping facilities. The home has a lounge/diner, a conservatory and kitchen facilities, five toilets, two bathrooms (one of which is on the top floor for the staff), a shower room, and a laundry. There is a small garden at the front of the home and a larger, partly paved garden at the back. The main objective of the home is to work in a way that enables residents to live as normally as possible in a situation were their individuality, independence and personal dignity is respected. The weekly fees range from £700 upwards based on the dependency levels of the prospective residents. Belmont House Care Home DS0000073028.V375319.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 two star. This means the people who use this service experience good quality outcomes. This is the first key inspection of the Belmont house since the new owners registered with the commission. We sought to confirm that the home is providing positive outcomes for residents. The inspection took place over one day. We were assisted by Mrs Pratima Rambojun, the registered provider, with the inspection. We spoke with three residents and two members of staff. We also spoke to professionals who work with people who live at home. We observed care practice and interaction between staff and people living at the home. We toured the building and examined a number of records relating to the care, health and safety and management of the home. At the end of the inspection feedback was given to the registered provider areas for improvement were discussed. We would like to thank the staff that assisted us by answering questions about the running of the home. We would also like to thank the people who live at the home who discussed their views of the service they receive. What the service does well: The statement of purpose identified the skills and staffing resources available We found that the service user guide contained all the relevant information. . Belmont house understands the importance of having sufficient information when choosing a care home. Care staff spoken to be able to explain the individual needs and preferences of the four people case tracked. We spoke A resident told us that, “The staff treat me well.” Admissions to the home only take place when staff have the necessary skills to meet the assessed needs of perspective residents. A resident said, “Staff know what help I need. ” We looked care plans for four of the residents have found that they all recently been reviewed and updated. Residents spoken to gave examples of activities. These included going for walks, visiting local places of interest and going to the local pub. A resident Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 6 said, “It is good to go out. I went to the pub and had lunch.” Residents are involved in meaningful daytime activities of their own choice, according to their individual interests and capabilities. A resident said, “the food is all right and they ask you what you would like to eat.” We found that there was a record that recorded resident’s preferences for the meals they would like to eat. A variety of meals are provided that reflect the individual preferences of residents. There is clear guidance on the use of medication as part of managing peoples challenging behaviour. Medication is only used to manage peoples behaviour when it is clearly required to meet their needs. We walked round the home and saw that all bathrooms and public areas had been redecorated. New carpet has been laid throughout the home. The dining and sitting room areas have been organised so that there is more space for residents. New dining room furniture and comfortable chairs are available for residents. We saw that the garden has been redesigned to provide sitting areas. Residents were seen to be able to spend time relaxing in the garden. The home makes sure that the environment is developed to provide improved outcomes for residents. What has improved since the last inspection? What they could do better: There are two areas for improvement identified in this report. Training records showed that staff had not received in-depth training in mental health issues. Discussions with staff showed that they needed further training in this area in order to make sure they could meet the needs of residents with mental health. Staff needs to be able to understand and have skill to meet the mental health needs of residents. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 7 Discussions with staff and registered provider highlighting that training had not been provided on the Mental Capacity Act and its relevance to the needs of the residents at Belmont house. Staff needs to understand how to support residents who may have difficulties in making decisions about how they live. 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. Belmont House Care Home DS0000073028.V375319.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 Belmont House Care Home DS0000073028.V375319.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1235 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have access to the necessary information to make a positive choice about whether to live at Belmont House. Staff at Belmont House have the necessary skills to assess and meet the needs of residents to make sure that they receive the care and support they want. EVIDENCE: The statement of purpose had been reviewed as part of the registration of the home and its new provider. A resident said, “The home has improved since the new management took over.” The statement of purpose was found to contain all the information that is required under the National minimum standards and care home regulations. Copies of the statement of purpose were available in the home so that residents have access to them if they wished to. No new residents as yet have come to live at home since the new registration. However, the registered provider explained that she would give prospective residents a copy of the same purpose along with other information about the home. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 10 The statement of purpose identified the skills and staffing resources available to meet the needs of people. We found that the needs of the residents case tracked were within a range of those specified in the statement of purpose. The statement of purpose confirmed that the cultural and religious needs of people would be respected. Records showed that people were supported by the home to maintain contact with their church or other community groups. The home provides a statement of purpose that is specific to the home and the resident group that they care for. We found that the service user guide contained all the relevant information. We discussed with the registered provider about how the service user guide could be more engaging for prospective residents. She explained that she would be adding photographs of the home and comments from residents about the support they receive from the home. It has been highlighted in the registration report that some minor amendments were needed to the service user guide. We found that these amendments had been made. Belmont house understands the importance of having sufficient information when choosing a care home. There have been no new admissions to the home since a change of its registration. All residents currently living at the home had been assessed prior to their coming to live at Belmont house. The registered provider explained that she would carry out assessments of prospective residents to make sure that their needs can be met. She has experience of assessing the mental health needs of prospective residents. This was gained in her work has a mental health nurse and running another home for people with these needs. The registered provider has prepared an assessment format. The registered provider explained that she would consult professionals, perspective residents and their significant people to make sure that a full understanding of their needs is established before they come to live at Belmont house. Care staff spoken to be able to explain the individual needs and preferences of the four people case tracked. We spoke with the registered provider who was aware that there are number of areas where staff need to develop their skills to be able to meet all the mental health of potential residents. This is discussed in more detail in the staffing section of this report. We observed the interaction between staff and residents. We found this supported their continued well being. A resident told us that, “The staff treat me well.” Admissions to the home only take place when staff have the necessary skills to meet the assessed needs of perspective residents. All the residents’ case tracked had contracts that detailed their rights and responsibilities while living at the home. The registered provider explained that new contracts would be issued to residents. Any new residents will receive a contract. We found that residents had signed their contracts. Residents spoken to understood their rights and responsibilities. Residents told us that the new owners had met with them to explain the changes they Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 11 will be making to the home. Residents are given the necessary information so that they know what to expect from the home. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 12 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6 7 8 9 10 People using the 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 involved in planning of how their needs will be met. The risks to residents are assessed to maintain their safety and well being. People know their rights and are confident that the home will protect their confidentiality EVIDENCE: The registered provider explained that she has reviewed all care plans and risk assessments to make sure that these reflect the needs of residents. Residents told us that the registered provider had spoke to them individually about their needs. A resident said, “Staff know what help I need. ” We looked care plans for four of the residents have found that they all recently been reviewed and updated. Care plans provided guidance on how to meet the needs of residents. Care plans were detailed when describing the mental health needs Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 13 of residents. Other health needs will also address and how these might impact on the individuals mental well being. For example, the diets of one resident needed to be monitored to make sure that they did not become constipated, which affected their behaviour. The care plans residents case tracked were personalised. The care plans provided detailed information on how individual needs would be met. Care plans were found to provide information on the support provided to residents. The registered provider explained that she is introducing life review plans. We looked at these are found that way highlighted the cultural needs of residents. This included whether or not they wish to participate in religious practices. Residents spoken to told us they felt that staff understood these are areas of their needs. Residents in cultural needs are identified and planned to ensure the well being. All residents have a key worker to make sure that the individual needs are met. I found that care plans had been developed with the involvement of people living at home. A person told me, “Staff spend time trying to understand what I want.” I observed that staff took time to understand people and do things in the way they had been asked. I also found that people were able to leave the home to visit the shops when they wished. The home involves individuals in the planning of care that affects their lifestyle and quality of life. Residents had a key worker to make sure that their individual needs are met. We found that care plans had been developed with the involvement of people living at the home. One person commented, “I have agreed with the staff what support I need.” We observed that staff took time to understand people and do things in the way they had been asked. We also found that people were able to leave the home to visit the shops when they wished. A person said, “ I can do what I want a lot of the time. The home involves individuals in the planning of care that affects their lifestyle and quality of life. Risk assessments were found to cover all areas that affected the residents daily life. Risk assessments identified the specific risk facing people. Risk assessments were detailed based on the history of previous risk-taking on the part of people living at the home. These are reflected in care plans. Risk assessments had been reviewed. Changes to the level of risk had been addressed. Staff was able to describe how they prevented risks to make sure that residents were safe and were supported to exercise control over how they live. Risks relating to behavioural issues were identified. We observed that staff engaged with residents in an appropriate adult way. Comprehensive risk assessments that are reviewed regularly are in place to ensure the safety and independence of residents. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 14 One of the residents case tracked were found to have an issue highlighted in the risk assessment relating to him having a healthy diet. The risk assessment clearly identified the issues involved. The registered provider explained that one of the residents who is diabetic only eat certain foods. This has been raised with his general practitioner and other care professionals as it has an adverse effect on his health. If risk assessments highlight issues that may adversely affect the health or safety of a resident then appropriate action is taken by the home. Residents told us that they felt that staff kept confidential issues private. There were clear policies on how confidentiality must be maintained. A resident told us, “ Staff listen to what I have to say.” Both observation and discussions with staff showed us that they were sensitive and aware of the importance of maintaining confidentiality. Residents told us they had seen their records and had provided information about their needs. People know that their confidentiality will be maintained at all times. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 15 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): This is what people staying in this care home experience: 11 12 13 14 15 16 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are supported to engage in a range of activities that meet their needs. People have community contacts and are supported to maintain personal relationships. People are supported to have a nutritious diet that reflects their personal choice. EVIDENCE: The registered provider explained that residents were encouraged to take part in a range of activities. The register provider has increased the range and variety of activities available to residents since taking over the home. Residents spoken to gave examples of activities. These included going for walks, visiting local places of interest and going to the local pub. A resident said, “It is good to go out. I went to the pub and had lunch.” Since the new Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 16 owners took over they have worked with three of the residents so that they now attend a day centre three days a week. One resident “I like going to the park and enjoy the day centre.” Residents spoken to told us that they had been consulted and could choose from a range of activities. The registered provider said that she would continue to improve the range of activities available to residents. Residents are involved in meaningful daytime activities of their own choice, according to their individual interests and capabilities. Daily notes and care plans confirmed that people were regularly involved in activities both in and outside of the home. This included household tasks such as shopping, washing and general cleaning. Residents are involved in the domestic routines of the home to further develop their daily living skills. Residents were enabled to develop contacts in the local community. We observed that while the residents were going out into the community when he wanted to. We spoke with this resident who told us, “I go out to the shops and meet friends.” Discussions with the registered provider said that a number of residents had recently extended trip away from the home. Residents spoken to confirm that they enjoyed this. They explained that they would be going to Belgium in a few weeks time. The residents said they were looking forward to this. Daily records showed that residents were supported to maintain contacts with family and friends. Residents have an opportunity to develop and maintain important personal, community and family relationships. We found that the menu is varied and reflected the cultural and dietary needs of residents. A resident said, “the food is all right and they ask you what you would like to eat.” We found that there was a record that recorded resident’s preferences for the meals they would like to eat. Residents told us that they have a weekly meeting at which meal options are discussed and a menu for the week is agreed. A resident said, “ I do some of the shopping for the food we need.” The registered provider explained that she would be working with residents so that they can become more involved in preparing their own meals. We observed that people were able to have a hot drink when they wish. A variety of meals are provided that reflect the individual preferences of residents. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People are supported with their personal care needs to maintain their independence. People are able to access the medical care they need. People are protected by safe procedures for handling medication. EVIDENCE: Care plans outlined the support residents require to maintain their independence in doing their personal care. We spoke with residents who explained that staff provided support and encouragement to maintain their personal hygiene. One resident told us, “ Staff know how to me in the morning.” Staff were able to explain the personal support needs of residents. Personal support is responsive to the varied individual needs and preferences of residents. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 18 Medical needs had been identified as part of the initial assessment and were referred to in care plans and risk assessments. A resident told us, “ I have my blood test every month.” Daily notes recorded that residents had access to the opticians, dentists and chiropodists. Records showed that mental health professionals made regularly visits to residents. All residents’ case tracked had been reviewed by mental health professionals to make sure the needs were being met. Residents are supported to access the healthcare they need. Peoples health needs are addressed to ensure their well being. The medication policy contained all the required information. We found that records for the administration of medication were complete. Records of medication received and returned were also complete. All medication was held securely. People’s medication had been reviewed regularly to ensure their continued well being. There is clear guidance on the use of medication as part of managing peoples challenging behaviour. This outlined when it was appropriate to use this medication. It clearly stated the types of behaviour that would indicate when it was appropriate to use medication. One resident who had recently had challenging behaviour had been monitored by the home and guidance had been obtained from the relevant mental health professionals. Medication is only used to manage peoples behaviour when it is clearly required to meet their needs. Daily notes showed that health professionals had been consulted to ensure that people were receiving the medicines they needed. All residents had medication profiles outlining why they needed certain medicines. Advice is available on possible side effects of resident’s medication to make sure that it was administered safely. Training records and discussions with staff confirmed that they have had training on the safe administration of medicines. Advice was available for staff on the side effects of medication. Staff that are properly trained to ensure the safety of residents administers medication. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. People can be confident that their complaints are listened to and acted upon. Adult protection procedures protect people from abuse. EVIDENCE: The registered provider she has put in place a clearly defined complaints policy with agreed timescales for managing complaints was in place for residents to use. We found that the detailed policy was in place. Residents told us they had received a copy of the complaints policy. There was a record in their files to show that they had been given the company of the home’s complaints policy. The registered provider explained that she had met with residents and told them that they could raise any concerns they had with her. No complaints had been referred by the Commission to the home since the new registration of the home. A complaints book is available to record all concerns, allegations and complaints. We found that the complaints book recorded the actions that had Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 20 been taken to address issues. There had been no complaint since the registration of the home. The complaints record showed actions taken to resolve complaints. Residents with whom we spoke confirmed that they knew how to make a complaint. A person told us, “ I have not had to make a complaint about anything. I know I can talk to the manager.” The home has an open culture that allows people to express their views, and concerns in a safe and understanding environment. There were policies on handling abuse and protection. People living at the home felt confident that any concerns they raised would be handled sensitively and appropriately. A resident told us, “ I can tell staff if I am worried.” There had been no adult protection issues concerning the way in which the home cares for residents. The registered provider explained that she had referred an issue regarding one resident to the host local authority’s safeguarding team. The registered provider was concerned about the resident and making sure that they are safe. We found that staff had received training on adult protection. Staff spoken to could recognise the signs of potential abuse, and explained how they would respond to it. Resident said, “I am safe here and I can trust the staff.” People feel safe and well supported by the home, which has their protection and safety as a priority. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24 25 26 27 28 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that provides a safe and homely environment that meets their individual needs. The home is clean and hygienic. EVIDENCE: All residents spoken to were pleased with the way in which the new registered provider had improved the homes environment. One resident said, “Since the new management came here they have brightened the place up.” Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 22 The registered manager explained that since taking over Belmont house she has carried out a fall redecoration and refurbishment of the home. We walked round the home and saw that all bathrooms and public areas had been redecorated. New carpet has been laid throughout the home. The dining and sitting room areas have been organised so that there is more space for residents. New dining room furniture and comfortable chairs are available for residents. We saw that the garden has been redesigned to provide sitting areas. Residents were seen to be able to spend time relaxing in the garden. While the residents explained, “We have been involved in choosing and planting some of the flowers in the garden.” Residents were able to access all areas in the home safely. The home makes sure that the environment is developed to provide improved outcomes for residents. Belmont house is a two-storey building of the Edwardian period. It is situated in a very attractive area of South Tottenham. The home is located close to public transport links and local shops. These are within walking distance of the home. Residents told us that they regularly visit the local shops. The homes location helps to support residents continued independence Since taking over the home the registered provider has redecorated all the residents bedrooms. New beds curtains and bedding have been purchased. We saw that bedrooms were personalised with items of furniture and pictures belonging to people. One person said, “ My bedroom is very nice.” Another resident told us that; “ Ive got my own things in my bedroom. The registered provider explained that she encourages and supports people who live at the home to personalise the bedrooms. People had a lockable space in their rooms to keep their personal and valuable items. People are encouraged and supported to personalise their bedrooms. We saw that the home was clean. We found that a range of appropriate measures is in place to prevent cross infection. The home has detailed policies on the prevention of cross infection. Staff have received training on infection control measures. Staff spoken to understood how to work to minimise the possibility of cross infection. Staff confirmed that they had access to disposable gloves and aprons. Liquid soap and paper towels were available throughout the home. The experts by experience noted “I found the rooms were clean and smelling of freshness.” Effective infection control measures are in place to make sure that residents are safe. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Sufficient staff are always available to meet the needs of people who live at the home. Staff do not have all the skills to meet the assessed needs of people who live at the home. Staff are supported and supervise so that they can effectively meet the needs of residents. Residents are protected by the home’s recruitment practices. EVIDENCE: The rota showed that a consistent staffing level was being maintained in the home. We observed that staff were available to provide individual needs for residents. A resident told us that, “ Staff always come and help.” Staff said that the current staffing level allowed them to meet the needs of residents. The registered provider explained that she would be carrying out a review of the staffing level due to the increasing needs of residents. This will allow her to determine whether any changes to the staffing level need to be made to Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 24 meet the needs of residents. The staffing level is reviewed regularly to make sure there are sufficient staff to meet the needs of residents. We looked at training records and were able to show over 50 of staff have achieved the National Vocational Qualification in care. The registered provider explained that a number of staff are also either working towards or have completed their national vocational qualification in care at level 3. Training records we examined confirmed this. Staff training records showed that staff had done training in the essential areas, such as food hygiene, health and safety, administration of medication and infection control and first aid. The home ensures that all staff receives relevant training that is focused on delivering improved outcomes for people. Training records showed that staff had not received in-depth training in mental health issues. Discussions with staff showed that they needed further training in this area in order to make sure they could meet the needs of residents with mental health. The registered provider explained that she had been talking to staff about the mental health needs of residents. However, she had not arranged training on this area. We found from looking at initial assessment and care plans for residents that they had a range of mental health needs. This meant that staff would need to develop their skills to work in this area to meet the needs of residents. Staff needs to be able to understand and have skill to meet the mental health needs of residents. Discussions with staff and registered provider highlighting that training had not been provided on the Mental Capacity Act and its relevance to the needs of the residents at Belmont house. When case tracking residents we found that there were a number of issues to do with the capacity that needs to be addressed. This was discussed with a registered provider who agreed to make sure this training is provided to staff. The registered persons should make sure that Staff receives training that provides them with skills and knowledge to implement their responsibilities under the Mental Capacity Act. Staff needs to understand how to support residents who may have difficulties in making decisions about how they live. We looked there at six staff files. These contained all the necessary documentation to ensure that these members of staff were safe to work with people who live at the home. Their employment record had been checked. Two references and a POVA first/CRB check had been obtained prior to them starting work at the home. This showed that the home followed a clear recruitment procedure that ensures the safety of people. The staff group reflect the cultural backgrounds of residents. Residents said they felt that staff could be trusted. Robust recruitment procedures are followed to ensure the safety and well being of residents. Staff told us that they have received regular supervision since the new persons have taken over the home. We found that there is a record of individuals’s Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 25 supervision in their files. This showed that supervision was being given to staff regularly. Staff said that they found the support provided through supervision enabled them to understand the needs of residents. Active support is provided for staff so that they can meet the needs of residents. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37 38 39 40 41 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence, including a visit to this service. Effective management systems are in place to make sure that people’s will being and safety is promoted. People’s views of the service are sought and used as the basis for improvement. Policies and records supports the ways in which care is provided in the home. People who live at home and staff’s health and safety is promoted. EVIDENCE: Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 27 The registered provider had been through the registration process as part of taking over the management and ownership of Belmont house. The registration report showed that the registered provider had the necessary skills and experience to manage a home for people with mental health needs. She has already managed a home for the same client group. This is rated as a good service. Registered provider has many years experience of mental health nursing. We saw from the registration report and confirmed by discussions with registered provider that she has continued to update their skills. The registered provider explained that she will be applied to the registration team to also be the registered manager for Belmont house. We saw from care plans and other records that the registered provider as all ready introduced new practices to the home. Residents and staff spoken to confirm that there had been positive change introduced by the registered provider. The registered provider understands and knows what needs to be improved in the home. She has already addressed a number of issues relating to care practice and skills of staff. When looking at care plans and other records it was clear to see that there had been an improvement in the outcomes for residents. The registered provider has the required qualification and experience, to run the home to ensure the best outcomes for people. We saw that staff wear nursing uniforms when working with residents. We discussed this with a rift provider. She explained that she has told staff that this practice needs to stop. She will not be providing staff with nursing uniforms in the future. Staff are provided with disposable aprons for when they provide personal care or when they are handling food. The registered provider said thats she would make sure that this practice is stopped. She explained that there are a number of issues in how staff works with residents that she is addressing. The registered provider is aware of the impact of the Mental Capacity Act. As discussed in the staffing section of this report training is required in this area. We discussed with the registered provider the needs of one of the residents who has issues relating to his continued health and well-being that may require referral under the mental capacity guidance. The best provider was already dealing with this issue and that contacted the relevant place in authority. She will make sure that this is followed up and necessary assessment is carried out. A system is in place to monitor the quality of the service provided by the home. The registered person explained that she carries out quality monitoring on a regular basis. People are consulted about how the home is run. Minutes were seen of meetings held with people to discuss the quality of the service provided. People said that they are encouraged to discuss their views of the service. Action to improve the service had been agreed with people who live at the home. Theres a strong emphasis on being open and transparent in all areas of the running of the home. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 28 We looked at a sample of policies and procedures are found that this provided clear guidance to staff on how to respond to issues that might arise. As part of the registration process policies were checked and found to be in place. The registered provider explained that she is updating all policies and procedures. Policies and procedures are in place to support staff in their work with residents. We looked at a number of records relating to the care and management of the home. These were found to be sufficiently detailed. Care records were being maintained to make sure that resident’s needs were being met. The registered provider ensures that the safety risks to residents and staff are identified. Measures are put in place to provide a safe living and working environment. Records showed that fire equipment was tested regularly and maintained. The fire alarm had been updated so that it more reliable. Drills were taking place. The fire risk assessment provides details of potential risks of fire. All health and safety policies were available. Certificates for gas and electrical testing were in date. COSHH guidance is in place and chemicals were stored safely. Residents are aware of safety arrangements and have confidence in the safe working practices of staff. Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 29 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 3 2 3 3 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 x Version 5.2 Page 30 Belmont House Care Home DS0000073028.V375319.R01.S.doc 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA32 Good Practice Recommendations The registered persons should make sure staff receives ongoing training to enable them to meet the mental health needs of residents. The home ensures that all staff receives relevant training that is focused on delivering improved outcomes for people. The registered persons should make sure and staff at training in issues relation to the Mental Capacity Act Staff needs to understand how to support residents who may have difficulties in making decisions about how they live. 2 YA32 Belmont House Care Home DS0000073028.V375319.R01.S.doc Version 5.2 Page 31 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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. 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