Inspection on 22/06/10 for Care Assist in Harrow

This is the latest available inspection report for this service, carried out on 22nd June 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 04/09/2010.

Random inspection report Care homes for adults (18-65 years) Name: Address: Care Assist in Harrow 236 Kings Road Harrow Middx HA2 9JR zero star poor service 19/04/2010 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Collisson Date: 2 2 0 6 2 0 1 0 Information about the care home Name of care home: Address: Care Assist in Harrow 236 Kings Road Harrow Middx HA2 9JR 0208688240 Telephone number: Fax number: Email address: Provider web address: c.piper@careassistuk.com Name of registered provider(s): Name of registered manager (if applicable) Care Assist Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 6 Number of places (if applicable): Under 65 Over 65 0 0 learning disability mental disorder, excluding learning disability or dementia Conditions of registration: 6 6 The maximum number of service users who can be accommodated is: 6 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 needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD Date of last inspection Brief description of the care home 236 Kings Road, Harrow is a care home for six people with mental health needs and learning disabilities. The Provider is Care Assist in Harrow Ltd. It is located in a Care Homes for Adults (18-65 years) Page 2 of 17 1 9 0 4 2 0 1 0 Brief description of the care home residential area of Harrow, close to public transport facilities and within walking distance of the shops. The home has six bedrooms, all with en suite showers. The communal areas consist of a large open plan lounge, dining area and kitchen. There is a games room located in the garden. The laundry room and a small office are located on the ground floor, and an office/sleeping in room for staff in the loft. Care Homes for Adults (18-65 years) Page 3 of 17 What we found: We carried out this visit on 22nd June 2010 to look at the progress of compliance with the Statutory Requirement Notice issued on 13th May 2010. The inspection took five hours. A new manager designate had been appointed in May 2010 and was present. The Statutory Requirement Notice was in respect of the the record keeping at the home when it inspected in April 2010 when the home was in breach of Regulation 17 (2) (3) (a)(b) & Schedule 4 of the Care Homes Regulations 2001. The registered person was required to maintain in the care home the records specified in Schedule 4, and by the 9th June 2010. The records were required to be kept up-to-date and available for inspection. The records referred to are as follows: 1) A copy of the statement of purpose. 2) A copy of the service users guide. 3) A record of all accounts kept in the care home. 4) A copy of all inspection reports. 5) A copy of any report made under regulation 26 (4) (c). 6) A record of all persons employed at the care home including in respect of each person so employed. a) his full name address date of birth qualifications and experience. b) N/A c) a copy of each reference obtained in respect of him. d) the dates on which he commences and ceases to be so employed. e) the position he holds at the care home the work that he performs and the number of hours for which he is employed each week. f) correspondence reports records of disciplinary action and any other records in relation to his employment. g) a record of all training undertaken including induction training. 7) A copy of the duty roster of persons working at the care home and a record of whether the roster was actually worked. 8) A record of the care homes charges to service users including any extra amounts payable for additional services not covered by those charges and the amounts paid by or in respect of each service user. Care Homes for Adults (18-65 years) Page 4 of 17 9) A record of all money or other valuables deposited by a service user for safekeeping or received on the service users behalf which a) shall state the date on which the money or valuables were deposited or received the date on which any money or valuables were returned to a service user or used at the request of the service user on his behalf and where applicable the purpose for which the money or valuables were used and b) shall include the written acknowledgement of the return of the money or valuables. 10) A record of furniture brought by a service user into the room occupied by him. 11) A record of all complaints made by service users or representatives or relatives of service users or by persons working at the care home about the operation of the care home and the action taken by the registered person in respect of any such complaint. 12) A record of any of the following events that occur in the care home. a) any accident b) any incident which is detrimental to the health or welfare of a service user including the outbreak of infectious disease in the care home c) any injury or illness d) any fire e) except where a record to which paragraph 14 refers is to be made any occasion on which the fire alarm equipment is operated f) any theft or burglary 13) Records of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise and of any special diets prepared for individual service users. 14) A record of every fire practice drill or test of fire equipment including fire alarm equipment conducted in the care home and of any action taken to remedy defects in the fire equipment. 15) A statement of the procedure to be followed in the event of a fire or where a fire alarm is given. 16) A statement of the procedure to be followed in the event of accidents or in the event of a service user becoming missing. 17) A record of all visitors to the care home including the names of visitors. We looked at the records required to be available and up-to-date. The Statement of Purpose and Service Users Guide have been revised since the Care Homes for Adults (18-65 years) Page 5 of 17 inspection in April. There were some minor amendments still to be made and some outof-date information revised but they were otherwise satisfactory. We looked at a sample of the residents finance books. Money is kept on their behalf by the home and there are also separate books to records the money they receive for food shopping, which has numbered receipts. We saw that these are now being audited on a weekly basis by the manager. There was a file containing the last inspection report and other documents associated with the Care Quality Commission. We saw that there had been two recorded Regulation 26 visits by the registered person or their representative since the April 2010 inspection, one dated in April and one in June 2010. The manager said that one had been undertaken shortly after she commenced work in the home in early May but this was not available for inspection. She provided a copy of this shortly after the visit. We did note that the Regulation 26 reports did not contain information as to the specific records checked, with dates. This would be useful evidence that the records are being kept up-to-date. We looked at the recruitment records. There were files in place for each member of staff who works on a permanent or casual basis in the home. There were still some gaps in recording, although the staff had two references and Criminal Records Bureau (CRB) disclosures. One staff was working with an ISA (formerly POVA) 1st check. There were some gaps in employment records for two new staff of which some evidence was available, but it was not clearly recorded and records needed to be better organised. The style of application and reference forms need to be improved to ensure that the information is easier to check and obtains the information, such as dates of employment, which can be checked against the employment history. We were provided with a record of the training staff have received in this and previous employments. We asked for the records for the agency staff currently employed as waking night staff. These were not available. We issued an Immediate Requirement as no checks had been made on their CRBs, training, references or other information. The manager obtained information, which included the details of the staff member working that night, while we were still in the home. She provided the remainder of the information within the timescale. We saw a copy of the weekly roster which included the staff on duty for the day we visited. The staffing has been changed to include a waking night, rather than a sleeping in staff, and there are now two staff on duty for all day time shifts. Information on the additional services that residents may have to pay are included in the Service Users Guide. The manager said that no valuables are deposited for the residents at present, apart from the money for food and personal allowances. There is currently no facility available to store the residents valuables should it required. There needs to be a facility available for the safekeeping of valuables and a method of recording any deposits and withdrawals from this place. We asked if there was a record of any furniture brought to the home by the residents and Care Homes for Adults (18-65 years) Page 6 of 17 were informed that none had been brought in and all of the furniture was the property of the Providers. The manager said that they were starting to compile inventories of the residents personal belongings. A book to record complaints had been put in place since the April 2010 inspection. We were informed that no complaints had been made. We recommended that a summary is made of any future complaints to ensure that there is a permanent record in case the documenation needs to be confidentially stored. We saw that there was a file of incidents recorded. No Regulation 37 notifications had been sent to the Care Quality Commission and we saw that there were some incidents where this should have been done. In the case of hospital admissions, the Commission had not been notified and this must be done. Each of the residents in the home has their meals separately and mostly do their own shopping. They are all able to go out independently and have meals out without staff support. The Manager said that they are recording the meals taken in the home but this is not a full recording of all the meals eaten when the residents are unaccompanied. The fire records were available for inspection and we saw that both a day and night drill had been held since the inspection in April 2010. The information held was basic and we recommended that this shows more detail, such as who was involved in the evacuation, to ensure that all staff have this experience. Weekly fire tests have been carried out. There is a procedure for evacuation. Although the missing persons procedure was included in the index of the policies and procedures for the home, there was no copy available and it could not be found on the computer system. The manager undertook to replace the missing copy. We saw that there is a visitors book in place, which is kept in the hallway of the home and completed. Overall, we found that the majority of the records were now available for inspection. In some cases, the explanation as to why the record or documentation had not been obtained was available. However, we found that the home had not been reporting the issues required under Regulation 37 although it had recorded the incidents. We have made a requirement for this to be done in future. Where items could not be found, such as the Missing Persons procedures, there was evidence that the provider had produced one. The manager designate was new in post and the home had been without a manager since it opened in February 2010. We gave her feedback on the areas where there was still some improvements to be made to meet fully all of the Regulations. What the care home does well: This inspection was to look only at compliance with the Statutory Requirement Notice. Care Homes for Adults (18-65 years) Page 7 of 17 What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Adults (18-65 years) Page 8 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 3 18 The Registered Providers 07/07/2010 must ensure that staff have the training which helps them to support the needs of the people living in the home and meeting the needs of the residents. In particular training in mental health and learning disabilities must be offered. To ensure that staff have the knowledge and skills to provide a good quality of support. 2 5 5 The Registered Providers must ensure that the residents have information regarding the terms and conditions for living in the home. To ensure that people who live in the home and those who are prospective resdidents are fully informed of their rights and responsibilities. 30/06/2010 3 6 15 The Registered Providers 31/07/2010 must ensure that care plans are correctly prepared and in a format to suit the people using the service. Care Homes for Adults (18-65 years) Page 9 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To ensure that the care plans reflect the support the residents need and agree. 4 7 12 The Registered Providers must ensure that there is evidence that people are involved in the decisionmaking processes in the home and there is evidence of this. Where there are any restrictions, these must be seen to be recorded and agreed. To show that people are involved in the decisions which affect their daily lives. 5 9 13 The Registered Providers 31/07/2010 must ensure that there are clear risk assessments which are seen to be discussed with, and agreed with, the residents and their representatives. To demonstrate that people are supported to take responsible risks, within the homes risk management strategies. 6 12 16 The Registered Providers 31/07/2010 must demonstate that people are supported to make choice regarding education, work and training. To ensure that people are aware of the options available to them for development and education. 31/07/2010 Care Homes for Adults (18-65 years) Page 10 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 7 17 16 The Registered Provider must 31/07/2010 ensure that the people living in the home are encouraged towards healthy eating with choices of meals made available. To ensure that peope have the opportunity to have a healthy diet. 8 20 13 The Registered Providers must ensure that the medication administration is correctly recorded, and that there is an audit trail to ensure it has been administered correctly. To ensure that residents have their medication correctly administered. 31/05/2010 9 20 13 The Registered Providers must ensure that staff are competent to administer medication and that appropriate action is taken when errors are made. To ensure that residents have their medication correctly administered. 31/05/2010 10 23 13 The Registered Providers must ensure that staff are trained in safeguarding as part of their induction and ongoing training. To ensure that staff are fully aware of the procedures for reported safeguarding issues. 30/06/2010 Care Homes for Adults (18-65 years) Page 11 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 11 31 33 The Registered Providers 31/07/2010 must ensure that staff are familiar of their roles and responsibilities within a registered home environment through training and information. To ensure that the people in the home are protected by good staff management and compliance with the Care Homes Regulations. 12 32 18 The Registered Providers 31/07/2010 must ensure that staff have the induction and training, which include all of the basic training courses required, to carry out the work they perform. To ensure that staff are trained and their training needs are indentified. To ensure that the people who live in the home are supported by people with the knowledge and skills to do so. 13 33 18 The Registered Providers 30/06/2010 must ensure that is evidence that there are sufficient staff to meet the needs of the residents. To ensure that people have sufficient choice of activities. 14 34 19 The Registered Person must ensure that all of the information in respect of staff recruitment is obtained 09/06/2010 Care Homes for Adults (18-65 years) Page 12 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action as required and is available for inspection. To ensure that people are protected by robust recruitment practices. 15 35 18 The Registered Providers 30/06/2010 must demonstrate that staff have the opportunity for staff to undertake National Vocational Qualification. To ensure that staff are able to develop their skills. 16 36 18 The Registered Providers must provide evidence that staff are supported through regular one-to-one supervision. To ensure that staff have regular support from the management staff. 17 37 18 The Registered Providers must ensure that there are sufficient management staff available in the home to ensure that the home can meet its stated purpose, aims and objectives. To ensure that the home is being managed and residents and staff are supported through a well-managed service. 18 39 24 The Registered Providers must demonstrate that the home has good quality monitoring processes in 30/06/2010 30/06/2010 31/07/2010 Care Homes for Adults (18-65 years) Page 13 of 17 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action place. To ensure that the services the home provides are monitored and reviewed as part of a quality assurance process. 19 42 13 That all of the health and 21/04/2010 safety checks including water temperatures, fire alarms, emergency lighting and any equipment are checked and recorded. Action must be taken if any prove deficient. To ensure all health and safety checks are carried out to confirm the safe operation of equipment. 20 42 13 The Registered Providers 30/06/2010 must ensure that there are systems in place to carry out the required health and safety checks and that the completion of these is monitored. To safeguard the people living in the home, staff and visitors by ensuring that Care Homes for Adults (18-65 years) Page 14 of 17 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 1 34 17 That information on all staff who work in the home is available including Criminal Records Bureau disclosures information, references, training and other related information. To ensure that people are protected by the information on all staff who work in the home being obtained. 25/06/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 23 17 The registered provider must 31/07/2010 ensure that there is the facility for recording any valuables held on behalf of the residents by the providers. Suitable storage needs to be provided. To ensure that people can have their valuables held securely. 2 42 37 The registered person must ensure that all issues which should be reported under Regulation 37 are reported as required. To ensure that all of the required notifications are 30/06/2010 Care Homes for Adults (18-65 years) Page 15 of 17 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 made to the Commission. 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 22 That the system of keeping complaints is improved to include a summary of the complaint, its outcome and dates of response. That a system of recording who participates in fire drills is recorded to ensure that there is evidence that all staff and residents have an awareness of the procedures. 2 42 Care Homes for Adults (18-65 years) Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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