Inspection on 29/04/09 for Craven Park Nursing Home

This is the latest available inspection report for this service, carried out on 29th April 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.

Other inspections for this house

Craven Park Nursing Home 11/12/07

Craven Park Nursing Home 10/01/07

Craven Park Nursing Home 20/10/05

Craven Park Nursing Home 11/04/05

Craven Park Nursing Home 18/11/04

Craven Park Nursing Home 14/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

Key inspection report CARE HOMES FOR OLDER PEOPLE Craven Park Nursing Home 1 Craven Road Craven Park Harlesden London NW10 8RR Lead Inspector Judith Brindle Unannounced Inspection 29th April 2009 08:10 DS0000022925.V375105.R01.S.do c 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 homes for older people 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. DS0000022925.V375105.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 DS0000022925.V375105.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Craven Park Nursing Home Address 1 Craven Road Craven Park Harlesden London NW10 8RR 020 8961 5678 020 8965 2789 cravenpark@gsgnursinghomes.com www.cravenpark-nh.co.uk GSG Nursing 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) Ms Milda Williams Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places DS0000022925.V375105.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 26 Date of last inspection Brief Description of the Service: Craven Park Nursing Home is a care home providing nursing and personal care, and accommodation, for up to 26 older people. The registered owner of the home is GSG Nursing Homes Ltd. The home is located within a residential area of Harlesden, within the London Borough of Brent. It is a few minutes walk from local amenities and Harlesden tube station. Bus routes are located close to the home. The home has a private driveway. There is parking for several vehicles on the forecourt of the care home. The building has three floors. Access is by passenger lift or stairs. One of the homes bedrooms is a double room. The bedrooms are fully furnished, and all but two have en-suite toilet facilities. The home has three communal bathrooms that all have adaptations. There are a number of additional toilets. The home has a large dining room that is also used as a sitting room for some people using the service. There is a separate main lounge. The home has medium-sized, enclosed garden, which includes a patio. Prospective residents and others have access to information about the service provided by the care home. Details in regard to fees can be accessed from the care home. DS0000022925.V375105.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The unannounced key inspection of Craven Park Nursing Home took place during a day in April 2009. This was a second key unannounced inspection carried out within six months due to the service being rated poor following the previous key unannounced inspection that took place on the 18th November 2008. A Regulatory inspector and a Local Area Manager of the Care Quality Commission (CQC) carried out this inspection. We were told that there were two residents in hospital and three vacancies at the time of the inspection. Prior to this unannounced key inspection the Commission received a completed Annual Quality Assurance Assessment (AQAA) document from the manager of the care home. The AQAA is a self-assessment of the service provided by the care home that is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. This AQAA was completed very comprehensively by the manager and told us what we needed to know about Craven Park Nursing Home. A number of feedback surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, relatives/significant others, health and social care professionals, and staff. At the time of writing this report, we had not received any completed feedback surveys. We were told that they had been distributed to people. Other information received by us since the previous key unannounced inspection about Craven Park Nursing Home was also looked at. This included information such as incidents that the service has told us about that have happened in the service, these are called notifications, and are a legal requirement. Other documentation inspected included; care plans of people using the service, risk assessments, staff training, staff personnel records, and some policies and procedures. The inspection included a tour of the premises. DS0000022925.V375105.R01.S.doc Version 5.2 Page 6 Assessment as to whether the requirements, from the previous inspection had been met, also took place during this inspection. These were judged to have been met. 24 National Minimum Standards for Older Persons, including Key Standards, were inspected during this inspection. The inspector thanks the people living in the care home, staff, the manager, all those who spoke with us during the inspection for all their assistance in the inspection process. What the service does well: The home is welcoming. A visitor spoke of the home having a very nice ‘atmosphere’. The manager is experienced and keen to develop and improve the service. She completed the Annual Quality Assurance Assessment (AQAA) very comprehensively, including information about what the home does well and of the plans for developing and improving the service. Meals meet the various religious, ethnic and vegetarian needs of people using the service. Comments included ‘the meals are very good’, and ‘I can choose what I want’. A visitor also spoke positively about the presentation of the meals. Staff receive appropriate training to ensure that they have the skills to understand, and meet the varied and multiple needs of people using the service. Comments from people using the service include; ‘the care is always very good’, and the ‘staff are helpful and kind’, and ‘the staff are wonderful’. What has improved since the last inspection? The manager and other management staff have responded promptly and appropriately to the issues/concerns from the previous key inspection (and other random inspections carried out by a pharmacist inspector), which had led to the home being rated poor. These issues/concerns had resulted in a number of inspection requirements relating to health care issues, poor numbers of permanent trained nurses, and concerns with regard to the administration of medication. During this key inspection, all requirements from the inspection carried out on the 18th November 2008 were judged to have been met. DS0000022925.V375105.R01.S.doc Version 5.2 Page 7 Medication systems have been reviewed, and further guidance and procedures put in place to ensure that medication is stored and administered safely at all times. Resident’s care plans have been reviewed, improved, and monitored closely by senior staff. There have been improvements to the environment, which has included; redecoration of resident’s bedrooms, new carpets and other flooring in some bedrooms and communal areas of the home, and a new nurses office/station. The roles and responsibilities of staff have been reviewed, and changes have been made to ensure that the knowledge and skills of staff are being used and developed to improve the service provided to people using the service. Staff spoke positively of these changes. Several trained nurses have been recruited. The key worker and named nurse system has been better developed, to ensure that there is better support and interaction given by staff to people using the service. Staff are better supervised by senior staff, so that they are well supported to carry out their role and responsibilities in supporting and caring for people using the service. The format of some documentation has been developed, to improve the accessibility of information to people using the service, who might have difficulty in reading. What they could do better: If you want to know what action the person responsible for this care home is DS0000022925.V375105.R01.S.doc Version 5.2 Page 8 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. DS0000022925.V375105.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000022925.V375105.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 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): Standards 1, and 3 (6 is not applicable) 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. People who may use the service and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. EVIDENCE: The care home has documentation and information about the service provided by the care home. We were told that people using the service are given an ‘information pack’ with these details. The statement of purpose, and service user guide were looked at. These were comprehensive, up to date, and gave people the information that they need to make an informed choice about whether the care home would meet their DS0000022925.V375105.R01.S.doc Version 5.2 Page 11 needs. This documentation included a summary of the complaints procedure, and the terms and conditions of residence. The format of the ‘service user’ guide documentation should be further developed to improve its accessibility to people using the service, particularly for the residents that have difficulty reading or whose understanding of English is limited. We were informed by the AQAA (Annual Quality Assurance Assessment) that ‘the home manager or the registered nurses undertake a full comprehensive needs assessment with prospective residents, prior to their admission to the home, to determine ‘whether or not the home can meet their healthcare and social needs’. We were told that people using the service are fully involved (as far as they are able to be) in this process of assessment of their needs. Care plans looked at by us included evidence of initial assessment being carried out by senior staff prior to a person moving into the care home. In the care plans looked at there were also some recorded assessment information/hospital discharge summaries about the needs of people using the service that had been completed by hospital and/or community healthcare staff. The manager and other staff reported that there was an ‘on-going’ assessment of the person’s needs, during their ‘settling in’ period, of living in the care home. A resident told us that she had been admitted to the home from hospital, but that her relative had visited the home before she moved in. DS0000022925.V375105.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 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): Standards 7,8,9,and 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. Each person using the service has a plan of care, in which residents’ health, personal, and social needs are set out. People using the service are respected and their right to privacy upheld. People using the service are protected by the home’s policies and procedures for managing and administrating medication. EVIDENCE: Each person using the service has a plan of care. Six care plans were inspected. It was evident that since the previous key inspection, the care plans had undergone considerable review to improve the content, accessibility, and organisation of the information about each resident. The care plans looked at, were based upon the assessed needs of each individual person. The AQAA told us that there is regular auditing by management staff of the resident’s care plans. DS0000022925.V375105.R01.S.doc Version 5.2 Page 13 The content of the care plans are developed from the initial assessment of the person’s needs, and are based a variety of needs including health, medication, nutritional needs, continence and mobility needs. Other information in the care plans included details of people’s leisure needs, night care and emotional/psychological needs. There was some information in the care plans inspected that was not dated nor signed. AQAA told us that there are robust policies in place with regard to the equality and diversity (race, gender identity, disability, sexual orientation, age, religion, and belief) needs of people using the service. We were also told that the home carries out staff training to ensure that all staff understand the ‘diversity of cultures, and religious requirements (of people using the service) and how to meet individual resident’s needs’. Care plans indicated that cultural and religious needs were generally assessed. There could be a broader assessment in the care plans of people’s equality and diversity needs, which should include more information with regard to the six strands of diversity needs, to ensure that it is evident that these are being met by the home. Care plans included information about the level of assistance (with regard to resident’s personal care needs) to be given by care staff. Staff spoke of their role in supporting residents with their personal care, which included ensuring that resident’s dignity and privacy were respected. During the inspection, staff provided assistance, and support to residents in a sensitive and respectful manner. It was evident from observation, and from talking, with staff that they have an understanding of the importance of upholding resident’s right to privacy. A resident spoke of making choices, People were observed to be dressed appropriate to their culture and age. We spoke to people using the service who told us that they are treated with respect Care plans include risk assessments, such as risk of falls, moving and handling assessment, use of bed rails and risk of pressure sores. We were told that there is close monitoring of any pressures sores. AQAA told us that the home ‘excels in pressure sore prevention’ as there is staff guidance to ensure that each resident’s pressure area needs were recorded in their care plans. We were told that care plans and risk assessments were reviewed at least monthly, and ‘more frequently if the resident’s needs change’. A visitor told us that his/her friend/relative had their personal care needs fully met by the care home. This included their relative having their ‘hair done’ and ‘finger nails cut’. We were also told that the visitor’s relative was ‘settling’ into the home ‘very well’. AQAA told us that that the service is planning to involve relatives and friends (with resident’s agreement) in the ‘care planning process of service users’. We were also told of how within the staff team, the key worker role had been developed since the previous inspection. We were informed that ‘immediately service users are admitted we link them with key workers’. A staff member DS0000022925.V375105.R01.S.doc Version 5.2 Page 14 told us about the more active role that key workers, and the named nurse for each resident have, which includes supporting residents to settle into the home. A list of names of key workers, named nurses, and the residents that they support was available. A staff member spoke of her key working role in supporting and caring for several residents. Records, staff, residents, and feedback surveys told us that people using the service have access to care, and treatment from a variety of health professionals, and specialists. These include GP, optician (the optician and a GP visited the home during the inspection), physiotherapist, and chiropodist. We were told from the manager that people using the service receive dental treatment when they needed too. She told us that she had been looking into trying to obtain regular dental check ups for all the residents but had had difficulty accessing this service. The manager should continue to look into obtaining a dental regular ‘check up’ service for residents and should seek advice from the Local Primary Care Team. A resident told us that he/she had ‘seen the doctor’. We were told by staff that the home has very close liaison with the GP service, and that they review the medical needs of the residents on a regular basis, and make referrals to specialists as and when required by people using the service. This was evident on the day of the inspection when concerns about a resident’s health care were raised with e GP who came out quickly to see the resident. The GP also took time to speak with the relatives to discuss the resident’s health needs and action taken. The home has a medication policy/procedure. Medication is stored securely. The registered nurses on duty administer the medication to people using the service. The home has had had (prior and following the previous key inspection in November 2008) some significant issues/concerns with regard to the administration of medication in the care home. This led to medication requirements and enforcement activity from us taking place, and a number of inspections by a pharmacist from the Commission were carried out. Medication inspection requirements were judged to have been complied with during a random inspection carried out by a pharmacist inspector in February 2009. During this inspection there were no issues of concern. We were told by the manager and senior staff that all the medication systems in the care home have been fully reviewed, and that further guidance and procedures had been put in place to ensure that medication is stored and administered safely to people using the service, at all times. AQAA told us that new competency assessments have been introduced for all new and existing staff that handle medication. We observed the staff nurse administering medication to residents at lunchtime. This was carried out correctly with all medication signed for at the time of administration. Staff and records informed us that regular audits of the medication administration and storage systems are carried out to monitor the medication storage systems and the quality and safety of the medication administration DS0000022925.V375105.R01.S.doc Version 5.2 Page 15 procedures. We were shown a new medication storage area that had recently been put in place. DS0000022925.V375105.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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): Standards 12,13,14, and 15 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. People have the opportunity to take part in a variety of preferred activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that people using the service have the opportunity to develop and maintain important relationships. Meals provided are varied, and wholesome, and meet the cultural and faith needs of people using the service. EVIDENCE: The home employs an activity coordinator, who works part time during weekdays. Information about activities is displayed on a daily basis. During the inspection residents were observed to take part in a number of leisure pursuits. A resident spoke about enjoying the activity that she had taken part in. Records informed us that people using the service participate in arts and crafts, ball games, reminiscence sessions, word games, including quizzes and other memory games, bingo, and current affairs. Staff told us how the religious/spiritual needs of people using the service are identified, and met by DS0000022925.V375105.R01.S.doc Version 5.2 Page 17 the care home. A visitor and observation told us that care staff also carry out one to one activities with the residents. The manager told us about plans to make use of the ‘second’ sitting room as a venue for evening activities. The home has a piano. During the inspection, a resident spent some time with a staff member playing the piano. Staff told us that residents have the opportunity to choose to spend time in the garden during warm weather. We noted that garden seating was accessible to people using the service. We were told by the manager that community facilities are being accessed by people using the service much more frequently. This access includes going to local shops, and residents having the opportunity to have their hair done at a local hairdresser. We were also informed that all the residents have registered with ‘dial a ride’, and several people using the service had been out for ‘drives’ in the local community. AQAA told us the activities programme is regularly reviewed, ‘following consultation with our service users’. The visitor’s record book indicated that a significant number (sometimes 20 or more each day) of people regularly visited the home. Residents spoke of the visitors that they had had. A resident spoke of a family member regularly visiting her. We spoke to visitors during this inspection. They told us that they are happy about how their relative is looked after, and that the home keeps them informed of the progress of their friend/relative. Visitors told us of being happy with the service provided to their family members/friends by the care home. A visitor spoke of the pleasant atmosphere at Craven Park Nursing Home. The home has a menu. This is exhibited in small print on the wall of the dining/sitting room. There were some large brightly coloured pictures of food and meals also on display in the dining/sitting room, but these pictures did not correspond to all the courses of the meals served during the inspection. We spoke with the manager about ways of improving the accessibility of information, including the menu to people using the service. The manager spoke of the home having recently having purchased a digital camera, and that she would look in to building up a portfolio of photographs of meals from the menu, so be able to make this information more accessible to residents, on a daily basis. The format of the menu information should be as accessible as possible to people using the service, so that those who have difficulty in reading, or in retaining information, should be able know what the meals provided in the home are. This was a previous recommendation. AQAA told us that people using the service ‘are given a choice in relation to meals and mealtimes’. A resident confirmed that she had a choice of meals. During the inspection we saw staff offering residents a choice of what they wanted to eat, and they were seen to respond promptly, when people using the service asked for anything, such as another drink. Staff including the cook spoke of the particular food preferences and dietary needs of people using the service, and of how these are met by the home. Some residents were assisted DS0000022925.V375105.R01.S.doc Version 5.2 Page 18 with meals. This was carried out sensitively and in an unhurried manner by staff, who sat beside the resident during the meal. Residents told us that they had enjoyed their lunch. Drinks were regularly provided to residents during their meals and throughout the inspection. DS0000022925.V375105.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 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. People using the service and others are confident that their complaints will be listened to, looked into and action be taken to put things right. There could be development in the recording of “comments/concerns” from people using the service. Residents are protected from abuse, neglect and self-harm by the home’s safeguarding policies. EVIDENCE: AQAA and previous inspection told us that the care home has an appropriate complaints procedure. A summary of this is included in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. The home should look at ways of improving and developing the format of the complaints procedure to improve its accessibility to people using the service who have difficulty in reading. AQAA told us that there have been three complaints within the last twelve months, and that ‘all complaints received are taken seriously and expedited in a sympathetic manner’. We were told that ‘all relatives/friends/advocates are made aware of the complaints procedure’, and that complaints ‘are welcomed’. The manager spoke of ensuring that complaints are resolved promptly, and DS0000022925.V375105.R01.S.doc Version 5.2 Page 20 she told us that she monitors all complaints closely. A record is kept of all complaints made about the home which was shown to the inspectors. The manager/owner spoke of the ways that she and the staff team respond to ‘concerns’/complaints from people using the service, and others. She confirmed that she was continuing to improve the systems and practices of recording any ‘concerns’ communicated to them by people using the service. A resident spoke of talking to staff and his/her relative if she/he was unhappy about something. We saw a number of ‘thank you’ cards from relatives, and others, which indicated they were happy with the care provided by the home, of their friend or family member. The home has a safeguarding adult’s policy, and a whistle blowing policy, and also has the lead local authority safeguarding procedure. AQAA told us that the ‘home takes the protection of service users very seriously’. Records confirmed that they had received training in abuse awareness. The manager told us that she had awareness and understanding of the Mental Capacity Act 2005 (this Act governs decision-making on behalf of adults who may not be able to make their own decisions). It is recommended that all staff receive training with regard to the Mental Capacity Act/Deprivation of Liberty Safeguards to ensure that they know about their role with regard to the Act, and what it means to people using the service. DS0000022925.V375105.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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): Standards 19, 24 and 26 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. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. There remain are some areas of the home that could be redecorated. Resident’s bedrooms are individually personalised and meet their individual needs. EVIDENCE: The care home is located a few minutes walk from Harlesden, where there are a variety of amenities including shops, restaurants, banks, and cafes. The home is situated close to public bus and rail services. The front of the property is generally tidy and attractive, with a number of potted flowers located near the entrance. There is parking for a number of cars on the forecourt of the home. There is an attractive enclosed garden at DS0000022925.V375105.R01.S.doc Version 5.2 Page 22 the rear of the property, which is accessible to people using the service. We were told by staff that people using the service, that they make use of the garden facility during nice weather. The home is better maintained, that at the time of the previous inspection in November 2008. Several areas of the care home have been redecorated (these include some bedrooms, stairwells and other communal areas), and new carpet has been laid in a number of bedrooms, and corridors. We saw that there had been new kitchen flooring fitted, and new storage cupboards for linen, cleaning chemicals, and medication. We were informed that the kitchen ‘hot plate’ was not working. This should be repaired. We were told by the manager that the front door, porch door, and ‘second’ sitting room fire door (leading out into the garden) have been replaced. We were informed that these new doors had improved access for people who use wheelchairs, and for other residents, and visitors. Staff via an intercom could ascertain who was at the front door and they could open it without having to leave the area of the home that they were working in. We were told that there was a new keypad system in place that enabled staff to enter the home without having to ring the front door bell. There was maintenance work going on in the home during the inspection. We were told that there remained significant redecoration and maintenance work to be carried out, and further improvements to be made to make the care home more homely. We were told that a bathroom was to be completed refurbished. Some redecoration had taken place in other bathrooms. The manager spoke of other areas of the home that she had plans to improve to develop the attractiveness of the environment for people using the service and visitors. Further improvements could continue to be made to several areas of the home (including some bathrooms, and other rooms, such as the ‘second’ sitting room). We were informed that the home plans to make a bathroom that is not use at present into a walk in shower room, which will give more choice a bathing facilities for the residents. More pictures and/or other furnishings could be displayed, to improve the homeliness of the environment. We looked at a record of the action plan for refurbishment of the home. Though a significant number of maintenance and refurbishment issues had been completed there were a number of areas that were still not fully completed. AQAA told us that the home will carry out an ‘annual environmental audit ‘and ‘will formulate a plan of action to address identified issues’. This is positive. A resident spoke positively of his/her bedroom. Comments from people using the service included ‘I’m happy with my room’. The manager told us that she replaced the television in several bedrooms. The AQAA told us that people using the service are encouraged ‘to personalise their rooms by bringing in their memorabilia’ when they move into the care home. The call bell system has been improved, so that staff on any floor of the home can ascertain who is ringing their call bell. This is positive. DS0000022925.V375105.R01.S.doc Version 5.2 Page 23 Laundry facilities are located away from food storage, and food preparation areas. The person responsible for the care and laundering of resident’s clothes spoke positively about the laundry systems that are in place in the home. Previous inspections have told us that it was evident that there is a quality laundry service provided to people using the service. Hand washing facilities are located throughout the home. Alcohol gel dispensers for hand cleaning are accessible. There were paper hand towels and soap in bathrooms inspected. Staff were observed to wear protective clothing including disposable gloves, as and when needed. Records confirmed that staff had received infection control training. AQAA told us that the home’s water system ‘is Legionella tested, cleaned and chlorinated every year’. DS0000022925.V375105.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are 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): Standards 27, 28,29 and 30 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. Staff in the home are trained, skilled and competent to support people who use the service, and to ensure the smooth running of the service. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. It told us that there were generally one registered nurse (plus the registered manager 9-5pm week days) and five care workers including healthcare assistants on duty during the day, and one registered nurse and two care workers on duty at night. We were told that the number of staff on duty in the care home meets the dependency levels of the people using the service, and that this was kept under review. The manager spoke of having the flexibility to increase (or decrease) staffing levels in accordance to the needs and changing needs of people using the service. A care staff member confirmed that senior staff listened to care staff, when they reported changing needs of people using the service. Staff spoke positively of working in a team, and of enjoying their jobs. A staff member told us of the recent staff changes, which have led to several staff developing their role and responsibilities, by becoming health care DS0000022925.V375105.R01.S.doc Version 5.2 Page 25 assistants. We were told that these changes had improved communication systems between care staff and senior staff which has had a positive effect particularly with regard to meeting the varied needs of people using the service. During the inspection staff were observed to work well together. We observed staff taking part in a staff ‘handover’ session, in which staff (including the night staff) discussed each resident and planned the various duties of the shift. Staff were observed to be very approachable, and interacted with residents in a sensitive manner during the inspection. They spent a lot of time talking with them, sitting with them, taking part in activities with them, and assisting them promptly with their personal care needs. Visitors commented that staff were approachable, friendly and helpful. Staff were generally positive about their jobs, and told us that the home provides good induction training, and other appropriate training to ensure that staff have the essential skills for carrying out their roles and responsibilities. We were told by the manager that included in the staff induction programme there were several days’ observation/shadowing by new staff of other staff. A recently employed Registered Nurse told us that she had spent three days and two nights on shift with staff, as part of her induction programme. She told us that the induction programme was very thorough, and gave her the skills and knowledge that she needed to carry out her duties in providing a quality service to residents. Records told us that staff training included, medication training, fire awareness, First Aid, manual handling, health and safety, fire safety, food and hygiene training, dementia awareness and challenging behaviour awareness, infection control, safeguarding adults, and pressure area care. AQAA told us that the care home has included ‘care of the dying’ training for all care workers. There was a record of planned training for staff, and individual training records for each staff member. Certificates of staff training were accessible. A newly recruited staff member spoke of having received food and hygiene training and health and safety training, and told us that further training was planned. Staff confirmed that they have the opportunity to achieve National Vocational Qualifications (NVQ) level 2 care and level 3 in care and health. AQAA information told us that 8 out of 20 care staff have achieved NVQ level 2, and 2 care staff had achieved a NVQ level 3 health and care qualification. We were told by the manager that there were plans for the rest of the care workers to have the opportunity to achieve this qualification. A staff member confirmed that she had achieved an NVQ level 2 and 3 in care qualification The care home has a recruitment and selection procedure. AQAA told us that ‘all potential staff are subject to a detailed recruitment process’. Four staff personnel files were inspected. These contained confirmation that staff have DS0000022925.V375105.R01.S.doc Version 5.2 Page 26 received an enhanced Criminal Record Bureau check to gain information as to whether potential staff have a criminal record. The administrator told us that all staff receive a staff code of conduct, job description, and staff handbook when they are employed by the home. The files were noted to be well organised with all information easy to access. DS0000022925.V375105.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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): Standards 31,33,35, 36 and 38 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. The management and administration of the home is based on openness and respect, and has effective quality assurance systems to monitor and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted and protected, and their financial interests are safeguarded. EVIDENCE: The manager has managed the care home for several months, and had managed another care home prior to managing Craven Park Nursing Home. DS0000022925.V375105.R01.S.doc Version 5.2 Page 28 She is a trained nurse and has a significant number of years working with older people, and is in the process of registering with us. We were informed by the manager that there had been a deputy manager recruited since the previous key inspection, but that they had left employment. The manager told us that in the near future a deputy manager would be recruited. This is positive. It is evident that since the previous key inspection the manager has worked hard to improve the service provided to residents. She has put systems in place to improve several areas of the service including improving the décor, the medication administration and storage systems, care plans, and staffing. The manager told us that she is aware that there are still areas of the home that could continue to be improved and developed, and has plans to carry this out. She spoke of being very much ‘hands on’ in her role and told us that she has spent time gaining knowledge of every staff member’s role. She told us that she speaks to all the residents during the start of each shift. A staff member told us that the manager is ‘very approachable’, and that the staff member felt that she/he could discuss any issues concerning the care of residents with her at any time. Another staff member told us that the manager was ‘wonderful’. Staff spoke of the staff team working well together. We were told from the AQAA and records that the care home has a number of systems in place to ensure that the quality of the service is monitored closely and that action is taken to continue to develop and improve the service provided to people using the service. We looked at a record of a recent visit to the home by a representative of the organisation. This was comprehensive and indicated that the quality of the service was being closely monitored by the owner. We were told that ‘relative’ evaluation forms are supplied twice a year to relatives and/or significant others and that action is taken in response to this feedback. AQAA told us that people using the service have the opportunity to participate in resident meetings, and that there were plans to further develop these. Staff meetings also take place. AQAA told us that there were policies in place regarding the management of resident’s monies, and that residents were supported to manage their own money if they wished to do so. We were told that records of all financial transactions with regard to resident’s monies continue to be maintained. The administrator told us that the monies of people using the service were being managed in the way that they were at the time of the previous key inspection. Some residents have their finances managed by relatives/significant others. There were no concerns with the management of resident’s finances at that time. The home has a staff supervision policy. Staff confirmed that they receive regular staff one to one staff supervision, which ensures that they are supported in carrying out their role and responsibilities for meeting the care DS0000022925.V375105.R01.S.doc Version 5.2 Page 29 and support needs of people using the service. A record of recent staff one to one supervisions were seen. It was evident that the manager had worked hard to ensure that each staff member is supported in his or her role by receiving staff supervision. AQAA told us that all staff also have regular appraisals. The home has health and safety policies and procedures, to ensure staff and residents are protected and safe. AQAA told us that they had all been recently reviewed. The home has a recorded emergency plan, which was displayed. This includes information about what to do if there is a gas, electric or infection emergency. Required fire safety checks and fire drills are carried out, and there is a fire risk assessment. This could be further developed to include fire risk assessment of each room in the home. AQAA told us that equipment within the home had been serviced or tested as recommended by the manufacturer or other regulatory body. The manager told us that wheelchairs are serviced, and that they are regularly visually checked. The home lets us know about things that have happened; they have shown us that they have managed significant issues appropriately. The home has an accident policy/procedure. Incidents and accidents are recorded as required. We were told that there was an Environmental Health Inspection of food safety carried out in April 2009 and that there had been no significant concerns from this inspection. We were told that one issue (with regard to ensuing that there is recording of the testing of a food temperature probe) had been resolved. The home has an up to date employer’s liability insurance certificate displayed in the care home. DS0000022925.V375105.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 DS0000022925.V375105.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO 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 OP1 Good Practice Recommendations The format of the ‘service user’ guide documentation should be further developed to improve its accessibility to people using the service, particularly for the residents that have difficulty reading or whose understanding of English is limited. Information recorded in the resident’s care plans should be always dated and signed by the person making the record. There could be a broader assessment in the care plans of people’s equality and diversity needs, to ensure that it is evident that these needs are being met by the home. The manager should continue to look into obtaining a regular dental ‘check up’ service for residents and should seek advice from the Local Authority Primary Care Team. The format of the menu information should be as accessible as possible to people using the service, so that those who have difficulty in reading, or in retaining DS0000022925.V375105.R01.S.doc Version 5.2 Page 32 2 OP7 3 4 OP8 OP15 5 OP16 information, should be able know what the meals provided in the home are. The home should look at ways of improving and developing the format of the complaints procedure to improve its accessibility to people using the service who have difficulty in reading. There could be development in the recording of ‘comments/concerns’ from people using the service, so that it is evident that people using the service are always listened to. It is recommended that all staff receive training with regard to the Mental Capacity Act 2005/Deprivation of Liberty Safeguards to ensure that they know about their role with regard to the Act, and what it means to people using the service. Further improvements could continue to be made to several areas of the home (including some bathrooms, and other rooms, such as the ‘second’ sitting room) to improve the attractiveness of the environment for people using the service and visitors. The kitchen ‘hot plate’ should be repaired. Staff who have yet to achieve a National Vocational Qualification (NVQ) level 2 in health and care, should have the opportunity to obtain this qualification. The fire risk assessment could be further developed to include fire risk assessment of each room in the home. 6 OP18 7 OP19 8 9 OP30 OP38 DS0000022925.V375105.R01.S.doc Version 5.2 Page 33 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. 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. 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