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Inspection on 18/12/08 for Greenways

Also see our care home review for Greenways for more information

This is the latest available inspection report for this service, carried out on 18th December 2008.

CSCI found this care home to be providing an Good 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has developed a clear service user`s guide to provide residents, prospective residents and other interested parties with clear and accessible information about the home. The home receives very good support from the local learning disability team and the local mental health team in Harrow. The home is suitable for the needs of the current residents and provides a homely and comfortable environment in which to live in. Staff receive training to enable them to understand the needs of the residents and to provide a good level of support. Recruitment procedures are sufficiently robust to protect the residents.

What has improved since the last inspection?

There were twenty outstanding requirements from the home`s previous key inspection and subsequent pharmacy inspection. The home has worked hard to meet some of these requirements. Improvements were noted in the home`s management of medication, and medication was found to be administered as prescribed and accurate records maintained. The medication policy has been updated to outline procedures for managing medication when residents go out of the home. The controlled drugs are securely stored and regular medication audits are undertaken. Residents` care plan documentation has improved, with details of residents` cultural and faith needs being assessed prior to their admission and plans being kept under review. Photographs are kept on file for each resident in order to assist with their identification. The extent and range of activities available to residents have been extended. The home has obtained a copy of the London Borough of Harrow`s Safeguarding Adults policy and reporting procedures document and staff have received recent training in this area.

What the care home could do better:

The home`s statement of purpose must be made available on request for inspection by the Commission and by every resident and any representative of a resident so that all parties are clear on the aims and objectives of the home. The home should ensure they have all information about prospective residents before making the decision to admit the new resident. The personal profile summaries should be expanded to give a summary of the individuals` daily living routines etc to assist in focusing on key aspects of their care needs before going onto the care plans. Consideration should be given to condense the care plans into to fewer areas such as personal care, medication, health care, activities social and cultural needs.A training matrix should be in place to ensure that a clear record of when refresher training is needed is maintained. To ensure the safety of residents, COSHH assessments must be on file for all products used. The CSCI must be provided with a copy of the home`s Food Safety Act registration certificate. Action must be taken to make sure that reports from the visits undertaken on behalf of the registered person is forwarded to the home promptly, so that any required action identified during these visits can be taken without delay. The room temperature of the clinical rooms must be monitored so that they are kept below 25 degrees and thereby maintaining potency of the medicines.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Greenways Greenways 633 Uxbridge Road Pinner Middlesex HA5 3PT     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ffion Simmons     Date: 1 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Greenways 633 Uxbridge Road Greenways Pinner Middlesex HA5 3PT 08706092432 08706092435 john@minstercaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Maria Baughurst Type of registration: Number of places registered: Minster Pathways Limited care home 14 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The Registered Person may provide the following categories 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: Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD The maximum number of service users who can be accommodated is: 14 Date of last inspection Brief description of the care home Greenways is a new purpose-built three storey detached care home for 14 residents. The home is operated as two separately staffed units for 7 residents each. The unit on the ground floor is registered for people who?s primary care needs come under the heading of learning disability. The unit on the first floor is registered for people who?s primary care needs come under the heading of mental health. The bedrooms, offices Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 0 7 7 Brief description of the care home and meeting rooms on the second floor are used only by staff members. All the residents bedrooms are single, with en-suite shower and toilet facilities. The home has been built to be fully accessible to wheelchair users, and there is a lift to the first floor. The bathrooms have electric ceiling mounted hoists. Each unit has its own kitchen, communal lounge and quite rooms, and a small office. Substantial car parking space exists at the front of the premises, and a large secure garden is at the rear. The home is on a main road that is a bus route to the shops and other facilities in nearby Pinner town centre. Fees range from £1,300 to £2,016 per week. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The unannounced key inspection was undertaken by two inspectors on the 18th December 2008 and lasted a total of 7 hours. During the inspection, we spoke with residents, staff and the Registered Manager and observed care practices. We tracked the care of four residents and in doing so we checked their personal records. We also checked a range of other documentation including staff files, training records, health and safety documentation, medication records and quality asssurance documentation. Questionnaires were sent to the home for residents and staff to complete. We have used the informatioin within these questionnaires as part of the report. Care Homes for Adults (18-65 years) Page 6 of 30 The Registered Manager completed and returned the Annual Quality Assurance Assessment (AQAA) of the home, which has also been used as evidence to inform this report. What the care home does well: What has improved since the last inspection? What they could do better: The homes statement of purpose must be made available on request for inspection by the Commission and by every resident and any representative of a resident so that all parties are clear on the aims and objectives of the home. The home should ensure they have all information about prospective residents before making the decision to admit the new resident. The personal profile summaries should be expanded to give a summary of the individuals daily living routines etc to assist in focusing on key aspects of their care needs before going onto the care plans. Consideration should be given to condense the care plans into to fewer areas such as personal care, medication, health care, activities social and cultural needs. Care Homes for Adults (18-65 years) Page 8 of 30 A training matrix should be in place to ensure that a clear record of when refresher training is needed is maintained. To ensure the safety of residents, COSHH assessments must be on file for all products used. The CSCI must be provided with a copy of the homes Food Safety Act registration certificate. Action must be taken to make sure that reports from the visits undertaken on behalf of the registered person is forwarded to the home promptly, so that any required action identified during these visits can be taken without delay. The room temperature of the clinical rooms must be monitored so that they are kept below 25 degrees and thereby maintaining potency of the medicines. 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 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has developed a clear service users guide to provide residents, prospective residents and other interested parties with clear and accessible information about the home. The homes statement of purpose needs to be accessible. Pre-admission assessments are carried out to ensure good information is available on the needs of the residents, but information from the placing authority should be in place before a decision is made to admit residents. Evidence: The homes service users guide was seen during the inspection. The guide is clear and makes good use of pictures, making the documentation accessible to its residents. The guide reflects the current management arrangements at the home. The homes statement of purpose however could not be located at the time of the inspection. This must be made available for inspection and for other interested parties. Four care files were inspected to assess the way in which the home gathers preadmission information and writes the care plans based on this information in order to Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: meet individuals needs. These were found to contain comprehensive information on all aspects of each persons needs, including cultural and faith needs. There were comprehensive care plans in place for three of the four resident case tracked, which were detailed and covered all aspects of the persons daily living routines as well as their social activities and cultural needs. The fourth person had the key aspects of their care needs written in the care plan and staff were in the process of completing this. All care files contained risk assessments. There was also information on the health care needs included in the care plan with details of all healthcare contacts and appointments. Individuals likes and dislikes and preferred activities are also recorded There was also detailed information from the placing authority in three of the files sampled and reviews had been carried out by the placing authorities since the admission. The other person had recently been admitted and although the home had visited the person and carried out a detailed assessment to ensure they could meet their needs, they hadnt as yet received any written information from the placing authority. We were informed that this person has settled well and has regular family contact. However the home has still not received any more information from the placing authority. The manager informed us that the acting manager had organised this placement in her absence and that she was contacting the local authority concerned to get the information. It is strongly recommended that the home should ensure they have all information about prospective residents before making the decision to admit the new resident. The home has recently introduced a new preassessment form to improve on the way they gather information. This form is pictorial and is planned to be used with prospective residents. Prospective residents and their families are encouraged to visit and have have overnight stays prior to admission. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents needs and personal goals are outlined within their care plans. Individuals are supported to make their own decisions and choices. Risk assessments are in place to enable residents to take responsible risks. Evidence: Care plans for four residents were assessed. One person had been in the home for some time and had a very detailed support plan which covered every aspect of his daily life and activities. Another person had been in the home for a about 6 weeks but staff had used the information from the pre-assessment and had written care plans for key areas of the persons daily living needs such as personal care, medication and activities. Risk assessments were in place for all areas of need for all four residents i.e. communication, medication, kitchen access and community activities. The care plans were very detailed and in one case numbered 29 individual plans. We discussed with Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: the manager the potential unwieldiness of this amount of documentation and that possibly the care plans could be condensed to fewer areas such as personal care, medication,health care, activities social and cultural needs. The home also has good personal profile summaries on the case file. It is recommended that these could be expanded to give a summary of the individuals daily living routines etc to assist in focusing on key aspects of their care needs before going onto the care plans.The manager said she would look at these suggestions. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to take part in meaningful activities, which meet their individual needs, interests and preferences. They are supported to be part of the local community and to maintain links with friends and family. Evidence: Files sampled included comprehensive information about residents social, cultural and daily activity preferences. All had weekly activity planners. None of the residents case tracked go to a day centre so staff are available to ensure they are supported to participate in community and in house activities of their choice. Some of these were playing cards, dominoes, scrabble, watching films, listening to gospel music and talking to staff. All these activities involve them being with staff or other people which indicates that they have a lot of contact to help stimulate them everyday. We were informed that one person goes out to work with support and another is a volunteer. Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: One person does attend a day centre and the staff are in the process of looking for a day centre placement for another person. Generally residents are very much involved in participating in the local community activities such as swimming at the local sports centre. At the time of the inspection some residents were out doing their Christmas shopping. Most of he residents have good family contact and the manager said that she hoped that they would all be able to see their families over the Christmas period. We were also informed that all the residents had had a summer holiday this year, not as a group but as individuals with staff to places of their choice. Mealtimes were found to be flexible to fit around the activities of the day. There is a cooking, washing up and drying up time table in place for residents to share the kitchen duties and and promote independent living skills. The Registered Manager confirmed within the AQAA that menus are devised with service users and offer a healthy balanced diet with a variety of choices. This takes into consideration special dietary requirements and cultural requirements regarding food for service users. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive good support from the multi-disciplinary team. Residents are protected by the homes medication policies and practises. Evidence: Residents personal support and healthcare needs are well documented within their healthcare files and support plans. The Registered Manager explained that residents mainly benefit from some prompting in this area. We were informed that the home receives very good support from the local learning disability team and the local mental health team in Harrow. There is a consultant psychologist and psychiatrist involved as well. There is also an intensive support practitioner involved from the learning disability team. The home has a dedicated GP surgery and GP. Residents do go to the surgery but the GP will also visit. During the afternoon of the inspection, one of the residents was being supported by staff to visit the GP surgery. Medication reviews are held regularly. The chiropodist and optician visit the home and the residents attend a local dental practice. The homes management of medication was assessed on both units during the Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: inspection. The home uses the Boots Monitored Dosage system, which means that medication mainly arrives into the home in blister packs. Medication is stored within secure metal cabinets within air conditioned rooms. There was one controlled drug in use in the home at the time of the inspection. The controlled drug was securely stored and the balance was found to be correct. Staff are not recording the temperatures of the medication storage rooms and so it remains a requirement that staff record the temperatures of the rooms to ensure that the medication is stored at the correct temperatures. Medication administration records (MAR) for all residents who are on medication were checked. These records were well completed with no gaps seen in the recording. Allergies if known were written on the MAR charts, and a picture of each resident appeared with their MAR chart to ensure safe identification. There is a list of signatures of those staff responsible for administering medication kept with the MAR charts. Since the last inspection and as per the requirements of the pharmacist report, the medication policy has been updated with guidance available within it regarding taking medication out of the home when residents go on day leave/social leave. At the time of the inspection, there were no residents self-medicating. Risk assessments and forms are in place should residents choose to/are assessed as able to self-medicate in the future. The Registered Manager confirmed within the AQAA that staff receive annual training regarding medication. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints policy in place which is accessible to residents living at the home. Staff demonstrated an understanding of how to identify abuse and there are policies and procedures in place for responding to allegations and suspicions of abuse. Evidence: The Registered Manager confirmed both within the AQAA and in person during the inspection, that the home has not received any complaints within the last twelve months. The home has a complaints policy in place which is given to each resident when they move in. We viewed the service users guide during the inspection and found that a copy of the complaints policy and information about advocacy services was available in pictorial format within the guide. The Registered Manager also confirmed within the AQAA that the complaints policy is made available to all people who visit the home or who have contact with the home in what ever capacity. A copy of the complaints policy was also seen at the main entrance of the home, and we noted that this policy referred to the Commission. Staff spoken with during the inspection and who took time to complete a survey confirmed that they know what to do if a resident/relative or advocate has concerns about the home. No complaints were raised with the inspectors during the inspection. Policies and procedures are also in place for safeguarding vulnerable adults from abuse. Since the last inspection, the home has obtained a copy of the local multiCare Homes for Adults (18-65 years) Page 19 of 30 Evidence: agency policy and procedures for safeguarding vulnerable adults from abuse. The Manager and staff confirmed when we spoke with them that they had recently received refresher training on safeguarding adults from abuse. Staff were able to tell us how to identify abuse and were clear about their responsibilities for reporting any concerns in this area. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is suitable for the needs of the current residents and provides a homely and comfortable environment in which to live in. Evidence: The home is a purpose-built, three story detached care home, which is fully accessible to people with a physical disability as there is a lift to access the first floor. The home is situated close to bus routes which lead to Pinner town centre. Residents have a single bedroom with en-suite shower and toilet. The Registered Manager confirmed that each resident had been consulted with regarding the furniture they wished to have in their rooms. We were also told within the AQAA that furniture and fittings provided to service users are detailed in the care plans and are fully adapted and modified to meet the individual needs of the service users. There are two units within the home, which are operated separately. Each has its own kitchen and communal lounge. Residents benefit from access to a large secure garden to the back of the home. During our tour of the building, we found the home to be clean, tidy and comfortable. The Registered Manager told us within the AQAA that a new maintenance department has been set up for the home in Pinner has benefited Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: from having daily access to qualified maintenance support to deal with environmental issues that occur during the course of each week. One of the residents spoken with during the inspection commented that they were more than happy with the room and that the home is very clean and very tidy and I feel at home here. Another resident commented the house is clean and fresh and everyone help to clean and maintain. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are sufficient staff on duty to meet the needs of current residents living at the home. Staff receive training to enable them to understand the needs of the residents and to provide a good level of support. Recruitment procedures are sufficiently robust to protect the residents. Evidence: The staff rota was seen and we noted that staff work long days which the manager said was their preference. There is currently no deputy in place but there are three seniors who cover the shifts and are responsible in the managers absence. The manager was on the rota as well and also covered weekends. The units operate separately and there are separate staff teams for each unit. At the time of the inspection, the units were observed to be sufficiently staffed to meet the needs of the residents. Four staff files were inspected of both new and long standing staff. All the files were well organised and held all information relating to recruitment checks, training and supervision records. Training records were comprehensive. The Registered Manager told us within the AQAA that 31 of the staff team has an NVQ level 2 qualification and a further 56 of the staff team are working towards this qualification. Staff Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: commented that they had recently received training in health and safety, protection of vulnerable adults from abuse, key working, risk assessments and communication. We were told that residents had also been invited to take part in some of the training sessions offered. We recommend that a training matrix should be in place to ensure that a clear record of when refresher training is needed. Staff files sampled indicated that staff were supervised although not always on a regular basis. The manager has stated in the AQAA that this is an area for improvement to ensure staff have more regular 1 to 1 supervision. However the records were clear and there was a supervision agreement in place. Staff commented that they feel well supported and told us supervisions are being held regularly and any urgent concerns about my job, the way I work, my roles and responsibilities are being dealt with straight away by someone superior and I know I can meet with my Manager at any time to discuss any problems etc. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home currently has an experienced and qualified manager in post who has been registered previously with the Commission as the Registered Manager of the home. The home has appropriate quality assurance procedures in place, which involve residents but reports on behalf of the registered provider need to be forwarded to the home promptly. Some improvements are needed to ensure the health and safety of residents living in the home. Evidence: We were informed during the inspection that the Manager who was in-charge of the home at the last inspection left employment in November 2008. This Manager did not apply to the Commission for registration during their time as manager of the home. The home is now managed by a person who was previously registered with the Commission as the Registered Manager of the home. This arrangement will continue until a replacement is found. During the inspection, we requested that the home inform the Commission once a suitable replacement has been sourced and to ensure that this person lodges an application with the Commissions Registration Team to be Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: the Registered Manager of the home. Staff commented positively on the support they receive from the Registered Manager. Some of the comments received included The Manager is always on hand for staff and the Manager is very good, approachable and will help. She empowers staff to do things and gives them a chance to develop skills. The home has quality assurance policies and procedures in place which include residents meetings and quality assurance questionnaires. The Registered Manager told us within the AQAA that residents meetings are held monthly from which action plans are formulated to incorporate changes and developments to the service provided to meet the changing needs and wishes of the residents. We were also told that residents views are sought on a six monthly basis via questionnaires. We viewed a sample of these questionnaires and found them to make good use of pictures making them accessible for residents to comment on aspects of the running of the home. The Registered Manager confirmed that visits on behalf of the Registered Provider take place on a monthly basis. We checked the reports held at the home but found that there were no recent reports on file. It is a requirement that reports from the visits undertaken on behalf of the registered person is forwarded to the home promptly so that any identified action identified during these visits can be taken without delay. During the inspection we checked Health and Safety documentation and checked the AQAA and had a discussion with the Registered Manager. Records showed that regular fire alarm tests are undertaken including checks of fire extinguishers and emergency lighting. Monthly fire drills are also undertaken. A fire risk assessment was available for the building. Records also show that monthly health and safety checks of the building are undertaken. The Manager confirmed that there are identified individuals responsible for ensuring that health and safety checks are carried out. During the inspection, we noted that the home had met the requirement of the last inspection, which was to ensure that substances hazardous to health (COSHH) were securely locked away. We checked the substances against the assessments held in the home and found that there were no COSHH assessments available for some of the products in use in the home. To ensure the safety of residents, COSHH assessments must be on file for all products used. During the inspection, the Manager explained that they have had difficulty in obtaining a representative from Harrow council to visit to assess food safety standards in the home. It remains a requirement therefore that the home provide the Commission with a copy of the homes food safety act registration certificate. Care Homes for Adults (18-65 years) Page 26 of 30 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 42 23(5) The CSCI must be provided with a copy of the homes Food Safety Act registration certificate. 01/02/2008 Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 4 The homes statement of purpose must be made available on request for inspection by the Commission and by every resident and any representative of a resident. This is so that all parties are clear on the aims and objectives of the home. 01/03/2009 2 20 13 The room temperature of the clinical rooms must be kept below 25 degrees. To maintain potency of the medication. 01/02/2009 3 39 26 Action must be taken to make sure that reports from the visits undertaken on behalf of the registered person is forwarded to the home promptly. This is so that any required action identified during these visits can be taken without delay. 12/02/2009 Care Homes for Adults (18-65 years) Page 28 of 30 4 42 13 COSHH assessments must be on file for all products used. To ensure the safety of residents. 26/01/2009 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 2 The home should ensure they have all information about prospective residents before making the decision to admit the new resident. The personal profile summaries should be expanded to give a summary of the individuals daily living routines etc to assist in focusing on key aspects of their care needs before going onto the care plans. Consideration should be given to condense the care plans into to fewer areas such as personal care, medication, health care, activities social and cultural needs. A training matrix should be in place to ensure that a clear record of when refresher training is needed is maintained. 2 6 3 6 4 35 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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