Inspection on 30/07/09 for Hanom House

This is the latest available inspection report for this service, carried out on 30th July 2009.

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

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

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Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Key inspection report Care homes for adults (18-65 years) Name: Address: Hanom House 85 Broadwater Road London London N17 6EP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Margaret Flaws     Date: 3 0 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: Hanom House 85 Broadwater Road London London N17 6EP 02084939947 02088010620 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Wimborne House Limited Name of registered manager (if applicable) Rodney Ellington Type of registration: Number of places registered: care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary needs on admission to the home are within the categories: Mental disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home The home is in a residential area of Tottenham and is registered to provide care for four people with mental disorder. The Registered Provider is Wimbourne House Limited and the Responsible Individual is Mr. Kwame Adusei. The organisation runs a number of similar homes in the area. The home is an ordinary terraced house with four bedrooms, a kitchen dining area and a rear garden. The Statement of Purpose states that there are staff on duty twenty four hours a day. The home support residents who Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 4 4 Brief description of the care home may have a forensic mental health history. The fees are between 700 to 1300 pounds per week. Care Homes for Adults (18-65 years) Page 5 of 26 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: This key inspection took place over one day. During the inspection, we saw the care, general and staff records, spoke to the residents (all of whom were home), and staff. We also toured the building and grounds with the Registered Manager. The home also supplied us with an Annual Quality Assurance Assessment, which informed this inspection. Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 26 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 8 of 26 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. Current and prospective residents know that their needs will be assessed and that they will be given information about the what the home can offer. They can also be confident that staff will be trained to meet their needs. Evidence: No new residents have been admitted to the home since the last inspection. The four current residents have lived there at least the past two years. We saw all of their files, which were in good order. These included multidisciplinary assessments, discharge summaries and evidence of pre-admission meetings and plans. Assessments also coved the residents preferences, likes and dislikes. All residents had had reviews completed by their placing authorities since January 2009. The Registered Manager told us that information from these reviews was used to update the residents care plans and risk assessments. Along with information from the homes own reviews and Community Mental Health Reviews, this ensures that staff can meet residents identified and changing needs. All the current residents are in the home to support them with their mental health needs and history of drug Care Homes for Adults (18-65 years) Page 9 of 26 Evidence: abuse. Staff demonstrated a sound understanding of the residents needs. All staff have now received training in mental health issues and on drug awareness. This meets a previous requirement. The home provides information to prospective residents and referrers. Residents are offered visits to the home to help them decide if they would like to live there. The home has contracts in place for all residents. Care Homes for Adults (18-65 years) Page 10 of 26 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 are supported to make their own choices and have their needs assessed, reviewed and met. Evidence: We saw the files of all the residents and discussed these documents with the Registered Manager and staff. All residents had comprehensive care plans in place. These were clearly arranged and covered the main areas of each persons needs. They had been regularly and recently reviewed by the home, by mental health professionals and by social workers. Key working sessions with residents are progressing. Each session was clearly documented, with information in what was covered in each meeting. We spoke to staff, who had a good understanding of their keyworking role and showed us outcomes from these sessions. This information was confirmed by the residents. Each person has a risk assessment, which had been regularly updated to reflect any Care Homes for Adults (18-65 years) Page 11 of 26 Evidence: new risks to their wellbeing. These assessments demonstrated how the risks were managed without making life too constrained for the resident. They gave good guidance to staff, with details of behavioural early warning signs and ways to support the residents. In one case, where a resident had been smoking in his room and a small fire had started, the risk assessments were updated and discussed with residents and staff. Staff also had updated fire training. Throughout the inspection, we were able to observe positive and straighforward day to day interactions between the staff and the residents. The residents appeared comfortable and confident with the staff and able to express their wishes and needs. Staff were observed to be sensitive and responsive. Residents told us that they meet regularly formally and informally to discuss any issues they wish. We saw the minutes for the formal meetings and a resident said that this was an accurate reflection of the meeting. The daily life in the home appeared relaxed and residents were clearly spending time as they wished. They told us they were happy with this degree of flexibility. Care Homes for Adults (18-65 years) Page 12 of 26 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 develop their daily living skills and follow their own routines. The home supports the residents to use their time as they wish and in their choices of food. Evidence: Throughout the inspection, we saw good evidence that the residents are encouraged to develop as individuals and improve their independence and wellbeing. One resident said that he preferred spending time in his room, watching television, other residents got up (or not at all) as they wished, another resident went shopping with a staff member. Residents are supported and encouraged to develop independent living skills. This includes developing their abilities in cooking, cleaning and maintaining the household, shopping and going out into the community. They told us that they were happy with Care Homes for Adults (18-65 years) Page 13 of 26 Evidence: the way they were able to participate in the running of the home. Residents can go out independently and use public transport. They choose where they want to go and whom they want to see. They were less enthuisastic about the organisations activity programme (based at another home) and the Registered Manager told us that they preferred to make more flexible arrangments in this home. However, we talked with one staff member, who described, how is does some work each week focussed on structured activities with the residents. These included going on visits to museums and bike riding. The Registered Manager told us that the residents maintain the level of family contact they wish to. Some residents have a religious belief and others do not. These are clearly documented in their care plans. Their choices are supported by the home, as are their cultural preferences, such as food and music. Food choice appeared to be flexible. Although there was a menu displayed in the kitchen, residents said they choose what and when they eat on a daily basis. They either cook for themselves or make meals with staff support. Some residents have fridges in their rooms where they keep snacks. A record is kept of what people eat daily. The home had a food delivery on the day of the inspection. The home is close to shops in Tottenham and residents and staff go out shopping together each day. Care Homes for Adults (18-65 years) Page 14 of 26 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 have their dignity and privacy respected. They are supported with their healthcare needs, including their mental health and complex health needs. Residents are protected by safe systems for the storage and administration of medication and staff trained to use these systems safely. Evidence: We saw that the staff supported residents by prompting them for personal care at times. Staff told us that all residents are able to attend to their own personal care. We observed staff interacting sensitively with the residents, ensuring that their privacy and dignity were protected. The support for one resident with complex health needs has improved. We checked all the residents healthcare records on file. All have had regular regular health checkups, including input from opticians, dentists, and their GP. All healthcare records were kept up to date. The residents have had their mental health needs regularly reviewed by appropriate professionals. Staff told us that the home has a Care Homes for Adults (18-65 years) Page 15 of 26 Evidence: good working relationship with a local GP, who sees all residents regularly, knows them well and does home visits if needed. All residents have had their weight monitored regularly. One resident has been supoorted to give up smoking. His key worker described how they had worked on this programme together and said how pleased he was with the residents progress, especially in a home where all the other residents smoke. The Registered Manager gave clear examples of how the mental health wellbeing of the residents has improved over the time that they had lived in the home. These examples were confirmed by our observations. Througout the day, we observed the Registered Manager and the staff member administering medication. They followed the procedures in place safely. The home uses a blister pack system. The medication is stored in a locked cupboard in the office and in a medication fridge. The medication administration records showed when the medication is delivered to the home and when it is returned to the pharmacy, so that a clear audit trail is available. Medication administration records were signed appropriately by staff. This includes where two staff sign for the administration of a controlled drug, which is stored seperately. As requried medication now has written guidance for staff on when it should be administered. All staff who administer medication have now received medication training, meeting a requirement from the last inspection. Care Homes for Adults (18-65 years) Page 16 of 26 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. Residents have access to a clear complaints procedure and are happy to raise concerns when they have them. They are protected by staff trained in safeguarding and by the homes policies and procedures. Evidence: The complaints procedure is displayed in the home. The residents told us that they would speak to the manager or the owner if they had a complaint. They said that they were comfortable expressing any concerns they had as they arose and said that these were always dealt with appropriately. The complaints records showed that there have been no complaints received since the last inspection. The home has copies of the local authority and its own safeguarding procedures available. Staff have been trained in safeguarding adults. All staff have also received training in supporting people with challenging behaviour, meeting a requirement from the last inspection. All residents manage their own finances and there was clear information on file about how they are supported with budgeting. Care Homes for Adults (18-65 years) Page 17 of 26 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. Residents live in a comfortable, homely environment. Improvements have been made in the kitchen. Evidence: The home is in an ordinary terraced house. It is kept safe, clean and comfortable. There are local shops very close by and good access to public transport. The home has four single bedrooms, one with an accessible disabled shower. The communal space is a small lounge, domestic kitchen, dining area and an enclosed garden. Residents can smoke in their rooms. Residents and staff keep the home clean and a domestic staff member comes in twice a week to assist. There is a washing machine that has high temperatures to clean soiled laundry. The kitchen cupboards have been replaced since the last inspection, meeting a requirement. When we arrived at the home, neither of the two doorbells worked and no one responded to the intercom. We had to telephone the home to gain entrance. All residents and staff were at the home. We observed the process of the people trying to gain access to the home during the day. A staff member must be in the office to hear the faint buzz of the intercom. This is not acceptable and was clearly an Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: inconvenience. A requirement is made to repair the door bell. One resident showed us a leaky radiator in his room and the Registered Manager told us that the plumber had been called to fix it. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a stable staff team who have been trained appropriately. They are protected by the homes recruitment procedures. Evidence: The homes staff team has now stablised, with a period of recruitment completed last year. All staff have been safely recruited, with preemployment checks and inductions completed. These records were kept on the staff files. Staff also had checks on their right to work in the UK and contracts of employment in place. The most recently employed staff member described a clear induction process and confirmed that appropriate checks had taken place. The staff have all their training certificates kept on file. This covered all mandatory training in a rolling programme. Further training in health and safety and mental health and drug awarenes has been completed and meets requirements from the last inspection. Staff have or are working towards NVQ qualifications. Most staff work part time at Hanom House and part time at other homes run by the Registered Provider. During the day there are one or two staff on duty at night, one waking night staff member. The Registered Manager currently provides some support to other homes in the group. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: We saw the supervision records. All staff had received individual supervision. There were also some improvements in the range of issues covered in the supervision sessions, although there could still be improvement in the frequency of supervision. Care Homes for Adults (18-65 years) Page 21 of 26 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. Residents benefit from a well run home and are protected by the homes quality assurance and health and safety policies and procedures. Evidence: The Registered Manager has worked in the home for seven years. He demonstrated a sound understanding of the residents needs and worked sensitively with them. Residents told us that he was approachable and that they got on well. He has completed his Registered Managers Award and told us that he has four more units to complete in the NVQ4 in Care. We discussed the requirements from the last inspection. The Registered Manager told us that he had worked hard to ensure that these requirements were met and that he would guard against similar lapses in regulatory standards in the future. One staff member has taken on a new role as a Care Coordinator for the organisation and the Registered Manager said that this increase clinical input into Hanom House. One staff member works as an Assistant Manager and also has responsibilities for actvity coordination. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: The Registered Provider has applied for a new registration for the home, along with three other homes in the organisation. This is to change the Registered Provider status from an individual to an organisation, Wimbourne House Limited, with Mr. Adusei as the Responsible Individual. This application is in progress. The organisation surveys residents, their relatives and care professionals on annual basis to maintain quality standards in the home. The Registered Manager described to us how he acts on the feedback received to improve services and gave clear examples of how this was done in the past year. Health and safety checks had been done and we looked at the certificates kept at the home. These were in order. The home has up to date Public Liability Insurance. Fire safety checks are done regularly. We saw the records for quarterly fire drills, weekly alarms tests and the maintenance checks on the fire safety equipment. The home has a fire safety risk assessment. Staff had recently received updated fire safety training by the fire service. All staff have now completed training in general health and safety,food hygiene, first aid, infection control. This meets a requirement from the last inspection. Incidents are recorded in each persons file, care plans and risk assessments updated, actions taken, and a report of serious incidents sent to CQC under Regulation Thirty Seven. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 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 24 23 The Registered Persons must ensure that means of access to home is improved for the residents and staff. The residents and staff should be able to gain safe and easy access into the home. 30/09/2009 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 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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