Inspection on 03/09/08 for Real Life Options 96 Harrowdene Road

This is the latest available inspection report for this service, carried out on 3rd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Real Life Options 96 Harrowdene... 23/03/07

Real Life Options 96 Harrowdene... 18/11/05

Real Life Options 96 Harrowdene... 20/05/05

Real Life Options 96 Harrowdene... 08/12/04

Real Life Options 96 Harrowdene... 09/09/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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Extracts from inspection reports are licensed from CQC, this page was updated on 27/11/2008.

CARE HOME ADULTS 18-65 Real Life Options 96 Harrowdene Road 96 Harrowdene Road Wembley Middlesex HA0 2JF Lead Inspector Judith Brindle Key Unannounced Inspection 3rd September 2008 08:30 Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Real Life Options 96 Harrowdene Road Address 96 Harrowdene Road Wembley Middlesex HA0 2JF 020 8904 3543 F/P 020 8904 3543 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) www.reallifeoptions.org Real Life Options Manager post vacant Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Real Life Options 96 Harrowdene Road DS0000017454.V370568.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 only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 3rd September 2007 Date of last inspection Brief Description of the Service: 96 Harrowdene Road is a care home providing personal care for 6 adults with learning disabilities. The home is situated in a residential road in North Wembley. It is close to public bus and train services. The property has off street parking for three vehicles. There is also parking available in the street outside the house. The house consists of two floors. There is a seating area in the large entrance hall, a lounge, conservatory, dining room, kitchen, and laundry. Two resident’s bedrooms are located on the ground floor. Other bedrooms are situated on the first floor. Two bedrooms have an en-suite shower and toilet. There is a bathroom, a separate toilet, and office on the first floor of the home. Information about the service including the statement of purpose and service user guide are accessible within the home. Fees and any extra charges are recorded in the service agreements of people using the service. Details of fees can be obtained from the registered provider, Real Life Options. Real Life Options 96 Harrowdene Road DS0000017454.V370568.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 took place throughout a day in September 2008. There were no vacancies at the time of the inspection. We were pleased to meet, all the people living in the home. The acting manager was present during the inspection and Real Life Options London Divisional Manager was present during part of the inspection. Prior to this unannounced key inspection the manager was supplied by the Commission for Social Care Inspection (CSCI) with an Annual Quality Assurance Assessment (AQAA) document to complete. The AQAA is a selfassessment of the service provided by the care home, and is completed 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. The acting manager with the Divisional Manager completed this document comprehensively prior to the inspection. Reference to some aspects of this AQAA record will be documented in this report. A number of surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we had received four completed (with some assistance, from relatives and/or staff) surveys from people using the service, and three from staff. We have included some comments and details of the feedback from these surveys in this report. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. This included what the service has told us about things that have happened in the home. These are called notifications and are a legal requirement. Also assessed was relevant information from other organisations, and from what other people might have told us about the service. We spoke with all of the people using the service. All the residents have significant communication needs, with difficulty in responding to questions. One person can verbally communicate a few words. Other residents communicate by gestures, signs, facial expression and actions. Due to the communication needs of the people living in the care home, observation was a useful, and significant tool used during this inspection. Care staff were also spoken with, during the inspection. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 6 Documentation inspected included, three care plans of people using the service, risk assessments, staff training, and staff personnel records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements and recommendations from that inspection had been met also took place during this inspection. 28 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. We thank the people living in the care home, staff, and all those who supplied us with completed feedback survey forms, for their assistance in the inspection process. What the service does well: What has improved since the last inspection? Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 7 When we last inspected in January 2008 (random inspection), we made seven requirements (two were repeated requirements from the key unannounced inspection that took place in September 2007). These had been met or partially met by the service. The manager and the organisation have developed and improved the format of some of the documentation including some policies and procedures, to improve its accessibility to people using the service. Residents have been supported to be more fully involved in choosing and planning their menu. Pictures of their chosen meals are displayed. Some residents have been on a holiday this year. There have been two experienced care staff recruited, ensuring that there are presently few occasions when agency staff are employed. The acting manager has reviewed, and improved a number of systems in the home, including staff communication systems, environmental improvements, and involving people using the service in some aspects of the running of the home. He has plans for further improvements to several areas (i.e. kitchen, garden, and laundry area) of the care home, and to continue to develop and improve the service. What they could do better: There are areas of the environment that could be redecorated, these include the conservatory, and some paintwork in communal areas. A resident’s bedroom wall needs to be repaired. The garden could be more easily accessible to residents who have mobility needs including those who use a wheelchair. Handrails need to be installed either side of the ramp in the conservatory. The home should have access to the Internet. So improve and develop its communication systems. Residents could have the opportunity to participate in resident meetings and key worker meetings. The home could continue to seek ways of improving and developing the format of information and documentation so be more accessible to people using the service. The home could continue to further develop ways of ensuring that residents are supported to complain and/or communicate a concern. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a statement of purpose that is specific to the individual home, and the resident group cared for. It clearly sets out the objectives and philosophy of the service, supported by a service user’s guide. People using the service have a contract, statement of terms and conditions. EVIDENCE: The care home has documentation, and information about the service provided by the care home. The service user guide is in written/pictorial format. This guide includes comprehensive detail about the care home, and information about the fees, and of what to do if a person using the service has a complaint. The statement of purpose, and service user guide were dated July 2007, and needed to be reviewed and include up to date staff information including details of the change in manager. The acting manager informed us following the inspection that both documents had been reviewed and that up to date information about the service has been recorded. Care plan files inspected, included individual contract/statement of terms and conditions between the care home, and the person using the service. These contracts include a record of extra costs, which are not included in the fees. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 11 If a person using the service is unable to sign this document (or others) the reason for this should be recorded. The home has an admission procedure. Annual Quality Assurance Assessment (AQAA) information told us that this procedure is documented in a ‘service user friendly format’. There have been no residents admitted to the home for a number of years, so it was not possible to assess how the admission procedures work in practice. The three care plans that were inspected included evidence that the people using the service have had their needs assessed. These assessments provided information for staff of each person’s abilities, and of the areas that they need support. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7, and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service each have a plan of care. There could be some development in the care plans to ensure that it is evident that they are regularly reviewed, working documents, and that their information is more accessible to people using the service. Residents are supported and encouraged to make decisions and choices, and to take risks as part of an independent lifestyle. EVIDENCE: Three care plans were inspected. Each person has three personal files. The first file includes a variety of information about the resident, including assessment information, a personal profile, some risk assessments and health care information. Much of these large files included documents about each resident that were neither clearly dated nor showing evidence of having been recently reviewed. It was not apparent whether some information in this file Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 13 was current. Some information including recording appointments attended by the resident seemed to be up to date, but it was not clear whether other information (including risk assessments dated 11/06/01) were still being referred to. If information/documentation about a resident is no longer relevant with regard to providing a quality service of care and support to that person, then this information should be archived. Two resident’s files told us that there was evidence that their needs had recently been comprehensively reviewed. We were informed that residents, and significant others (i.e. relatives, and care manager) are invited to care plan review meetings. The acting manager and records confirmed that dates for the care plan review meetings for the other residents were planned. It needs to be evident that all resident’s care plans are reviewed regularly and when their needs change. This was discussed with the acting manager who spoke of plans to put into practice a monthly review (with the resident and their key workers and other staff) of the needs of each person using the service. This is positive. A resident’s second care plan file included an ‘assessment plan’, ‘care practice statements’ and risk assessments. It was not clear when these were written, as the documents seen were not dated. But the information included comprehensive assessment information about the person, with regard to their needs including personal care needs, health care needs, mobility needs, emotional/behaviour needs, social needs and religion/cultural/spiritual needs. There was also recorded guidance in the care plans to ensure that resident’s needs were met, as preferred by the residents. It was not clear when this guidance was likely to be reviewed. Nor evident that these care plans were working documents, so ensuring that changes in resident’s needs however minimal (including any short term goals) are acknowledged, recorded and responded to by staff and by the people using the service. It was not clear when this guidance was likely to be reviewed. A third file was called the ‘person centred’ plan, and included some pictures, and included information about the health, social, communication, personal preferences of residents, but these documents were not always dated, (and some were dated 2006) so it was not clear as to whether these plans had been recently updated. Though it is evident that religious, cultural and disability needs of people using the service are assessed, some equality and diversity aspects of this assessment could be further developed to ensure that the all six strands of diversity (including gender identity, age, and sexual orientation) are assessed. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 14 Comprehensive ‘daily’ progress records are completed of each resident’s needs. These include reporting on the health, social, behavioural and personal care needs of each person living in the care home. AQAA information told us that there were plans to ensure that staff sign when they have read and understood each resident’s ‘care practice statements’. The format of the care plans could continue to be reviewed to improve and develop the accessibility of the information to residents who have difficulty reading and/or understanding the written word (particularly when English is a second language). The system of having three care plan files could be reviewed to ensure that staff can easily access up to date information about each person using the service. Following the inspection the acting manager told us that he had made the information in one file more accessible to staff, and had plans to continue to improve the care plans. Individual risk assessments were documented. These were linked to the care practice statements were clearly written, and included recorded action required to reduce identified risk, and to manage it. Risk assessments covered health risks, mobility risks as well as financial and medication risk assessment. These showed evidence of having been reviewed. AQAA information told us that the home could develop ‘ more individual risk assessments for each service user’, and that all there were plans to continue to review all of the resident’s risk assessments. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12, 13, 14,15, 16 and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care home has a commitment to support, and enable people using the service to participate in a variety of preferred activities, including community based leisure pursuits. The visiting arrangements are flexible and meet the needs of visitors and residents, so as to ensure that residents have the opportunity to develop and maintain important relationships. People using the service are supported to make choices. Meals provided are varied, and wholesome. EVIDENCE: All the residents attend the Real Life Options day resource centre, where they participate in a variety of activities. We were informed that each resident spends at least one day at home during the week to enable him/her to participate in 1-1 activities with staff, which often includes accessing community facilities, such as going shopping. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 16 Three residents spent the day at home during the inspection. One person went out shopping with a staff member, another attended a health care appointment, and one person rested at home having recently felt unwell. A resident indicated that she enjoyed going out shopping and confirmed that she was going to Harrow on the day of the inspection. AQAA information told us that residents have the opportunity to be supported in participating in varied leisure pursuits on a 1:1 and/or 2:1 staff/resident ratio. There was a residents’ activity programme displayed in the home. This was in written and pictorial format, and it was evident that it was an up to date record of each person’s daily activities. There was more recorded evidence (than during the previous key inspection in September 2007) that residents participated in a variety of activities/ leisure pursuits including accessing community facilities. The manager spoke of plans to continue to improve and develop the format of this activity programme information to ensure that it is as accessible as possible to people using the service. This is positive. AQAA information told us that there were plans to develop ‘personalised individual communication systems for each service user’, including ‘talking photo albums/scrap books’, and ‘using photos taken from previous activities and outings’. The manager spoke of plans to display throughout the home, up to date photographs of residents enjoying recent day trips and holidays. I was shown some photographs of residents enjoying their recent holiday. It was evident from talking to residents, and staff, and from records and observation that the people living in the home had busy lives. As well as attending the resource centre, people go out for drives to various amenities, and have regular meals out. They also participate in music sessions. AQAA information told us that there were plans to improve and develop ‘a more varied programme of activities to include evenings and weekends’. Residents were observed to make choices during the inspection. One resident chose to have her lunch in the lounge so that she could watch a particular television programme. We were told that residents have the opportunity to participate in household duties, and that one resident particularly enjoyed some cleaning duties. This resident indicated that this was an activity that she took pleasure in. The home has a visitor’s policy. This was inspected during the previous key inspection, and confirmed that residents choose who they see and when. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 17 People using the service have the opportunity to meet visitors in their own room or another private area of the home. Staff, records, and a resident confirmed that relationships with family and friends are supported and encouraged (with resident’s agreement). We were told that the amount, and the kind of contact that people using the service have with family/significant others is varied, some residents have very close contact with family members, and others have little or no contact. A relative who supported their family member (a resident) to complete a feedback survey, commented that their family member ‘is well treated and is very happy and contented’. We were told that a resident’s family member visits the home regularly and participates in music sessions with people using the service. AQAA information told us that the home is continuing to find advocates/befrienders to support individual residents to make choices about their lives. The home has a menu. This was displayed. Food recorded was varied, and judged to be wholesome and nutritious. The manager told us that a new system of involving residents more in choosing meals has been recently put in place. This involves residents (on a weekly basis) choosing meals (including meals that meet cultural/religious needs of residents) by picking out coloured cards of pictures of meals. Then participating in shopping for the ingredients needed for the meal. A resident confirmed that he went food shopping at a supermarket, and that he enjoyed this activity. The cards of the meals chosen for the day of the inspection were displayed. This is a positive development from the last inspection. A resident indicated that he was aware of this information, and confirmed that he found the menu board useful. A variety of frozen, fresh (including fresh fruit), dried and tinned foods were stored in the care home. Fresh fruit was accessible. Food eaten by residents is recorded. Residents were observed to be offered a choice of what they wanted to eat for lunch. A staff member was observed to assist a resident with their meal. This support was provided to the person in a sensitive and respectful manner. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using the service have their personal care and healthcare needs met. Systems are in place to ensure that medication is stored and administered safely to people using the service. EVIDENCE: Staff provided assistance and support to residents in a sensitive and respectful manner. They have an understanding of the importance of upholding resident’s right to privacy. The home has a ‘service user privacy’ procedure. People using the service showed signs of ‘well being’. They smiled a lot, and wore clothes of quality, appropriate to their age. A resident confirmed that she had chosen the clothes that she was wearing. People living in the care home seemed to know the staff well and approached them freely without hesitation. Residents indicated that they were happy living in the care home. Care plan information informed us that residents’ health and personal care needs were assessed and that guidance is in place to ensure that staff have Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 19 knowledge and understanding of how to support residents in managing these needs. People using the service have access to care, and treatment from a variety of healthcare professionals including, GP, dentist, optician, psychiatrist, and chiropodist. Records including the AQAA told us that residents have access to specialist health care support, including speech and language therapy and physiotherapy. A resident attended a healthcare appointment during the inspection. Individual health action plans were evident but it was not clear whether some were up to date: for example one person’s health action plan was dated 19/05/06. This information should be kept up to date. AQAA information told us that this was an objective that was planned to be carried out. It was not clear how residents who are unable to stand without support are able to have their weight monitored. This was discussed during the last inspection. The manager confirmed that action would be taken to look in to this. A risk assessment should be completed to ascertain as to whether regular monitoring of a person’s weight is a significant need for them. There was some indication in a resident’s care plan that a resident had a tendency to lose weight. Following the inspection the manager told us that the issue of accessing weighing scales that are appropriate for residents who have mobility needs was being looked into by a staff member. The home has an accessible medication policy. Medication is stored securely Medication is administered via the monitored dosage system (resident’s medication is dispensed by a pharmacist into single dosages). Staff told us that system is works well. We were told that staff receive medication training from a pharmacist. Records indicated that some staff had recently received ‘refresher’ medication training. Staff told us that medication training was included in the staff induction programme. The manager informed us of the process of staff ‘in house’ medication training that takes place prior to a new member of staff administrating medication. We were told that this ensures that staff are comprehensively assessed as competent to administer medication to people using the service. There should be a record of this ‘in house’ staff medication assessment, to ensure that it is evident that staff are assessed and judged as competent to administer medication to people using the service. Following the inspection the manager told us that following discussion with his line manager, a date has been agreed when each staff member will have a ‘refresher’ assessment of competence in the administration of medication, and that this will be recorded. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 20 A staff member told us that two staff administer medication. A record of signatures of staff that administer medication was available for inspection. Significant stocks of medication are not kept by the home. The manager reported that no residents were presently being prescribed controlled drugs. There were no gaps in the recording of medication administered to people using the service. There was clear guidance recorded in regard to the administration of medication to be given as and when required i.e. analgesia medication such as paracetamol. A number of residents receive medication in liquid form. It was not evident that the date of opening of bottles of medication is recorded. This is significant because some medications need to be discarded within a few days/weeks once the bottle has been opened. This was discussed with the acting manager, who confirmed that prompt action would be taken to ensure that this issue was resolved. The temperature with regard to the storage of medication needs to be monitored to ensure that all medication is stored at the prescribed temperature. For example records told us that some medication needed to be stored below a certain temperature. AQAA information told us that there were plans to develop ‘individual risk assessments for taking medication’ with regard to each resident. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to an effective complaints procedure, and are protected from abuse, and have their rights protected. EVIDENCE: The care home has a complaints procedure, a summary of which is recorded in the service user guide. This is in written and in pictorial format. The complaints procedure includes timescales with regard to responding to a complaint. There have been two recorded complaints since the previous inspection. Both had been responded to, and resolved appropriately. The issue of recording ‘concerns’ was discussed with the manager. One recorded complaint indicated that steps had been taken to develop and improve ways of supporting residents to communicate concerns, and would record them. The manager told us that work would continue to be carried out to ensure that it was evident that people using the service were supported in communicating any ‘concerns’ or complaints that they might have. AQAA information told us that this was an area that could be better developed by the service. Resident’s feedback surveys confirmed they know who to talk to if they are not happy. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 22 AQAA information told us that the care home has a ‘positive culture towards complaints’, and that the service recognises ‘the value and importance they bear in driving the service forward and protecting individuals’. The staff who spoke with us had an awareness, and understanding of the reporting, and recording procedures with regard to responding to ‘concerns’/complaints, and/or any suspicion or allegation of abuse. The manager told us that all staff had received training in safeguarding adults. Staff confirmed that they had received this training, and that it had been included in their induction programme. The home has clear and robust policies and procedures with regard to the protection of people using the service, and has the local authority safeguarding adult’s guidance. Safeguarding adult’s guidance is displayed in the home, and includes information that is in pictorial as well as written format. AQAA information told us that the care home has comprehensive policies and procedures ‘covering all areas of discrimination’, whistle blowing and ‘equal opportunity’. Residents have support from staff in managing their finances, details of this support is recorded in the care plans. Records of purchases were appropriately documented. It was evident that since the previous key inspection, the care home had reviewed its procedures with regard to the management of resident’s monies to ensure that residents are protected from risk of financial abuse. We were told (and observed) that two staff check residents ‘monies’ every day, and that a representative of the organisation also monitors the management of resident’s finances on a monthly basis. The Divisional Manager told us that he was currently in the process of auditing all the residents’ financial records including records of purchases and expenditure. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 24, 26 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. There are some maintenance issues that require attention. Resident’s bedrooms, meet their individual needs, and are individually personalised. EVIDENCE: The care home is in keeping with other houses in a residential area. It is located in North Wembley within a few minutes walk from a variety of local shops, restaurants and banks. Bus and train public transport facilities are accessible close to the care home. Staff and a resident told us that the local shops were used regularly by the home, to purchase a variety of items including food and toiletries. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 24 The inspection included a tour of the premises. The care home is well maintained, homely, clean and airy. Feedback surveys from people using the service confirmed that they thought that the home was fresh and clean. The living environment is appropriate for the particular lifestyle, and needs of people living in the home. Houseplants, ornaments, photographs, pictures, a fish tank, and a music system are located in the communal sitting/dining room of the home. The furniture (sofas and armchairs) in the sitting room seemed to be rather low and possible lacking back support for some residents. There could review (possibly with occupational health advice) of this furniture and it be replaced if necessary. The home has a large enclosed garden, which was generally well maintained. There was access from the dining room via a ramp to the garden, but staff told me that the slope of the ramp was fairly steep, so people who use a wheelchair (two residents) needed staff support if they wished to access the garden. There is also a ramp leading from the lounge to the conservatory, which needs handrails to minimise risk of a wheelchair falling of the ramp. There is a difference in level from the conservatory floor to the patio, and no ramp, so people who use a wheelchair need assistance from staff to access the garden from the conservatory. There should be a ramp (or other system) with handrails in place. There should also be a ramp/slope in place to allow easy access to the garden from the patio. The Divisional manager told us that there were plans to develop the garden to improve its accessibility to residents. This should take place, raised flowerbeds should be considered, so that residents who use a wheelchair could (if they wish) participate in gardening. AQAA information told us that there were plans to involve residents in maintaining the garden. The manager spoke of the possibility of having an area of the garden for the growing of vegetables. This is positive. There is a selection of garden furniture located in the garden. We were told that the home has an allocated annual maintenance budget, and that there is a ‘five year’ maintenance programme. Maintenance requirements from the previous inspection had been generally met. There are areas of the care home that could be ‘freshened up’. Such as the conservatory, where paintwork could be repainted, and it’s furnishings could be reviewed to make it a more attractive communal area for people using the service. Similarly some paintwork in other communal areas of the home could be improved. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 25 There should be a thermometer located in the conservatory to monitor the temperature of this room. The service should review the need for blinds in the conservatory to minimise the risk of the area becoming to hot or bright. We were told that there were plans to refurbish the kitchen, to ensure that it would be more accessible to residents (particularly those who use wheelchairs), so that they can participate more easily in cooking sessions. Staff confirmed that residents would be fully involved in choosing the furnishings/décor of the kitchen. This is positive. Plans for the design of the new kitchen were available to look at. Following the inspection the acting manager informed us of the date when work on improving the kitchen would commence. The entrance/hall area of the home has been improved since the last key inspection. The seating area, and furnishings are more pleasing. A bathroom located on the ground floor has two doors, one door leads to a resident’s bedroom, and the other leads to a communal passageway. There have been large bolts put on the bathroom side of each door. The home needs to ensure that it is of minimal risk to people using the service (and others) with regards to having this type of lock on the bathroom doors. If not of minimal risk, locks need to be in place so that staff in the event of an emergency can access the bathrooms.. We were told that residents when using the bathroom generally require assistance and support from staff. Two bedrooms were looked at. A person using the service kindly showed me her bedroom. This was observed to be individually personalised, with lots of photographs, and ornaments, and other personal possessions including ‘cuddly toys’. She indicated that she was happy with her bedroom. Another bedroom was also seen. This was also personalised to meet the person’s needs. There was a previous requirement with regard to repairing and repainting a resident’s bedroom wall, which shows signs of dampness. We were told that there had been some work done on the wall, but following recent investigation by a maintenance person it was concluded that major work on the outside wall and guttering needs to take place, and that this was in the process of being organised, and would be carried out promptly. Contact and other action taken by the home to resolve this maintenance issue was evident from recent records. The major repairs to the outside wall and guttering of the care home need to take place, and a resident’s bedroom wall must be repaired and redecorated. The laundry facilities are located away from food storage and food preparation areas. Disposable gloves were accessible to staff in the home. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 26 The home has an infection control procedure. Records confirmed that staff had received infection control training. Soap and paper hand towels were accessible with hand washing facilities. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff in the home are trained, skilled and in sufficient numbers to support the people using the service, and to support 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 informed us that there were three care staff on duty during the day plus the manager, and that at night there is one ‘wake’ night staff and a staff member who carries out a ‘sleep in’ duty. Staff told us that they felt that care staffing numbers were sufficient to ensure that the needs of residents. Staff spoke of there being flexibility in regards to staff numbers on duty depending on the needs of the people using the service. We were told by the acting manager that that there are plans to have a notice board that displays information, (in photographic format) of the staff are on duty. This was discussed at the previous key inspection, and could be positive for people using the service. Particularly as we were informed that a resident regularly asks ‘who is on duty’. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 28 Staff spoke of their role as key worker to residents. This includes supporting residents to purchase toiletries, planning activities with them, and participating in the review of the care plan of their key person. Staff feedback questionnaires told us that they felt that residents were respected, and were given ‘lots of choice’. Staff confirmed that they were aware of the equality and diversity needs of the residents. It was clear from the staff feedback that changes in managers had been difficult for them, but talking to staff during the inspection there was general agreement that with the employment of the acting manager and Divisional Manager, that this situation had improved. A staff member said that the staff handover, with the recent shift planner and ‘shift leader’ ensures that each staff member is aware of the duties that they need to carry out during each shift. From talking to staff, observation and records it was evident that staff are competent and have a good understanding and knowledge of how to meet each person’s needs. Some staff were seen to use some sign language to help residents understand what they were saying to them. Two staff spoke of the recent staff induction programme that they had received; both confirmed that this ensured that they felt knowledgeable and competent in carrying out their role and responsibilities. We were told by a staff member that this staff induction involves a period of several weeks of ‘shadowing’ experienced care staff when they carry out their duties. We were informed that staff receive induction training during the first six weeks of employment and that this leads to foundation training, which is linked to the Learning Disability Qualification requirements, (accredited training to ensure that staff have the knowledge and understanding to be able to carry out their responsibilities in regard to supporting adults who have a learning disability). AQAA information told us that there has been a Learning Development officer appointed by Real Life Options to ‘look at all our staff and assess their training needs’. Training records were inspected. These included individual staff training and development records. Care staff confirmed that they had received varied and appropriate staff training to ensure that they are competent to care and support residents. Recent staff training included safeguarding adult’s training, fire training, and health and safety training. Certificates of staff training were available for inspection. These confirmed that staff had received recent training in several areas. This included moving and handling, fire, health and safety, medication, 1st Aid, and food and hygiene training. Records and staff told us that epilepsy training had been recently booked for staff, but had had to be postponed. The manager was in the process of Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 29 rebooking this. We were told by the manager following the inspection that this epilepsy training for staff had been booked to take place in September 2008. He confirmed that all staff knew what action was to be taken if a resident had a seizure, and was observed to update a resident’s care plan and other records with regard to this. He spoke of plans to discuss epilepsy within staff meetings, staff supervision, and staff handovers. AQAA information told us that management staff had had training with regard to gaining knowledge and understanding of equal opportunities, and that ‘Makaton’ (a form of sign language) refresher training for staff is planned. It should be evident that staff have received training with regard to the Mental Capacity Act 2005, and in up to date equality and diversity training. The acting manager told us that equality and diversity is to be discussed in team meetings. AQAA information informed us that the percentage of staff working toward National Vocational Qualification level 2 or above in care, was 47 , and that five staff were presently working towards this qualification. The home should ensure that all staff have the opportunity to achieve this qualification. The home has a comprehensive recruitment and selection policy/procedure, which includes the need for an enhanced Criminal Record Bureau check, (to gain information as to whether a person has a criminal record) and a protection of vulnerable adults (POVA) check (to ensure that the POVA list is checked to gain knowledge whether a person is banned from working with vulnerable adults). Staff records inspected recorded evidence that appropriate recruitment procedures are followed. It should be evident that the home and organisation has a system in place for ensuring that records of staff’s right to work are kept updated. This was discussed with the manager. He told us following the inspection that Real Life Options were reviewing their procedures with regard to this. Records and staff confirmed that they have the opportunity to attend regular staff meetings. AQAA information told us that staff have clear job descriptions, that there is a six month probation period for all staff, and that there were plans to involve residents in the recruitment process. Records and staff told us that staff receive regular 1-1 staff supervision and appraisals, which ensures that staff are supported in their role, and have the opportunity to develop and achieve goals in regard to carrying out their duties in caring and supporting people using the service. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 30 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect, has effective quality assurance systems, which ensures that a quality service is 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. EVIDENCE: The care home at present does not have a registered manager. During approximately the last two years, there have been several acting managers who have managed the care home. AQAA information told us that the frequent changes in temporary managers has made it more difficult for the care home ‘to improve as much as we would have liked’. Due to there being ‘a level of consistency’ having been ‘lost’. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 31 We were told by the Divisional manager that recruitment for a permanent manager is currently taking place. Following the inspection the acting manager told us that a date for interviewing for the management post has been planned. The acting manager confirmed that once a new manager is appointed he will be fully involved in the person’s induction programme, so the new manager will have knowledge and understanding of all aspects of the home including the plans and goals for developing and improving the service. This is positive. The home should ensure that the care home recruits a permanent manager and ensure that this person be registered with the Commission for Social Care Inspection. There is an acting manager currently running the home. He knows the service well having managed the home temporarily in 2007. His permanent position is deputy manager of another Real Life Options home. The acting manager has several years experience in a management role working with adults with a learning disability. He has a very much ‘hands on approach’, and spends significant time supporting residents to meet their needs. He also works a variety of shifts so can monitor the care and support needed and received by residents at different times of the day. It was evident that during the short time that he has been managing the home he has been aware of the need for some changes in the care home. He has been pro-active in improving the quality of the service for residents. During the visit we felt that the acting manager demonstrated a good knowledge of recent and planned developments in best practice in the field of learning disability. The acting manager, (and AQAA information) told us that he was aware that there were a number of further improvements that still could be made to the service, and that action was being taken to carry them out. The home should have access to the Internet. So improve and develop its communication systems. Following the inspection we were told by the Divisional Manager that this was planned. Talking to staff and inspection of records confirmed that the home has systems in place to improve and monitor the quality of the service provided to people using the service. This includes a quality management system of monthly monitoring systems within the home. We were supplied with an up to date business/development plan of the service prior to this unannounced inspection. This included a number of objectives to improve and develop the service. The home completed the AQAA comprehensively. We were told that this document would be reviewed and updated on a quarterly basis to ensure that it is evident that the service is monitored closely. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 32 We were told that the home regularly provides stakeholders with feedback surveys to obtain their views of the quality of the service provided to people using the service. A record of this was available to look at. A monthly audit of the quality of the service is carried out by a Divisional manager of Real Life Options. Copies of these documents were seen. The care home has up to date policies and procedures to ensure that the interests of people using the service are safeguarded. It was evident that the organisation is taking steps to develop and improve the format and accessibility of several policies/procedures that are of particular relevance/interest to people using the service. This is positive. AQAA information told us that the home planned to introduce regular resident meetings. This is positive. The home has a health and safety policy, and risk assessment. No health and safety issues were noted during the inspection. Cleaning products are stored securely. The home has installed some door safety mechanisms (including on the kitchen door), since the previous inspection. AQAA information told us that there is close monitoring of health and safety systems in the care home. Records confirmed that required service checks of gas and electrical systems in the home are carried out and are up to date. Fire safety systems are monitored closely. Regular fire drills, and fire training takes place. The home has a fire risk assessment, and there are displayed procedures in place with regard to the resident’s needs in the event of a fire. The general fire risk assessment could have been better developed to ensure that there is thorough fire risk assessment of each room in the house, particularly taking into account the use of electrical equipment within in each room. Following the inspection the acting manager told us that this has now been carried out. This is positive. Fire safety guidance is displayed. Accidents/incidents are recorded as required. An incident with regard to a resident’s safety whilst travelling in the care home’s vehicle occurred during the inspection. Staff took appropriate steps, (including supporting the person to attend hospital for a check up),and ensuring that all residents safety is protected when travelling in the house passenger vehicle. AQAA information told us that Legionella testing of the water systems in the home are carried out. The care home has an up to date employer’s liability insurance certificate, which is displayed. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 33 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 34 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2) Requirement It needs to be evident that all resident’s care plans are reviewed regularly, and as and when their needs change. The date when a bottle of liquid medication is opened needs to be recorded to ensure that medication is administered to residents safely. Timescale for action 01/11/08 2 YA20 13(2) 01/11/08 3 YA24 12, 13(4) 23(2) 4 YA24 23(2) The temperature with regard to the storage of medication needs to be monitored to ensure that all medication is stored at the prescribed temperature. The ramp leading from the 01/11/08 lounge to the conservatory needs handrails to minimise risk of a wheelchair user falling of the ramp. The major repairs to the outside 01/12/08 wall and guttering of the care home need to take place, and a resident’s bedroom wall must be repaired and redecorated. The home needs to ensure that it 01/12/08 is of minimal risk to people using the service (and others) with DS0000017454.V370568.R01.S.doc Version 5.2 Page 35 5 YA27 13(4) 23(2) Real Life Options 96 Harrowdene Road regards to having a bolt type of lock on the bathroom doors. If not of minimal risk, locks need to be in place so that staff can access the bathroom in the event of an emergency. 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 2 Refer to Standard YA5 YA6 Good Practice Recommendations If a person using the service is unable to sign their statement of terms and conditions document (or other documents) the reason for this should be recorded. If information/documentation about a resident’s care and support needs is no longer relevant This information should be archived. All care plan information should be dated to ensure that staff provide residents with up to date care and support. There should be monthly reviews of the care plans with participation of residents, to ensure that all the resident’s needs are being met. Key worker/key person meetings should take place regularly to give residents the opportunity to make plans and review their goals with regard to their care and support needs. Some equality and diversity aspects of assessment/care plans could be further developed to ensure that as well as religious and cultural needs, other strands of diversity (including gender identity, age, and sexual orientation) are assessed. The home could develop each care plan into being more of a ‘working’ document. This ensures that it is evident that all changes in resident’s needs however minimal (including any short term goals) are acknowledged, recorded and responded to by staff, and by the people using the service. The format of the care plans could continue to be reviewed to improve and develop the accessibility of the information Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 36 3 YA6 4 YA6 to residents who have difficulty reading and/or understanding the written word (including when English is a second language). The system of having three care plan files could be reviewed to ensure that staff can easily access up to date information about each person using the service. Resident’s health action plans should be reviewed regularly. A risk assessment should be completed to ascertain as to whether regular monitoring of a person’s weight is a significant need for them. There should be a record of this ‘in house’ staff medication assessment, to ensure that it is evident that staff are assessed and judged as competent to administer medication to people using the service. The care home should continue to ensure that it is evident that people using the service are supported in communicating any ‘concerns’ or complaints that they might have. There should be a ramp leading from the conservatory to the patio to ensure that people who use a wheelchair can access the garden without assistance from staff if they wish. There should also be a ramp/slope in place to allow easy access to the garden from the patio. Raised flowerbeds in the garden, should be considered, so that residents who use a wheelchair could (if they wish) participate in gardening. The conservatory paintwork could be repainted, and the furnishings of this room be reviewed to make it a more attractive communal area for people using the service. There should be a thermometer located in the conservatory to monitor the temperature of this room. The service should review the need for blinds in the conservatory to minimise the risk of the area becoming to hot or bright for people using the room. It should be evident that the home and organisation has a system in place for ensuring that records of staff’s right to work are kept updated. It should be evident that all staff have received training with regard to the Mental Capacity Act 2005, and up to date equality and diversity training. DS0000017454.V370568.R01.S.doc Version 5.2 Page 37 5 YA19 6 YA20 7 YA22 8 YA24 9 YA24 10 11 YA34 YA35 Real Life Options 96 Harrowdene Road 12 YA37 The home should ensure that all staff have the opportunity to achieve a NVQ (National Vocational Qualification) in care. The home should ensure that the care home recruits a permanent manager and ensure that this person be registered with the Commission for Social Care Inspection. Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Real Life Options 96 Harrowdene Road DS0000017454.V370568.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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