Inspection on 03/06/09 for Tower House

This is the latest available inspection report for this service, carried out on 3rd June 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tower House 28/08/07

Tower House 22/06/06

Tower House 18/11/05

Tower House 04/04/05

Tower House 10/11/04

Tower House 19/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Tower House 10 Tower Road Willesden London NW10 2HP Lead Inspector Judith Brindle Unannounced Inspection 3rd June 2009 08:00 DS0000035842.V375666.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House Address 10 Tower Road Willesden London NW10 2HP 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) 020 8933 7203 020 8930 3681 Mary Christabell Chongo Mundy Mary Christabell Chongo Mundy Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies 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. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 39 28/07/2008 Date of last inspection Brief Description of the Service: 10 Tower House is a care home providing personal care for 7 elderly residents. The home is situated in a quiet residential area close to the varied amenities of Willesden Green. Transport facilities include bus services, and the local underground stations of Dollis Hill and Willesden Green. The owner of the home is also the registered manager. The home consists of two houses, which have been converted into one property. There is an open plan lounge, and dining area on the ground floor. The first floor areas are separate, and each has its own staircase. There are two bedrooms on the ground floor, and five bedrooms on the first floor. Four bedrooms have en-suite facilities. There is a garden at the front and at the rear of the property, and off street parking available for 2 cars. Parking in the street outside the home is restricted to permit holders (and their visitors) or pay and display parking. There is level access, via a portable ramp, to the front of the house. Information about the service is recorded within the statement of purpose and the service user guide documentation, which is accessible in the care home. Fees are approximately £500 per week; details can be obtained from the owner/registered manager, and are recorded in the service user guide documentation, and in the contract/terms and conditions of people using the service. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 Star. This means the people who use this service experience good quality outcomes. The unannounced key inspection of 10 Tower House took place during eight hours within one day in June 2009. There were no vacancies at the time of the inspection. Prior to this unannounced key inspection the Commission received a completed Annual Quality Assurance Assessment (AQAA) document from the manager/owner of the care home. The AQAA is pre-inspection paperwork, which is a self-assessment of the service provided by the care home to residents. It is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. This AQAA generally told us what we needed to know about 10 Tower House. It could have included more detail in some areas of the document, and each section should have been better linked to the key National Minimum Standards for Older Persons for that particular outcome group of the AQAA. This was discussed with the deputy manager. A number of feedback 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 3 completed surveys from people using the service, 2 from staff and 2 from health care professionals. We also spoke to a visitor via the telephone. During the inspection we talked with people using the service, a care manager, and staff (including the manager and deputy manager). Other information received by us since the previous key unannounced inspection about 10 Tower House was also looked at. This included information with regard to incidents that the service has told us about that have happened in the home. These are called notifications, and are a legal requirement. Other documentation we looked at included; care plans of people using the service, risk assessments, staff training, staff personnel records, and some policies and procedures. The inspection also included a tour of the premises. Assessment as to whether the requirements, from the previous inspection had been met, also took place during this inspection. These were judged to have been met by the home. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 6 24 National Minimum Standards for Older Persons, including Key Standards, were looked at during this inspection. The inspector thanks for all their assistance in the inspection of 10 Tower House; the people living in the care home, care staff, the manager, deputy manager, and all those who spoke with us prior and during the inspection, and those who completed feedback surveys What the service does well: The home is welcoming, clean and homely. There is an attractive, accessible garden. People using the service spoke very positively about the care and support that they received from 10 Tower House. Comments from residents included ‘I’m happy here’, ‘I get what I want’ and the ‘staff are nice’, and ‘I like the garden’. The manager is experienced and it is evident that she cares about providing a quality service to the residents, and is keen to continue to develop and improve the service provided by 10 Tower House to people living in the care home. The staff team are competent, caring and approachable. The home has close liaison with health care professionals. Resident’s health needs are met by the home. The home is now separate (there is now no longer a connecting passage way, to the adjoining care home within the organisation) and it has its own systems (including its own staff) in place for providing a service to people living in the home. Each person using the service keeps their care plan in their own bedroom, so that their plan of care is accessible to them. What has improved since the last inspection? It is evident that the home has taken appropriate steps to improve the quality of its service. The requirements from the previous key unannounced inspection that took place on the 28th July 2009 were judged to have been met. The décor of the care home has been improved, most areas of the home have been repainted, and new carpet has been laid in several areas. New chairs have been purchased for the sitting room. The dining area has been reorganised to make the area more attractive, and to promote interaction between residents at mealtimes. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 7 More staff have had the opportunity to achieve a National Vocational Qualification (NVQ) level 2 or 3 and above in care and health. Care plans of people using the service have been further developed and reviewed. They include generally more comprehensive information about the needs of each person. There is better recording of; meals eaten by residents, resident’s personal item inventories, and of activities that they participate in. Better window restrainers have been installed and further improvements to these are planned. The staff recruitment and selection procedure is better. It is evident that staff induction is carried out, when staff start working at 10 Tower House. 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. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3 and 6 N/A People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who may use the service and their representatives have the information needed to decide whether the home will meet their needs. People using the service have their needs assessed prior to moving into the care home, and have the opportunity to visit 10 Tower House, which makes certain that the home knows about the person, and the support that they need. EVIDENCE: Annual Quality Assurance Assessment (AQAA/pre inspection paperwork) told us that the documents (statement of purpose and service user guide) that give details about the service provided to residents by the care home had been recently reviewed. We saw that each resident has a copy of the service user guide located in their bedroom. The format (i.e. picture, sign, audio etc) of this document could be improved to make its information more accessible to Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 10 residents who have difficulty reading, have English as a second language, and/or have sensory needs. A person living in the home, who has particular sensory needs, could have information from the service user guide recorded in Braille or in audio format. This was a previous recommendation. The care plans looked at incorporated information about the varied initial assessed needs of each person using the service. These included information about the person’s mobility, personal care, health, nutritional, emotional, sensory, and other needs. It was evident that some aspects (assessment of the person’s religious beliefs, languages spoken) of prospective residents equality and diversity needs were looked at, and that there is written guidance in place to meet these needs. This assessment information could be broadened to incorporate more information about each’ person’s cultural needs, age, sexuality, and disability needs. This was discussed with the deputy manager. AQAA told us that residents have the opportunity to attend religious services, and that representatives of churches visit the home. It was evident from care plans looked at that an initial assessment of the person’s needs is also carried out by the funding Local Authority. A resident told us that she/he and family members were ‘asked questions’ about him/her before they moved into the home, and that ‘more’ questions were asked by staff about the person’s needs once they had moved into the home. Senior staff told us that there was ‘on-going’ assessment of the person’s needs, during their ‘settling in’ period, following moving into the care home. A resident told us that she/he visited 10 Tower House before moving into the home. Care plans included a contract/statement of terms and conditions between the resident and 10 Tower House. These contracts include information about the fees. Feedback from resident surveys told us that they had received a contract. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each person using the service has a plan of care, in which residents’ health, personal, and social needs are set out. There could be further development of the care plans, and it could be more evident that people using the service participate fully in their plan of care. People using the service are respected and their right to privacy upheld, and are protected by the home’s policies and procedures for managing and administrating medication. EVIDENCE: Each person using the service has a plan of care. The three care plans looked at, were based upon the initial assessed needs of each resident. It was evident that the care plans had been improved since the previous key inspection (28th July 2008) of the service. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 12 The recorded needs in the care plans looked at included; nutritional, communication, religious, mobility, sensory, activities, and some personal care needs. The care plans could be further developed to include a broader spectrum of the person’s assessed needs, based upon the initial assessment of the resident. For example the care plans could incorporate more fully; the cultural needs (such as the person’s hair care needs, skin needs), financial, social, and dietary/nutritional needs. The deputy manager spoke of plans to arrange hair appointments at a local hairdresser, which would meet their particular cultural hair care needs. This should take place. Generally there was clear staff guidance in place to ensure staff understand and know how to meet each person’s individual needs. The care plans could be more ‘person centred’ (where the resident’s care plan is central to them, and led by them), and be more of a ‘working tool’, as well as show more evidence of the resident being involved in the development and review of their plan of care. This was discussed with the deputy manager, who spoke of further developing the care plans. Following the inspection the deputy manager told us that she and the manager were in the process of developing each care plan into a more ‘person centred’ format. This is positive. Records told us that the care plans of each person using the service were reviewed regularly, by the home, and with Local Authority care managers (a care manager reviewed a resident’s care plan/placement during the inspection). Care plans told us that people using the service have their weight monitored. Some records in the care plans included some reference to ‘nursing’. These should be removed or amended due to the home not being registered to provide nursing care. This was a previous recommendation. It was evident that records of the progress of each person using the service are written by staff each day and night. These records include information about the health, personal care and social activities that the person took part in. Resident feedback surveys told us that they receive the care and support that they need, and that staff listen and act on what they say. During the inspection, staff provided assistance, and support to residents in a sensitive and respectful manner. It was evident from observation, and from talking with staff that staff have an understanding of the importance of upholding resident’s right to privacy. Staff were seen to interact with residents in a positive manner. A resident spoke of having a key worker who she knew the name of. Residents told us that they were supported to make choices. These choices include; deciding what to eat, times of getting up, choice of clothes etc. People were observed to be dressed appropriate to their culture and age. A person using the service spoke of choosing what to wear each day. We spoke to people using the service who told us that they are treated with respect by staff and others. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 13 A resident confirmed that he/she had the use of a call bell, which was generally answered promptly by staff. It was evident that equipment/aids including wheelchairs are accessed by the home for residents as and when needed by them. A record of each person’s possessions, including clothes were seen in the care plan. These records were seen to be up to date. Care plans included some evidence of risk assessment (i.e. risk of falls, nutritional assessment, behaviour, and mobility assessment). These incorporated some clear staff guidance to minimise these risks for people using the service. Though there was some evidence of general risk assessment of each person, there were some aspects of risk assessment which could be further developed, for example: individual bathing assessments, road safety assessments etc. This was discussed with the deputy manager. Staff feedback questionnaires told us that they are given up to date information about the needs of the people that they support or care for. Records, staff, residents, and feedback surveys told us that people using the service have access to care, and treatment from a variety of health professionals, and specialists. These include GP, community nurse, optician, dentist and chiropodist (we were told by the deputy manager that residents now receive treatment and care from a chiropodist and that no staff member now trims any resident’s toenails). Surveys from people using the service told us that they receive the medical support that they need. AQAA told us that no residents have a pressure sore. The home has a medication policy/procedure. We found that the home generally has appropriate medication storage and administration systems. The cupboard door of the medications storage area appeared to be quite low. The home needs to put up a warning sign and carry out a risk assessment, of this and put in place systems to minimise the risk of anyone knocking their head on the doorway. We were informed that no person using the service self-medicates any tablets. We found that the administration (and receipt) of medicines was being recorded correctly, and that this process was up-to-date. Dates of opening liquid medications (including eye drops), to enable appropriate and safe disposal in due course, needs to take place. We were told by staff and records that staff receive medication training. The deputy manager told us that the pharmacist is going to carry out medication training for staff in July 2009. We were told that the manager carries out ‘in house’ medication training for staff. This should be recorded. The content of the ‘in house’ medication could be looked at, particularly in the area of ensuring that staff who administer medication to people using the service, Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 14 have knowledge and understanding of the indicators, contra-indications and side effects of all medication administered to people using the service. The home has an up to date copy of the British National Formulary (BNF) (a reference book with regard to medication usage and details of its administration). A resident told us that she ‘gets her medication on time. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14, and 15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service generally have the opportunity to take part in a number of preferred activities. Activities and leisure pursuits for people using the service could continue to be further developed. People using the service have the opportunity to develop and maintain important relationships. Meals provided are varied. It could be more evident that all meals are wholesome, and at all times meet the choice, cultural and nutritional needs of people using the service. EVIDENCE: It was evident that since the last inspection improvements have been made with regard to the provision and choice of activities for people using the service. The home now has access to a small activities room, which is used by residents and staff and stores a variety of equipment needed for leisure pursuits. This room was used by a resident for an activity session during the inspection. Other people using the service were seen to participate in some one-one activities, with staff. These included going for walks with in the Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 16 garden with staff, talking with staff, and using some of the activity items for leisure pursuits. It was evident that residents were offered the choice whether to take part in an activity. A resident was asked by a staff member if she wanted to go for a walk, this resident declined and her wishes were respected. Some residents chose to watch TV. We were told that some people using the service attend a day centre on a weekly basis. AQAA told us that some residents had been on outings to shopping centres including Brent Cross and Kilburn, and that some people using the service participated in gardening. A resident feedback survey told us that there are usually activities arranged by the care home. AQAA gave us examples of the way that the home could improve the daily life and social activities of people using the service. This includes celebrating ‘events’, and ‘involving the next of kin’ to ‘contribute ideas to meet client’s culture’. It also told us that the home had plans to purchase more equipment for activities, to ‘invite somebody to do bingo’ (a resident told us she would like to have the opportunity to take part in a bingo session), also to create a ‘computer room’. Residents could have the opportunity to go out for meals on occasions. The home could look into enabling residents to have access to a passenger vehicle so they (particularly those with mobility needs) might have a better opportunity to access community facilities. Feedback from some residents indicated that staff could support them in taking part in more every day living skills tasks such as making snacks, ironing, doing their own laundry (with support), accompanying staff food shopping etc. A resident told us how much they had enjoyed ironing when living in her own home. This was discussed with the deputy manager who told us that residents could make drinks etc with staff support, and she agreed to put things in place for residents to be involved in carrying out other household tasks if they wish A healthcare professional told us that residents interact with ‘each other, and staff’. There could continue to be further development in providing more activities (particularly community based leisure pursuits, and in house everyday living tasks) for people using the service to ensure that their social and activity needs are fully met by the care home. We were told that the activities board located in the dining room area did not display up to date relevant information with regard to leisure pursuits. This information should be removed as it could lead to confusion for people using the service. The visitor’s record book indicated that a number of people regularly visited the home. Residents spoke of the visitors that they have. Records told us that some residents go out with family members and/or friends on some occasions. Feedback from a health care professional told us that residents are ‘always’ going out for walks, with staff. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 17 The home has a menu. The menu was exhibited in small print in a book in the kitchen. We spoke to three residents who told us that they did not know what was for lunch. We spoke with the deputy manager about ways of improving the accessibility of the menu information, to people using the service. Particularly with regard to those residents who have short term memory needs, or who have difficulty in reading, and/or have sensory needs. The deputy manager spoke about her plans for obtaining pictures of the meals recorded on the menu and of displaying them in the dining room area of the care home. Following the inspection the deputy manager told us that the daily menu is now displayed on a board in the home, and that some general pictures of food are also displayed. She told us that she would further develop and put in place photographs of food/meals that correspond with the meals provided to residents. We sat with residents while they ate their breakfast. They told us that they enjoyed the meal, and were seen to be offered some choice during breakfast. This choice including staff asking residents if they wanted jam or marmalade, and residents were seen to help themselves to various condiments. A resident mentioned that she would like some bacon, but this was not provided. The deputy manager told us that residents do have a cooked breakfast on occasions. The breakfast menu could be reviewed so that particular food requests could be available if a resident asks. It was noted that there was no fruit juice offered during breakfast. Paper towels were used as napkins. Material napkins could be provided to people using the service. Following the inspection the deputy manager told us that she had purchased table napkins for each resident. Staff cook the meals provided in the home. The deputy manager told us that the menu is flexible. She told us that the residents (with staff) plan on Sunday the menu for the following week, and are spoken to on a daily basis about what they would like to eat on that day. The deputy manager told us that staff were aware of the particular food preferences and dietary needs of people using the service, and told us how these are met by the home. A resident told us that the ‘food is good’. Feedback surveys from people using the service told us that they generally like the meals provided in the home. There was fruit accessible in the sitting room during the inspection. Residents were offered a number of drinks throughout the inspection. Food eaten is recorded. There was some indication (but not consistent according to records) that some meals met the cultural needs of some people i.e. meals that included corn meal, rice and peas. These records also indicated that sandwiches (sometimes there was soup) were generally provided for most evening meals. These meals (and sometimes lunches) included a significant amount of carbohydrates, (i.e. cake, bread, lardy cake etc) and lacked evidence of much fruit and vegetables. We were told that the evening meal takes place at approximately 6pm and that breakfast was served at about 8.30 am or 9 am. This is a significant length of time between meals, and it needs to be evident that food is provided in-between these meals to ensure that all residents receive appropriate nutrition and are never hungry (a resident told us Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 18 that she had felt ‘hungry’ before his/her breakfast). The deputy manager told us following the inspection that a late night snack is now provided to all residents. AQAA told us that the home plans to ‘try and establish’ a link with a dietician so ‘he/she can visit 10 Tower House’ for ‘regular advice’ with regard to residents nutritional needs. With regard to the above information it is strongly recommended that this takes place. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service and others are confident that their complaints will be listened to, looked into and action be taken to put things right. It could be more evident that all ‘concerns’ from residents are listened to. Residents are protected from abuse, neglect and self-harm by the home’s safeguarding policies. EVIDENCE: AQAA and previous inspection told us that the care home has an appropriate complaint’s procedure, and we were given details of how the home would respond to any complaint. The complaints procedure includes timescales with regard to responding to a complaint. The home should look at ways of improving and developing the format of the complaints procedure to improve its accessibility to people using the service who have difficulty in reading. Feedback from surveys completed by residents told us that people using the service and others knew who to speak to if they were not happy. AQAA and looking at complaints records told us that there have been no recorded complaints within the last twelve months. The home should look at ways of developing the recording of any ‘concern’ communicated by people using the service (and others). This was discussed with the deputy manager. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 20 A resident spoke to us about a complaint/concern, which the deputy manager told us she would investigate, and record. A person using the service told us that staff are very approachable. A resident spoke of speaking to their relative if they had a ‘concern’ or complaint. Resident feedback surveys told us that they know who to speak to if they are not happy. A staff member and staff feedback surveys informed us that they had knowledge and understanding of the complaint’s procedure. The home has a safeguarding adult’s policy. There were leaflets with regard to the Local Authority safeguarding adult’s procedure accessible within the care home. AQAA told us that there have been no safeguarding issues in the home within the last twelve months. A staff member who spoke to us had knowledge and understanding of what to do if there is an allegation or suspicion of abuse. AQAA told us that staff have received appropriate safeguarding adult’s training. The deputy manager told us that the home has an understanding and awareness of the Mental Capacity Act 2005 (this Act governs decision-making on behalf of adults who may not be able to make their own decisions). She told us that there was planned staff training for her and the manager with regard to the Mental Capacity Act/Deprivation of Liberty Safeguards. There were leaflets about the Mental Capacity Act/Deprivation of Liberty Safeguards, located in the home. The deputy manager spoke of ensuring all staff were aware of the significance of this Act with regard to its relevance to people using the service. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 24 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment of the home is safe, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose. The bedrooms of people using the service are individually personalised and meet their individual needs. EVIDENCE: The care home is located a few minutes walk from local shops, and is close to the facilities and amenities of Willesden Green. The front of the property is tidy and attractive, and there is parking for two cars on the forecourt of 10 Tower House. There is an attractive enclosed garden at the rear of the property, which is accessible to people using the service. We were told by staff that residents make use of the garden facility during nice weather, and that some people Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 22 using the service participate in gardening. A resident spoke of enjoying spending time in the garden. There was accessible seating available to people using the service located in the garden. Some residents were observed to have a walk in the garden during the inspection. At the time of the inspection the home was clean, with no unpleasant odours. A feedback questionnaire from a health care professional told us that the environment was ‘nice’. There is a large television in the sitting room. We were told from the AQAA and staff that some areas of the home, including some bedrooms had been recently redecorated. It was evident that the décor of the home had improved significantly since the previous key inspection. Communal areas have been repainted, and new furnishings including lounge chairs, a cooker and microwave had been purchased. The dining area has been re-organised and two new tables bought to improve its layout, and to encourage positive interaction between the people using the service. Carpet in some communal areas have been replaced. We were told that the sitting room carpet was to be replaced in the near future, and that there were plans to paint all the doors in the home. It was noted that there were some cracked tiles in the kitchen, and a ‘wobbly’ tap in an upstairs bathroom. These need to be repaired. There was a clock with the right time displayed in the sitting room. A resident asked us what the date was. This information should be displayed in the home to support people with their orientation needs. The deputy manager told us following the inspection that the date and day information is now displayed in the care home. A resident spoke positively of his/her bedroom. Comments from people using the service included ‘I’m happy with my room’. A resident told us that she/he had brought personal items including family photographs with her/him when she moved in to the home. He/she told us that they were planning to obtain more items from their previous home. A resident told us that other residents on occasions open his/her door and ‘look into her room’ and have on occasions walked in. This was discussed with the deputy manager who told us that she would look into this issue and seek to resolve it. This issue needs to be recorded in the complaints procedure and appropriate action taken in line with the policy. It was noted that when talking with a resident the sound of a his/her television suddenly came on. The resident did not know why this happened, and found it disturbing. The deputy manager told us she would look into the issue. Laundry facilities are located away from food storage, and food preparation areas. We were told that there was a part time laundry person who launders resident’s clothes and other items. There were paper hand towels, and soap in the bathrooms, and hand cleaning gel was accessible in the home. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 23 Disposable gloves were available throughout the home for staff to use as and when they need. AQAA told us that there were plans to carry out assessments with regard to supporting a resident to do their laundry. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28,29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are competent to support people who use the service, and to ensure the smooth running of the service. It could be more evident that staff receive appropriate on-going development and training. People using the service are supported and protected by the care home’s recruitment policy and procedure. EVIDENCE: The staff rota was available for inspection. It recorded the hours worked by each staff member and told us that there were generally three staff on duty during the day, and one to two staff at night. Some feedback from staff told us that due to care staff having to carry out cleaning tasks and laundry duties there is not enough time to spend with residents. The manager should review the staffing needs in the care home and look at the possibility of employing a permanent domestic staff member and cook. The deputy manager told us that the staff numbers on duty were flexible to meet changing needs of residents. AQAA told us that there were staff who have worked in the care home for approximately five years. We observed that staff interacted in a positive manner with people using the service, during the inspection. They were seen to spend time with residents, Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 25 often on a one to one basis, talking with them and supporting them in some activities/leisure pursuits. AQAA, staff feedback surveys, and staff records told us that staff receive an induction when they start working in the home, and that there is good communication between staff with regard to meeting the needs of people using the service. We were told by staff that staff receive a ‘handover’ about each person during each shift. Records and staff feedback surveys told us that staff had received some training (some training had been achieved during previous employment). This included; medication training, fire awareness, First Aid, manual handling, health and safety, food and hygiene, mental health, dementia awareness and challenging behaviour awareness, infection control, safeguarding adults, and pressure area care training. Certificates of staff training were accessible. It should be more evident that all staff receive on-going training provided by the home. Staff should have the opportunity to receive equality and diversity training. AQAA told us how the home has improved considerably in the last 12 months with regard to staff achieving a NVQ care qualification, and that there were four staff in the process of achieving NVQ level 3 in care and health (which includes mandatory staff training) , and that two staff including the deputy manager have achieved NVQ level 4 qualification. Records and staff told us that they have the opportunity to participate in regular staff meetings. We were told that care staff have a key worker role in supporting people using the service. The care home has a recruitment and selection procedure. AQAA told us that appropriate staff recruitment procedures are carried out. Three staff personnel files were inspected. These included evidence that appropriate required checks, (such as obtaining at least two references, enhanced Criminal Record Bureau check (check to find out if staff and/or prospective staff have a criminal record), and an employment history) are carried out during the recruitment and selection process of staff. The staff files looked at included a contract between each staff member and the home, and a relevant job description. Staff feedback forms told us that required recruitment and selection procedures are carried out. AQAA told us that the care home had improved in the last twelve months by recruiting ‘experience senior carers’. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35, 36 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based on skills, and experience. There are some quality assurance systems in place to monitor and improve the quality of the service provided to people using the service. So far as reasonably practicable the health, safety and welfare of people using the service is promoted, and protected, and their financial interests are safeguarded. EVIDENCE: The manager/owner has managed 10 Tower House for a significant number of years, and has significant experience in providing care and support for older people. It was evident that she cared about providing a quality service to Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 27 people living in the care home, and has worked hard since the previous inspection (July 2008) to make a number of improvements to the service. The deputy manager told us that she and the manager ensure that they update their knowledge and skills by receiving a variety of training relevant to their roles. We were told that the manager and deputy manager both have very limited skills with regard to using a computer. It is recommended that they seek an appropriate training course to develop their skills in this area. This was discussed with the deputy manager. The manager told us in the AQAA record that she was aware that there were areas of the service that could be improved and she gave us some details of the plans to achieve this. Though staff feedback forms told us that they receive support from their manager. Records told us that it was not evident that 1-1 staff supervision is taking place regularly. This needs to be looked at to ensure that it is evident that all staff are well supported with regard to carrying out their roles and responsibilities. There was some evidence that staff appraisals have taken place. Following the inspection the deputy manager told us that all the staff had received a one to one supervision session and that there were plans to ensure that all staff receive at least six staff supervisions per year to meet National Minimum Standards. We were told from the AQAA and records that the care home has systems in place to ensure that the quality of the service provided to residents is monitored closely, and that action is taken to maintain and develop it. AQAA told us that policies and procedures had been reviewed recently, and that there were plans to write an annual development plan for this year. Records informed us that feedback about the service is obtained regularly from residents. The deputy manager spoke of plans to use the AQAA as a working tool with regard to monitoring the quality of the service provided to people using the service. A care manager spoke positively of the service provided by the home to residents, told us that he/she was kept informed of any changes in resident’s needs. He/she told us that improvements to the home had been made, and that staff were approachable and friendly. The deputy manager told us that there were policies in place regarding the management of resident’s monies, and that resident’s finances are generally managed by their relatives or the Local Authority. We were told that when residents buy items, an invoice with regard to the cost is supplied to the person managing the resident’s money. A resident told us that his/her relatives purchased toiletries for them. AQAA told us that the home has health and safety policies and procedures, to ensure staff and residents are protected and safe. The pre-inspection records confirmed that all major equipment checks, such as for gas and electrical systems and hoists, are being professionally inspected in a timely manner. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 28 Bath water temperatures are monitored. Required fire safety checks and fire drills are carried out and daily fire safety checks. Emergency fire action guidance was displayed in the care home. The home needs to have an emergency plan, particularly with regard to the current swine flu pandemic. We checked the accident book for the home. This indicated that there had been no recorded accidents/incidents since the last key inspection. The deputy manager confirmed this. The home has an up to date employer’s liability insurance certificate which is displayed in the care home. Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 23(2) Requirement The home needs to put a warning sign, carry out a risk assessment, and put in place systems to minimise the risk of anyone knocking their head on the low medication cupboard door frame. Dates of opening liquid medications, needs to take place, to ensure that medication is administered safely at all times to people using the service. It needs to be evident (from records) that all meals provided to people using the service are nutritious. it needs to be evident that food/meals are provided at intervals that ensures that all residents receive appropriate nutrition and are never hungry The ‘cracked’ tiles in the kitchen and the ‘wobbly’ tap in an upstairs bathroom need to be repaired. The manager needs to review the issue of privacy with regard to residents allegedly opening a DS0000035842.V375666.R01.S.doc Timescale for action 10/07/09 2 OP9 13(2) 20/07/09 3 OP15 12(1) 20/07/09 4 OP15 12(1) 20/07/09 5 OP19 23(2) 01/09/09 6 OP24 12(4) 01/08/09 Tower House Version 5.2 Page 31 7 OP30 18(1) 7 OP36 18(2) 8 OP38 12(1) residents door (and sometimes walking into the bedroom) without knocking. This needs to be investigated in accordance with the complaints procedure. There could be more evidence of 01/09/09 staff training carried out/organised by the home, to ensure that it is evident that staff update their skills, to remain competent in their roles, with regard to providing care and support to people using the service. It needs to be evident that all 01/08/09 staff receive regular 1-1 staff supervision that meets National Minimum Standards to ensure that all staff are well supported with regard to carrying out their roles and responsibilities. The home needs to have an 01/08/09 emergency plan in place which includes action to be taken in response to flu (including swine flu pandemic), and significant gas and or electrical faults, and any other possible emergency that might occur in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The format (i.e. picture, sign, audio etc) of the service user guide document could be improved to make its information more accessible to residents who have difficulty reading, have English as a second language, and/or have sensory needs. A person living in the home, who has particular sensory Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 32 2 OP3 3 OP7 needs, could have information from the service user guide recorded in Braille or in audio format. The initial assessment information of a prospective resident’s needs could be broadened to incorporate more information about each’ person’s cultural needs, age, sexuality and disability needs. The care plans could incorporate more fully; the cultural needs (such as the person’s hair care needs, skin needs), financial, social, dietary needs. The home could arrange (if the residents agree) hair appointments at a local hairdresser, which would meet the particular cultural hair care needs of people using the service. The care plans could be more ‘person centred’ (where the resident’s care plan is central to them, and led by them), and be more of a ‘working tool’, as well as show more evidence of the resident being involved in the development and review of their plan of care. Some records in the care plans included some reference to ‘nursing’. These should be removed or amended due to the home not being registered to provide nursing care. Aspects of risk assessment could be further developed, for example: individual resident’s bathing assessments, road safety assessments etc. The ‘in house’ medication could be reviewed, particularly in the area of ensuring that staff who administer medication to people using the service, have knowledge and understanding of the indicators, contra-indications and side effects of all medication administered to people using the service. The content of the ‘in house’ staff medication training should be recorded. To ensure that it includes all the training needed to enable staff to administer medication to residents safely. Staff could support people using the service in taking part in more every day living skills tasks such as making snacks, ironing, doing their own laundry (with support) etc. To ensure that residents keep skills that they have and possibly develop further skills. The home could look into enabling residents to have access to a passenger vehicle so they might have a better opportunity to access community facilities. 4 5 OP7 OP9 6 OP12 Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 33 There could be further development in providing more activities (particularly community based leisure pursuits) for people using the service to ensure that their social and activity needs are met by the care home. The activities board located in the dining room area which does not display up to date relevant information with regard to leisure pursuits, should be removed as it could lead to confusion for people using the service. The accessibility of menu information could be further developed, so that it is mores accessible to people using the service. The breakfast menu could be reviewed so that particular food requests could be available if requested by a resident. The home should seek advice from a dietician with regard to ensuring that the nutritional content of all meals meets the needs of each person using the service. The home should look at ways of improving and developing the format of the complaints procedure to improve its accessibility to people using the service who have difficulty in reading. The home should look at ways of developing the recording of any ‘concern’ communicated by people using the service (and others). The manager should look into and resolve the issue of sound of a resident’s television. The manager should review the staffing needs in the care home and look at the possibility of employing a permanent domestic staff member and cook to ensure that care staff have the opportunity to spend 1-1 time with people using the service. Staff should have the opportunity to receive equality and diversity training. It is recommended that the manager and deputy manager seek an appropriate training course to develop their computer skills. The Annual Quality Assurance Assessment (AQAA) could have included more detail in some areas of the document, and each section should have been better linked to the key National Minimum Standards for Older persons in each part (outcome group) of the AQAA. 7 OP15 8 OP16 9 10 OP24 OP27 11 12 13 OP30 OP31 OP33 Tower House DS0000035842.V375666.R01.S.doc Version 5.2 Page 34 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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