Inspection on 14/11/08 for Two Rivers

This is the latest available inspection report for this service, carried out on 14th November 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Two Rivers 100 Long Lane Finchley London N3 2HX     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Duncan Paterson     Date: 1 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Two Rivers 100 Long Lane Finchley London N3 2HX 02083464236 Telephone number: Fax number: Email address: Provider web address: tworivers@suncarerecovery.co.uk Name of registered provider(s): Name of registered manager (if applicable) Gyan Dass Type of registration: Number of places registered: Suncare Recovery Limited care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on asmission to the home are within the following categories: Learning Disability - Code LD Mental Disorder, excluding Learning Disability or Dementia - Code MD The maximum number of service users who can be accommodated is: 7 Date of last inspection Brief description of the care home Two Rivers was registered in May 2008 to provide accommodation and care support to seven adults who may have mental health issues or learning disabilities. The care home is in a converted property in Finchley close to shops, services and transport links. The house has been carefully converted and extended and provides seven bedroms with en suite facilities, a large kitchen / diner, a lounge as well as a multipurpose area which is used for activities. There is a large, attractive garden to the rear Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 0 7 7 Brief description of the care home of the home. The service is run by Suncare Recovery Limited, a company operated by a husband and wife team. Mrs Gyan Dass is both the registered manager and one of the co-owners. Suncare also plans to provide a Supporting People service. The aims of the service are to provide a high quality, spacious, therapeutic and culturally appropriate environment for Asian women who may have mental health concerns or learning disabilities. The service is new and currently there are two people using the service. There are plans to bring the service up to full occupancy. Only one person stays overnight. The fees are £1500 per week. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection took place over three days between 14th and 17th November 2008. The three visits involved an initial visit, a weekend visit to meet residents and a morning visit to inspect paperwork including staff recruitment and care plans. The Annual Quality Assurance Assessment (AQAA) which had been sent to us by the home was taken into consideration. The inspection also involved discussions with the manager and staff, a premises tour and an inspection of a sample of the homes records, policies and procedures. The inspector thanks all those involved for their help and assistance. Care Homes for Adults (18-65 years) Page 6 of 29 Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. Care Homes for Adults (18-65 years) Page 8 of 29 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Good quality information is provided about the service for residents and their families. Residents can be confident that their needs will be thoroughly assessed and that these needs will be responded to within a culturally appropriate and supportive environment. Evidence: The statement of purpose was reviewed in September 2008. It was inspected. It provides a clear description of the service provided setting out the aims and objectives. The statement of purpose is complemented by the homes service users guide and a colourful brochure. The brochure is attractive with good quality pictures of the home. Although clear and easy to read the statement of purpose and service users guide are not in pictorial form. The manager said that the intention is to provide pictorial versions in the near future. The assessment information obtained for the two residents was inspected. There was more detail available for one of the residents as the second resident was staying for day respite at weekends rather than for overnight stays. The manager said that there Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: had been some difficulty in obtaining local authority assessment information. The local authority assessment for one resident had been carried out some time ago and did not have uptodate information, for example. However, there was a great deal of assessment information that the home had compiled and there was evidence that the service had engaged well with local health care professionals and the local learning disabilities service in responding to residents needs. The service sets out to provide an appropriate environment for Asian women. There are essential blocks in place to make this a reality. For example, the owners are Asian and speak Asian languages. And a number of the staff are Asian. One staff member cooked the evening meal so that culturally appropriate food could be provided. The specialist nature of the service also fits in with families of residents. One of the residents returned to her family at night and there was evidence of a good relationship between the service and the family. This arrangement will also help the resident to become familiar with the home so that future overnight stays can be smooth. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning arrangements are good with lots of support offered to residents to take part in an active lifestyle at the home and in the community. Evidence: The two residents care plans were inspected. One was more detailed than the other as this resident had been living at the home for some time. A good standard has been achieved. The care plans were clearly set out in sequential order and were easy to follow. There was evidence of a great deal of consolidation work that had taken place to address a residents health care needs. For example, there were details of remedial dental treatment as well as a health care assessment. There was also a record of a medication review carried out by the GP. In addition, there were plans in place to meet day-to-day care needs and evidence of input to encourage activities and healthy eating. The placement was relatively new and the home was waiting for a Speech and Language assessment as well as further details from the local authority. There was a detailed risk assessment on file. The manager was able to describe some of the risks, Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: such as road safety, that had been highlighted and addressed by staff at the home. The records are kept securely in the homes office. Both residents were spoken with and time was spent on the Sunday visit playing games and looking at art work and photographs that the residents had completed. Both residents were happy and get on well with staff. There were friendly exchanges and staff have created a warm, friendly environment. The resident who has stayed longest spoke about her activities which included swimming, going to clubs and the cinema as well as taking part in rehearsals for a Christmas show at a local theatre. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered a wealth of opportunities to lead active and healthy lifestyles. Staff support residents to a high degree to follow interests, be active and to eat healthily. Evidence: A very good standard has been reached in supporting and encouraging residents to develop, to engage in relevant activities and to enjoy active and healthy lifestyles. One of the residents is very active and has activities every day. These include taking part in rehearsals for a Christmas show, swimming, activities within the home in art, photography and computing as well as going to clubs and groups in the community. The resident is lively with lots of energy. The manager and staff felt that the resident had blossomed since coming to the home in that she is more active, more lively and keen to enjoy life. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Staff are good at supporting residents. During the inspection staff took a resident to the theatre, for swimming, to the dentist and spent time with her at the home playing games and doing art work. Such a level of activity may not be possible when the home is full. However, the home has set a high standard and has been able to demonstrate the benefits of full engagement with and support for residents. Healthy eating was discussed throughout the inspection. The manager and staff have encouraged the residents to eat healthily and take an interest in food ingredients. Staff helped the residents to make a fruit smoothie to drink, for example. This allowed staff to show the residents the ingredients before the drink was made. Residents go shopping with staff as an additional way of becoming familiar with food. The main meal of the day is in the evening and the preparation of this was observed. An Indian meal was being prepared by a staff member who is a skilled cook. She was showing another staff member how to prepare Indian food. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that their health care needs will be identified and that well thought out plans will be in place to meet those needs. Evidence: As has already been described, the manager and staff have been pro-active in addressing residents health care needs. They have engaged well with health care professionals and have supported residents in taking up health care appointments as well as following care regimes to improve, for example, speech, dental care and foot care. The current residents, require, in the main, prompting rather than direct personal care. Discreet checking and prompting from staff to residents was observed during the inspection. The medication records and storage arrangements were inspected. These were suitably arranged with medication being kept securely in the office. The Boots medication system is used which is a relatively straightforward system to use. A GP Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: had reviewed medication for one resident and the manager retained a good overview of the residents prescribed medication. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safeguarding adults arrangements are suitable but would be enhanced through staff receiving more training. The service is set up to receive complaints. There is a suitable policy. Evidence: There is a complaints procedure which is made available to residents, relatives and others. So far, no complaints have been made to the service. The policies and procedures file was inspected. The manager is in the process of reviewing some of the policies and procedures now that the service has been operative for some months. The safeguarding policy and procedure is suitable and the majority of staff have received safeguarding adults training. However, as the service is new, some of the staff have received training from other sources rather than organised by the home. It is recommended that the local authority be contacted with a view to staff receiving local authority safeguarding adults training. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Attractive, comfortable facilities are provided for residents. Evidence: A very pleasant, comfortable and attractive environment is provided. The home is in a large converted and extended house which has many attractive features. Each bedroom has en suite facilities and has been given a clean, modern finish. Skylights have been added to provide additional light. A premises tour took place where all the bedrooms were seen. The majority of bedrooms are empty but they will provide good accommodation for prospective residents. On the ground floor there is a rear extension providing a large dining and kitchen area as well as a large, comfortably furnished lounge. The garage has been converted into living space and integrated into the home as an extra space for residents. Currently, activities take place here and there is computer access as well as space for art and photography. There is a large, well cultivated garden to the rear with plenty of space as well as garden furniture for sitting out. There is no lift at the home. However, there are ground floor bedrooms so access for people with disabilities may be possible. Care Homes for Adults (18-65 years) Page 20 of 29 Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are pleasant, motivated and well supported. However, the staff recruitment process and staff supervision arrangements are not yet robust enough and need improvement. Evidence: Currently, four staff, in addition to the manager are employed. This number will rise when the numbers of residents increase. Three of the staff were met during the inspection. The staff hours vary with one member of staff providing the bulk of the hours at the moment. When the residents are at activities which do not involve staff, as was the case on the first day of the inspection, staff do not work. The staff were all friendly and helpful and were enjoying their work. They have a variety of backgrounds. Some with medical experience overseas and others with care experience in Britain. The manager has been successful so far in establishing a positive, open staff culture. The staff recruitment and training records were inspected. There is a need to establish a clear recruitment process. For example, there are no standard reference request letters and the application forms do not provide space for the applicants to state Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: referees. This may account for the fact that two references had not been obtained for all staff. This does not comply with The Care Homes Regulations 2001 and a requirement is given about this. In addition, there was no CRB or POVA/First record for one applicant available but it was sent to us following the inspection. The training records are better organised. There are records for each person which record what training they have completed. There were also induction records for new staff. Some of the staff have received training in other care settings. As more staff are recruited and the service becomes established the provider will need to organise specific training sessions for staff. Staff supervision arrangements were discussed with the manager. She advised that informal supervision has been held but that records had not been made. Formal supervision is needed and records must be kept. A requirement is given about this. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager runs the home very well using her relevant experience and social work background to good effect. There is positive feedback from relatives and this can be used as the basis for more detailed quality assurance initiatives in the future. Evidence: The manager is an experienced social work professional. She set up the business with her husband and this is her first entrance into care home provision. Her plan was to establish the service slowly and then increase the numbers of residents. On the evidence of this inspection she has established the service well, provided good outcomes for people using the service so far and is now ready to increase the number of residents. The managers previous social work experience has provided a useful background for the work. She is knowledgeable about residents needs and the differing ways of working with them. In addition, she provides careful, supportive management for staff. The home is too new to have sophisticated quality assurance systems in place. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: However, letters were available from relatives which provided some feedback about the service. Both sets of relatives were highly appreciative about the service provided. A more detailed quality assurance process can be established as more people move to live at the home. The records of servicing the homes equipment and installations were inspected. These were all available and uptodate. The only exception was that of fire drills. The manager advised that a fire drill was planned for the weekend following the inspection. Regular fire drills should be held. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 34 19 Two written references must 01/01/2009 be obtained for staff before they are offered work at the home. This demonstrates compliance and establishes staff identity and previous experience. 2 36 18 Staff must be provided with regular supervision. Records must be kept. Regular staff supervision is an important management tool which provides staff with support and an overview of care provision. 01/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 23 Consideration should be given to producing the statement of purpose and service users guide in pictorial form. Consideration should be given for staff to receive local authority run safeguarding adults training. Page 27 of 29 Care Homes for Adults (18-65 years) 3 34 The application process should be reviewed with the aim of having in place reference request letters as well as an amended staff application form. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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