Inspection on 03/01/07 for 11 Kenton Road

This inspection was carried out on 3rd January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

11 Kenton Road 24/02/06

11 Kenton Road 28/08/05

11 Kenton Road 06/01/05

11 Kenton Road 14/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 11 Kenton Road 11 Kenton Road Harrow Middlesex HA1 2BW Lead Inspector Clive Heidrich Key Unannounced Inspection 3 & 8th January 2007 9:00 rd 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 11 Kenton Road Address 11 Kenton Road Harrow Middlesex HA1 2BW 020 8423 8090 020 8933 0307 nigel.brookarsh@ntlworld.co.uk 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) Residential Care Providers Ltd Mr Rajnikant Vinodrai Joshi Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2006 Brief Description of the Service: 11 Kenton Road is a registered care home providing personal care and accommodation for 6 adults aged between 18 and 65 who have learning disabilities. The registered provider is Residential Care Providers Ltd., a small, local care organisation. The home is a three-storey house situated on a busy main road in Harrow. It is close to all community facilities and amenities. Community transport is accessible but the home also has its own car. Initial registration was in 2000. All the bedrooms are single with no en-suite. There is a rear garden with seating which is accessible through the kitchen or the dining room. At the time of the unannounced inspection, the home had full occupancy. Information about fees, and the Service User Guide, are available on request from the provider organization. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home has been in contact with the CSCI since the last inspection, in respect of the application of a new manager, Mr Joshi. This was completed in May 2006. The previous manager, Mr Brookarsh, remains the owner of the organisation running the home and provides line-management support. The inspection took place across two weekdays in early January. It lasted just under fourteen hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. Only two service users were able to provide verbal feedback about how they found care services in the home. Other service users have limited verbal ability. Consequently, to uphold confidentiality of views about the home, feedback from staff or service users is collective referred to throughout this report as ‘feedback’. The inspection process also involved observations of how staff provide support to service users, checks of the environment, and the viewing of a number of records. The manager was present throughout, and was provided with overall feedback at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? Previous inspection requirements have been addressed. This includes for new carpets and flooring in key areas of the home, and keeping records of goalprogression for service users. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 6 The standards relating to service user assessments, community presence, and hygiene within the home, are all on this occasion judged as exceeded. This improves on previous inspection reports. In each case, there was evidence of outcomes for service users being better than the minimum standards, for instance with service users having very active lifestyles that reflect their individual wishes. New systems of overseeing accidents and incidents, and of providing clearer care plans that better involve service users, were just starting to be implemented at the time of the inspection. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are excellent standards of assessing prospective service users’ needs, through using many avenues of evidence including the views of the service user and their representatives. Prospective service users also have good opportunities to visit the home and find out about the service. The only improvement needed here is with ensuring that all service users have a copy of the Service User Guide, as none had this at the time of the inspection. This can disempower. EVIDENCE: One service user has moved into the home since the last inspection. There were feedback and records to show that this was a considered process which included assessment of the service user’s needs, acquiring information from the funding authority about the service user, and the service user visiting the home before committing to move in. There has consequently been a formal review meeting to consider how well the home is meeting the service user’s needs, which was held about ten weeks after moving-in. Reports from this were positive. There was a suitable initial assessment of the service users’ needs, using the standard HALO format. There was additional paperwork and feedback to show 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 9 that suitable discussions and assessments were undertaken about how the home would meet the service users’ needs, involving the service user, their family, a social worker, and representatives from day care placements. The manager noted that the assessments have greatly involved the organisation’s owner, and that some previous assessments have identified that the home was not able to meet other service users’ needs. The standard of assessment is consequently considered to be exceeded. It was ascertained that none of the service users have a copy of the service user guide. This prevents, to varying degrees, service users having full information on how the home operates and their rights within this. The manager agreed to address this. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are generally provided with assistance where appropriate to make decisions about their lives. They are also able to take considered risks as part of becoming more independent in their lifestyles. New care-planning systems are being introduced to enable service users to be able to participate suitably in their care plans. Current systems lack suitable service user involvement. The new systems must be fully implemented in due course. EVIDENCE: The files of three service users were checked through in respect of care plans and risk assessments. The vast majority of these had been reviewed by the manager within the previous month, updating on previous reviews from 2005. Very little was found to have changed. This contrasted with feedback about how service users have progressed and developed. The reviews additionally did not show evidence of involving the service user, or their representatives where 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 11 needed, which is necessary for the assessments and plans to be fully personcentred and to better ensure that service users’ personal goals are incorporated into the plans. The manager showed a revised care plan format that had recently been set up for one service user. This approach brought together all support areas into one document, and included an area for comments by the service user and/or their representative. The manager noted that these would be reviewed regularly, and that service users would be provided with a personal copy. This will improve service users’ ownership of the agreed support that they should be provided with, and will ensure that the plans reflect each service user’s personal goals. The manager must ensure that this is fully set up for all service users. For those service users checked on, formal review meetings were found to have been held within the previous six months. There were recorded plans for each service user to have a further formal review meeting in January, and then for four-monthly follow-ups of this. Social workers, family, and day care stakeholders are invited to the meetings along with the service user and relevant staff from the home. The home sometimes lacked fully up-to-date records of these meetings, either from the social worker or from the records not being typed-up and hence circulated to relevant people. This can prevent agreed actions at the meeting from being followed through. It is recommended that this be addressed. There was reasonable evidence of service users making decisions about their lives. Breakfast was for instance, observed to be at different times and with different foods for different people. Staff responded to communications from those service users who can speak little, to attempt to provide the support that they understood was being asked for. Staff were seen to liaise with service users about what they wanted to do for evening activities, and supported service users to be ready in time for their day occupations. There was feedback about residents’ meetings being used to make decisions about the home, for instance with the menu and holidays. The meetings were recently being held at a three-weekly frequency. To help some service users to be able to use the meetings better, it is recommended that the minutes of the meetings be easily available rather than stored within the office. The manager agreed to address this. There were written risk assessments in place where it is individually assessed about a restriction in a service user’s service, for instance with keeping an item of furniture locked unless support is present due to risks of accident. Other risk assessments, for instance for community presence and ability to leave in the event of a fire, were also in place as applicable. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 12 There was feedback about how service users have been supported to become more independent including in areas where some hazards are present, such as one service user becoming independent with using public transport. Suitable precautions were taken to minimise risks and maximise the chances of the service user being successful. Similarly, one service user is reported to have moved out to more-independent living, having gained sufficient skills whilst at the home. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are good standards of supporting service users to follow individualised activities, both in the community and at home. Visitors are welcomed and encouraged, with individual relationships supported by the service where needed. Service users are consequently generally very active, with the home a lively place to live. Service users are encouraged to develop and maintain skills depending on their individual needs and choices. Independence is encouraged wherever possible, and service users’ rights are overall respected. The home provides a good standard of home-cooked and healthy food, with individual diets catered for. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 14 EVIDENCE: There was good feedback about service users being provided with opportunities for personal development. This included about how staff have supported a service user to become independent in the use of public transport, about working on continence skills, and service users becoming more involved in household tasks such as hoovering and emptying the bins. The latter point was observed, with staff making respectful requests and service users appearing happy to be involved. The ethos appears to be about enabling each service user as much independence as is safely possible, which is appropriate as it values the person and can help to develop skills. Records are kept regularly about the development of certain skills depending on each service user’s goals. Checks of these found the records to be very repetitive and lacking in review and progress. This was discussed with the manager. It is recommended that these records be reviewed regularly, with the next step of the skill being highlighted for support and recording about as applicable. This should further help the skill development and make the records more purposeful. Service users were found to have very good standards of occupations and community involvement. A mixture of three day-services, one work placement, and individual college courses are provided in the community for different service users at different times. Feedback about these places was positive. Staff provide transport support where necessary, as the home has a sevenseater car and four drivers within the staff team. One other service user is based at home during the week, but has people such as a play therapist visit on most days, which the service user was seen to respond positively to. The service user was also observed to be supported to go for a walk on each day of the inspection. Feedback and records showed that service users are much involved in attending local activity clubs. Different service users use the community for such things as going to the library, shopping, for meals out, for yoga classes, and for swimming. There was a strong sense of the activities being led by individual service users’ wishes, but that opportunities for other service users to attend are also pursued by staff where possible. The home was found to be pleasantly decorated for Christmas, with plentiful seasonal food still available. There was feedback about staff and service users going out for a Christmas meal together, about a Christmas party at the home with a DJ, and about Birthdays being celebrated by the home. There was also feedback about a successful group holiday in 2006 to the coast, and records about 2007’s holiday starting to be planned. The standard of community presence is consequently judged as exceeded. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 15 The manager noted that visitors are welcome anytime, as confirmed by feedback. Support is provided by staff to help more dependant service users to visit their relatives regularly. There was feedback that service users are encouraged to make new friends where possible, and that these people are made welcome in the home. There was also feedback that service users can use the house phone anytime. There was evidence of service users being provided with involving 1:1 sessions in the home, and of the home generally being a lively place to live in. The manager noted that in his experience, involving and engaging service users more contributes to them feeling valued and content. He cited examples of a few service users who have become less withdrawn since living in the home. Service users were seen to smile a lot, and many could successfully initiate contact with staff and the manager. Service users were generally seen to have the freedom of the home, with only the sensory room and office kept locked. The front door has a warning alarm released by number code, preventing service users from being locked in but notifying staff should anyone leave the house. One service user has a key to their room, which they are reported to lock sometimes. Consideration should be given to providing keys to all service users, to further empower them. There was feedback that staff knock at service users’ doors and await permission before entering. There was feedback about the food being suitable and healthy, and that cultural diets are provided to reflect the cultures of the service users. Dietary restrictions are respected, including through reminder notes within the kitchen, and the use of vegetarian equivalents where practical. Decisions about meals are made in residents’ meetings. Different diets are provided for. A week’s menu showed that a reasonable diet is provided, with a clear attitude of healthy home-cooking. The inspector was kindly invited to stay for an evening meal. There was a friendly and chatty atmosphere at the meal, with staff sitting and eating with service users equally. The meal was an appetising, home-cooked, vegetarian shepherd’s pie with vegetables, along with a dessert. Everyone ate it, with some requesting and receiving small second-helpings. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive a good standard of personal support, including in respect of appearance, hygiene, and health matters. They can expect good support with meeting their health needs including through accessing healthcare professionals. Service users can self-medicate with support as needed. Staff provide suitable medication support for other service users. Improvements are however needed with formalising homely remedy procedures including via GP input, recording dates of opening on liquid medications, and recording about allergies consistently. EVIDENCE: Service users were seen from the start of the inspection to be wearing a good standard of individually-fitting casual clothing, and to have clean and wellmaintained appearances. Some service users need significant support with personal care, which suggests that they must be receiving good support from staff where needed. The inspector also observed staff prompting service users with the upkeep of hygiene and tidiness of clothing. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 17 Records and feedback found that service users are supported to attend individual health professional visits, such as the psychiatrist and for specialist footwear, where needed. Records about health visits within service users’ files were not always up-to-date, which is referred to further under standard 41. It was however established from further feedback that service users are up-todate with health check-ups such as at the dentist and the opticians. There was also evidence of praise from health professionals about the upkeep of individual health procedures. This tallied with feedback and observations of staff being duly diligent with providing medications and skin creams. Records also showed that frequent checks of service users’ weights are undertaken, with actions planned where needed. As per standard 17, the home aims to provide healthy meals. There was written guidance for responding to the epilepsy of one service user, and certified health authority training from late 2006 for some staff in respect of epilepsy. The manager explained about significant learning acquired from this course, which he was consequently liaising with health professionals about in respect of the epilepsy practices in the home. The home uses a local pharmacist to provide pre-filled NOMAD dosettes for some service users, and tablets in bottles and packages for others. Monthly stock-checking takes place to help ensure that medicines are kept and used correctly. Medication is securely stored in locked cabinets. One service user self-medicates. Their medication was also found to be securely stored during the inspection. Checks of three service users’ medications found records to be up-to-date and medications to tally with records. There are also clear records of medications being brought into the home, and of any returns to the pharmacist. Checks of liquid medications found that most did not have a date of opening on them. This has the potential to allow the medication to be kept too long and hence the effectiveness of the medication to be reduced. Guidance on this was provided to the manager on the second day of visiting. Dates of opening must be recorded, with consequent disposal where applicable. It was found that a few over-the-counter medications that are provided to service users. The manager reported about the effectiveness of these medications in some cases. Whilst this is encouraged, the medications have not been checked by the GP in case of unsuitability to individual service users. There is also no guidance about scenarios for the giving of these medications and when consequent referral to the GP is needed. This could all put service users at some risk of adverse reactions from these medicines. The manager must request GP clarification about providing specific homely remedies to each service user, and consequently produce written guidance for each service user. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 18 The personal profiles of two service users listed them as having allergies to certain items. Their medication records however recorded them as having no allergies. This could lead to a prescription of medication that may contain the allergic substance. The manager must establish the validity of the allergy and ensure that it is listed within medication sheets. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are reasonable systems in place to help protect service users from abuse. The home has an accident and incident recording system that is recently improved on, and provides training for staff on abuse awareness. The home has a practical system for ensuring that service users’ views are listened to and acted on. However, improvement is needed with ensuring that service users are aware of how to complain, as this was not in place at the time of the inspection. EVIDENCE: There was suitable feedback to suggest that service users are able to raise concerns and have staff address these. It was found however that service users do not have a copy of the complaints procedure. This can prevent awareness and ability to raise complaints. The procedure was itself found to have pictures to help explain the process. The manager confirmed that service users can raise complaints, noted that complaints are opportunities to improve the service, and agreed to ensure that the procedure is made available to all service users as required. There have been no complaints to the CSCI since the last inspection. The last entry in the complaint book dated from 2005. Consideration should be given to keeping the book more secure within the office, as it currently is accessible to all staff and hence is not sufficiently confidential. Staff also have a complaint form within which to initially log complaints that are raised. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 20 The home has a separate incident and accident file. It showed diligent recent recordings of accidents to service users including about falls, about when unexplained bruising is found on service users, and about any occasional incidents of physical aggression from service users that harm another person. The manager showed that a recent system of considering the month’s entries has been set-up, to help minimise the risks to service users in respect of particular entries or trends in entries. This is useful. The manager could also explain suitable responses to entries in the file, such as with investigating how a bruise occurred. Good practice would however include making a record of awareness of each entry and of any consequent investigation. The manager agreed to address this. There was feedback that there have been significant decreases in the behaviours of some service users that challenge. For instance, the use of a toy animal for one service user to relate to, based on a therapist’s recommendation, has assisted them. This was observed in action when the service user became excessively excited. The manager also spoke about working with some reclusive service users who are now much more open to joining in, which he explained was significantly due to positive interactions with the service users. There was a calm and cheerful ambience in the home, with most service users seen to be spending much of the time smiling, and some interacting a great deal. Staff were able to respond appropriately to abuse scenarios during discussions with the inspector. They reported having had training in abuse-prevention including through written testing. Criminal Record Bureau checks are in place for staff. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has excellent standards of hygiene and cleanliness, through staff and service user efforts. The home is generally spacious, well-furnished, and homely, so suiting service users’ general needs. This includes service users’ bedrooms. Improvements are only needed with some minor maintenance issues relating to bathrooms and toilets. EVIDENCE: The home is an adapted residential house located on a busy road just outside the centre of Harrow. It is consequently close to public transport and shops. The home has a lounge with comfortable seating for ten, a dining area that seats eight, a kitchen, an office, and a sensory room. The garden is compact and private, and is suitably looked-after. There are toilets on each of the three floors, with baths on the ground and first floor, and a newer, enclosed shower11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 22 cubicle also on the ground floor. The environment is overall comfortable and homely. Feedback about the home’s environment was mainly positive, including satisfaction with bedrooms. A tour of the home included the viewing of three bedrooms, usually with the support of the applicable service user. Bedrooms were found to be spacious, well-kept, with suitable furnishings, and with many signs of individuality. They were also suitably warm, and had covered radiators and window-restrictors where necessary. The carpets in the lounge and the dining room have been suitably replaced as required at the previous inspection. A small number of maintenance issues were identified for addressing during the tour. These were: • The toilet seat in the toilet next to the office being attached only via one of its two hinges. This could cause an accident. • The first-floor bathroom window area had very-flaky paintwork and a blind that was significantly blackened by mould. This is not suitably homely, and could be a health & safety issue. • The downstairs bathroom had a number of minor patches in its paintwork, and an old water stain on the wall near the shower. In terms of décor, these issues should be rectified. • The top-floor toilet door could not shut due to the door not quite fitting correctly. This prevents suitably privacy. The manager agreed to ensure that these issues are addressed. The home has a laundry room on the top floor. It contains two washing machine and two tumble-driers. One machine has sluicing and disinfection facilities. The room also has a sluicing sink and a hand-washing basin. Feedback, and signs in the room, showed good attention to infection control, including that one machine is used for kitchen hand-towels only. Staff are responsible for all cleaning in the home. Service users were observed to provide support when asked, and there was feedback about some service users developing skills in this area. The house was found to be suitably clean and tidy from the start of the inspection, which feedback confirmed is how the home usually is. Attention was being paid to infection control practices during the visit, and there was a supply of protective clothing in this respect being used. There were no lingering offensive odours noted during the visit, which again suggests suitable and effective cleaning. The standard on hygiene is consequently judged to be exceeded. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a consistent and capable staff team who are provided on shift in sufficient numbers to meet minimum standards relative to the number of service users present in the home. Staff are provided with training, including some staff undertaking NVQs. However, significant improvements are needed with keeping clear records of training undertaken and planned for, as there was little available during the inspection. Service users are protected by the home’s recruitment procedures, however improvements are needed with ensuring that the paperwork about recruitment checks is at a suitable standard to meet legislation. EVIDENCE: Staff were generally observed to be focussed on working with service users whilst most service users were at home. When all those going out had gone, staff attention turned mainly to cleaning and maintenance duties, 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 24 administrative work, and support of the one remaining service user. There was a clear commitment to the work amongst those staff seen. Feedback from staff, and about staff, showed that staff have a clear understanding of service users’ individual needs, and a suitable knowledge of good care practices. There was also sufficient feedback to show that staff are supported in their roles within the home, and that there are enough staff working in the home. Three weeks of roster from late December to mid-January were checked on. The home is ordinarily expected to have three staff working at all times of day and evening, with one staff sleeping-over. There were a number of occasions when only two staff were working. However, the manager explained that at weekends and bank holidays, some service users are away with family, and hence only two staff are needed. This is reasonable. It was also found that the manager provides cover where needed, including at weekends. During ordinary weekdays, the levels of three staff were upheld. The organisation has its own system of ‘bank’ (as needed) staff. The manager explained that the majority of those used are either in that position long-term or were previously permanently employed, hence they are generally wellknown to the service users. Consequently, agency staff are not needed. One person in the home has an NVQ qualification according to the manager. Two are currently undertaking NVQ courses, with two more registered to start shortly. Depending on ability and roles within the home, the courses being undertaken are at levels 2 and 3. It is consequently envisaged that the there will be 50 of staff with the NVQ qualification in place in due course, as expected under the National Minimum Standards. There were suitable induction training records in place for a staff member who started work in 2006. This was in the form of a standard and suitable document that had been signed and dated throughout by the staff member and the manager. This took place with reasonable timeliness. The manager noted that senior staff have attended ‘training the trainer’ courses so as to provide specific training to other staff in the organisation. Staff fedback positively about training received in the home, and there was no practical evidence of training shortfalls. The manager was open that training records were not up-to-date, stating that this was one of his current tasks in conjunction with undertaking staff Personal Learning Plans. It was also found that certification was not always in place for individual staff members despite internal training and written testing having taken place. It would currently be difficult to check that all staff have had suitable training, consequently making the planning for future training haphazard. The manager must ensure that individual staff training records are up-to-date. Where there is then found to be a gap in the key training areas of food hygiene, manual handling, 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 25 emergency 1st aid, health & safety, and abuse-protection, or if any such training has become out-of-date, further training must be provided. The recruitment records of two recently-appointed staff members were checked. It was found that Criminal Record Bureau disclosures were in place before they started working in the home, as expected. There was written evidence of application forms, interviews, and health declarations. Full employment histories are requested. Where this is not forthcoming, the manager stated that it is checked at interview. Good practice would be to record the findings. The manager stated that identification checks and two written references are always undertaken. The manager noted that phone checks of referees are undertaken, as is good practice. Records of this should additionally be kept as evidence. In both cases, there was a suitable written reference in place for the last employer of a care capacity, as expected. In one case, the second reference was not found. The manager noted that the original was supplied before employment, and efforts were made to provide a copy of the it after the inspection. In one case, there were written records of identification checks instead of a copy of the proof of identification. The manager noted that this is being addressed. Consequently, it appears that all suitable recruitment checks are undertaken, but that improvements are needed with holding evidence of this sufficiently. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a home that is appropriately-run by the manager, with an ethos of the development and respect of the service user in place within the staff team. There are strong support systems, such as through shiftplanning and keyworking, in respect of this. There are also suitable health & safety systems in place in the home. The home lacked a formal quality assurance system at the time of the inspection. This must be addressed, to enable service users and their representatives to fully contribute to the development of the home. Some improvements are needed with record-keeping in the home, in respect of organisation of files so that current information is clear, and with keeping some records up-to-date. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 27 EVIDENCE: The manager had been in post in this home for approximately nine months at the time of this inspection. He has three years’ experience of working in the home and the field, and has previous management experience. He came across as competent and conscientious in his management approach, including in respect of service users’ rights and needs. It is noted that he continues to work approximately one shift a week directly with service users, that he is present during some weekends, and that he continues working towards the achievement of the Registered Manager’s Award. Staff fedback positively about the support received in the home, and about the positive and caring management ethos towards service users and staff. Records showed good evidence from staff of a supportive attitude to colleagues and service users. There was a strong sense of organisation in how staff operate in the home. This includes through clear shift-plans that reflect individual service users’ needs, completing checklists of tasks, handover meetings, and positive feedback about the team working together for service users’ benefits. Some improvements are needed with the organisation of service users’ files to make them more-easily accessible and meaningful to staff. It was sometimes found that care plans contained different guidance in respect of the same need, despite recent reviews. There was also some older documentation mixed in with newer guidance. Where records are not up-to-date or the latest guidance, they must be separately archived so as not to confuse. There were also cases found of health appointments taking place but with no record in the service user’s health section of their file. Other records confirmed the attendance, however the manager agreed that an entry about the outcomes of the visit should be within the file to enable easy access to a recent medical history. This must be kept up-to-date. The manager was open that the home does not currently have a quality assurance system. Such a system is needed to ensure that all stakeholders are consulted about the overall quality of care that the home provides, and for there to consequently be evidence of year-on-year development of the service. Plans are being formulated to address this. There were however some other systems of helping to uphold quality. The provider undertakes monthly care-auditing visits that include discussions with service users, from which reports of the visit are provided to the CSCI. Service users receive individual formal review meetings within which they and other stakeholders can express views about the service. Service user meetings have also recently been restarted. 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 28 Professional checks of equipment in the home were generally found to be in place. This includes for the fire system and extinguishers, the gas, the electrical wiring and for portable electrical appliances. There was no formal check against legionella, which the manager stated was being addressed. This is recommended for completion promptly. An overall risk assessment of key hazards around the home was in place. There was also a specific fire-safety risk assessment for the home, and individual assessments of the ability of each service user to evacuate safely. The overall assessment was dated from 2004, and so should be updated in case of any aspects of it having become out-of-date. The fire bells were checked during both days of visiting. They are ordinarily checked weekly. Staff undertake other health & safety checks according to set frequencies, including monthly health & safety audits and weekly tap-water temperature checks. One minor health & safety issue was brought to the inspector’s attention during the first day of visiting. It was found to have been suitably addressed by the return visit through rearrangement of furniture. There was otherwise nothing of concern observed or fedback about. 11 Kenton Road DS0000017542.V325349.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 4 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 X 30 4 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 2 3 X 11 Kenton Road DS0000017542.V325349.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. Standard Regulation Requirement The manager must ensure that all service users receive a copy of the home’s Service User Guide. The manager must ensure that service users and their representatives are fully consulted, where practical, about the contents of the service user’s care plan. Where practical, the service user must be supplied with a copy of the plan. Dates of opening must be recorded on liquid medications, with consequent disposal where applicable. The manager must request GP clarification about providing specific homely remedies to each service user, and consequently produce written guidance for each service user in this respect. The manager must establish the validity of the allergies listed in some service user’s files and if applicable ensure that these are listed within medication sheets. Timescale for action 01/03/07 1 YA1 5(2) 2 YA6 15 01/04/07 3 YA20 13(2) 01/02/07 4 YA20 13(2) 01/03/07 5 YA20 13(2) 15/02/07 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 31 6 YA22 YA24 7 YA27 8 YA34 9 YA35 10 YA39 The manager must ensure that 22(5) service users all have a copy of the complaints procedure. The following maintenance issues must be addressed: • The toilet seat in the toilet next to the office must be made fully secure. • The first-floor bathroom23(2)(b, window paintwork must be d) redecorated, and the blind replaced. • The top-floor toilet door must be adjusted so as to be able to shut and lock easily. The manager must ensure that all recruitment check records required under legislation are in 17(3)(b) place for all staff before employment begins. There were occasional shortfalls in this respect during the inspection. The manager must ensure that individual staff training records are up-to-date. Where there is then found to be a gap in the key training areas of food 17 s4 pt hygiene, manual handling, 6g, 18(1c) emergency 1st aid, health & safety, and abuse-protection, or if any such training has become out-of-date, further training must be provided. A formal quality assurance system is needed to ensure that all stakeholders are consulted about the overall quality of care that the home provides, and for there to consequently be evidence of year-on-year 24 development of the service. A report from this annual process must be provided to the CSCI and made available to all stakeholders. 01/02/07 01/03/07 01/03/07 01/03/07 01/08/07 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 32 11 YA41 17(3)(a) Where records in service users’ files are not up-to-date or the latest guidance, they must be separately archived, so as not to confuse about the current practices. Service users’ health records must be kept up-to-date. 01/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA6 YA11 YA16 YA22 Good Practice Recommendations It is recommended that minutes of individual service users’ formal review meeting be kept clear and up-to-date. It is recommended that the skills development records of service users be reviewed regularly, with the next step of the skill being highlighted for support and recording about as applicable. Consideration should be given to providing room keys to all service users, to further empower them. Consideration should be given to keeping the complaint book more secure within the office, as it currently is accessible to all staff and hence is not sufficiently confidential. The manager should ensure that every entry in the accident/incident book is signed off by him, including records of investigations where necessary. The downstairs bathroom should be considered for further redecoration, to mask stains and gaps in the paintwork. It is recommended that records be kept both about any exploring of gaps in the work histories of employment candidates, and about any follow-up phone references undertaken in support of their written references. There should be a professional check against legionella in place. The fire-safety risk assessment should be updated annually. 5 6 7 8 9 YA23 YA24 YA34 YA42 YA42 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 11 Kenton Road DS0000017542.V325349.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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