Inspection on 22/07/05 for 3-5 High Worple

This inspection was carried out on 22nd July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

3-5 High Worple 25/05/07

3-5 High Worple 13/01/06

3-5 High Worple 04/01/05

3-5 High Worple 02/06/04

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 3-5 High Worple Rayners Lane Harrow Middlesex HA2 9SJ Lead Inspector Clive Heidrich Unannounced 22 July 2005 at 07:30h00 nd 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 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 Stationary 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. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 3-5 High Worple Address Rayners Lane Harrow Middlesex HA2 9SJ 020 8866 2867 020 8866 2867 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) ASRA Graeter London Housing Association Ltd Ms Dina Devshi CRH PC Care Home only 5 Category(ies) of LD Learning Disability 5 registration, with number of places 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 4/1/05 Brief Description of the Service: 3-5 High Worple is a care home providing personal care and accommodation for up to 5 people who have learning disabilities. The home specializes in the care of Asian people. There were no vacancies at the time of the inspection. The home is owned by ASRA Greater London Housing Association, a not-forprofit-making organization. The organisation’s head office, based in SE1, provides senior management support to the staff and manager of the home. The home was opened in 1998. It is a two-storey building that was not originally used for residential care but has been suitably adapted. The home is located within a residential area of Rayners Lane, within the London Borough of Harrow. It is around the corner from shops, pubs, and transport links including Rayners Lane tube station, and is close to a large park. The home has shared-driveway parking on each side. Parking restrictions apply on the road outside the home. All the home’s bedrooms are single, all fully furnished and with built-in sinks. The home has two bathrooms, and two shower rooms, all of which have toilets. Access to the first floor is by stairs. The home’s kitchen/diner and lounge afford it sufficient communal living space. The home has a reasonable-sized garden, with overlooking patio area that is easily accessible and well-maintained. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across one morning of a warm July day. It finished at 2:10pm. The inspector met with all five service users, using the support of an independent interpreter where necessary. Discussion also took place with the staff present, the manager, and a visiting health professional. The premises was inspected, including some bedrooms. Care practices were observed. A sample of records were checked through. The inspector thanks all involved for their patience and helpfulness with the inspection process. What the service does well: What has improved since the last inspection? The assessment and reviewing of risk factors involved with individual service users was now much more clearly documented. Service users continue to be supported to develop skills that involve the overcoming of manageable risks. The staff team have almost finished the NVQ level 2 courses in care. They have had refresher training in key areas such as health & safety and epilepsy care. The manager has also completed the NVQ level 4 in management. This gaining and reviewing of care knowledge should enable higher standards of care to be provided to service users. The inspector was impressed with the thought put into the moving-in processes for the two newest service users. These moves allowed each service user many opportunities to get to know how the home operates before moving in, allowed current service users to meet this new person before their move, and allowed management to assess as to whether they could meet the new person’s care needs. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 6 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. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 to 5 The inspector was impressed with the thought put into the moving-in processes for the two newest service users. It can be judged from this process that prospective service users’ needs are fully assessed, that they have good opportunities to see how the home operates before moving in, and that their needs continue to be monitored and addressed once they have moved into the home. It is also evident that the prospective service user is very involved with the moving-in process. EVIDENCE: The admissions procedures for the two new service users were checked through. Discussions with each service user did not shed any significant light on these processes. The record keeping in respect of their moves showed however an impressive process. Records showed that the home acquired key information about each service user, both through their own assessments and through community professionals, so that judgements could be made about whether the home could meet the service users’ needs. There were letters from the manager to the funding authority stating what additional support, if any, was needed. There were plans about initial visiting arrangements for each service user, including overnight stays. It was apparent that an established service user from the home was assigned to assist with 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 9 supporting each new service user with the moving-in process, which is judged as very enabling. An admissions checklist was in place and signed off by the keyworker and manager, for ensuring that all appropriate action had taken place once each service user moved in. It is recommended here that the new service user also sign off this form where possible in future. There were also detailed records of the key issues discussed with the service user and sometimes their family members. There were records of formal reviews of the trial period, which showed that all involved people attended the meeting and that key issues about the placement were discussed. The licence agreements for each new service user were on their files. Neither were signed, which the manager explained as being because neither placement was fully agreed. The licences would benefit from removing any reference to ASRA’s other homes, and from listing the furnishings expected within each room. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 to 9 Good attention to care planning and reviewing, that actively involves the service user, takes place. Service users are enabled to make decisions about their lives, with support from staff and other involved people where needed. Service users are actively consulted on, and participate in, all aspects of life in the home. Service users continue to be supported to develop skills that involve the overcoming of manageable risks. EVIDENCE: The filing systems used for each service user were judged as comprehensive. Many aspects of the keyworking file for each service user were written in the first person, and contained much evidence of the service user’s involvement. For new service users, an initial individual plan was set-up within days of their moving into the home for the formal trial period. The plan was then expanded on, to include a review and statements of goals, around a month later. Records and service user feedback found that work was progressing to meet these goals. There were also records of meetings between the keyworker and the service user to review and update on the goals. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 11 Records and feedback found that most service users now have advocates to support them with independent decision making. This ties in with the attitude of the home, that service users should wherever possible be making decisions for themselves. Risks were considered in writing within new service users’ initial visits to the home. Individual plans included reference to significant risks. A comprehensive risk assessment tool is used. It prompts for checks in a significant number of areas of possible concern, and in many areas of skills development. It is judged as easy to understand and use. Feedback from service users and staff showed that service users are encouraged to handle manageable risks with appropriate support, such as for travel training and kitchen independence. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 16 and 17. Service users are greatly supported to develop skills and live as independently as possible. They are part of the local community through a variety of activities including appropriate and individual weekday occupations. There are clear responsibilities expected of service users in the home. Food and meals are sufficient to meet service users’ needs. EVIDENCE: Service users as a whole gave positive feedback about how staff support them with personal development. There was a clear staff focus on service users doing what they can for themselves. A few service users however expressed the desire for additional staff support. In the opinion of the inspector, based on records and observations, staff and the manager pitch their levels of support according to the needs and abilities of each service user. Certain records also indicated that some service users are independently judged as improving skills from their time in the home. Service users spoke positively about community activities that they undertake. They noted that there is sufficient staff support for this where needed. Activity 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 13 plans were seen. Activities discussed included yoga, temple, shopping, and cinema. Service users also spoke of what they occupy themselves with by day. Individuals variously pursue college courses, work placements, and/or day care services. Those service users recently moved in have been supported to continue with such occupations, and have been supported to develop their interests into other schemes. This is judged as appropriate social support from the manager and staff. It was evident from feedback and observations that service users have keys to the house and their own room. One service user spoke about the process of getting a key replaced. There was a reasonable amount of food available throughout the kitchen. Service users confirmed that they often shop for their meals just before cooking them. A cleaning and laundry rota for service users was on display. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. Service users are fully supported to access the input of health and social care professionals where needed. There are strong processes to enable service users to be as independent as possible with medications. Minor improvements are needed to ensure that systems are sufficiently secure. EVIDENCE: Those service users spoken with about health needs spoke positively about staff support. They had no concerns with acquiring health care. Records showed that good attention was paid to the health needs of the new service users during their assessment process. Actions are also documented where support from community health professionals was judged as needed, both for new and established service users. Weight records were being kept up-to-date. Staff were aware of the key health needs of service users. The manager noted that one person self-medicates. They have a locked drawer in their room for this purpose. Other service users were supported to take their medication from a blister pack system. The records about service users having been offered their medications were mostly up-to-date. Some recent gaps were identified for one service user’s four-times-a-day medication. The manager must ensure that all medications are appropriately signed for. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Service users are able to express their concerns to staff and the manager, and can expect reasonable actions to be taken in response. Reasonable actions have been taken to protect service users from abuse. A minor improvement is needed to support staff with this. Robust actions are taken to investigate incidents and to minimise the chances of re-occurrence. EVIDENCE: All service users spoken with were able to positively say who they could raise concerns with. Two service users raised concerns with the inspector. It was apparent, through feedback from various sources, that the manager was aware of the issues and was addressing them. Both service users were satisfied with this. The complaints book showed summary details of one complaint raised by a service user since the last inspection. The manager explained outcomes from this. The staff member working during the visit was easily able to locate the new complaint forms that the home is now using. The manager emailed a copy of the revised adult protection policy to the inspector following the inspection. The policy was updated earlier in 2005, for the organisation as a whole, and was mostly suitable. The manager must ensure that it is easily accessible to staff at all times. The staff member present during the visit was able to locate the old version of the policy straightforwardly. Incident records being maintained appropriately. There were not many. Significant incidents are reported to the CSCI as is appropriate. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 16 The manager had followed up on a recent incident that she judged as posing significant risks, by acquiring the support of relevant community professionals. She was able to talk in detail about the incident and the agreed follow-up support. Records showed that these processes involved the service user in question. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28 and 30. The home environment meets service users’ needs. One shower area is recently refurbished, whilst the kitchen would benefit from this. Service users and staff all have responsibilities for cleanliness and hygiene. The home was suitably clean in most areas. EVIDENCE: The shower room in house #5 was seen to have been pleasantly refurbished as previously required. Service users reported no concerns about the environment. The home was generally observed to be comfortable and appropriate to service users’ needs throughout. The kitchen remained in a tired but workable state of repair. One service user spoken with was aware that it is to be refurbished but did not know when. The manager stated that she has been told that it is not a high priority within environmental work needed within the organisation. Its refurbishment is repeated as a requirement within the requirements list, so that service users do not have to put up with ongoing kitchen maintenance issues. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 18 The home was judged as reasonably clean throughout. The exception was the dining room table, which at mid-morning, long after all service users had had breakfast, had many grains of rice on it along with a few ingrained sticky patches. It must be kept clean, to minimise hygiene risks to anyone eating off it. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 35. Service users are supported by a consistent and established staff team who are continuing to improve their care knowledge through appropriate training. Staffing levels are upheld. EVIDENCE: Feedback from service users about staff in the home was positive. They were all happy with the staffing levels provided. Staffing levels during the week are of one staff in the morning, and two staff from mid-afternoon until late evening. At weekends, one of the two late-shift staff start work at around lunchtime. This slight addition of staffing hours ties in with slightly increased funding with relation to one service user. The staff roster for the week was on display on the kitchen notice board. The four permanent staff work all the day shifts and sleep-overs with occasional practical support from the manager, whilst the waking nights are worked by agency staff, some of whom have worked in the home a number of years. The staff and management team in the home has remained unchanged for at least two years now. Service users benefit greatly from this consistency. There is good investment in staff training. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 20 Staff have almost finished their NVQ level 2 courses in care. They have also had refresher training in key areas such as health & safety, and epilepsy care. This gaining and reviewing of care knowledge is enabling higher standards of care to be provided to service users. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42. Service users benefit from an appropriately-qualified home manager and a well-run home. Appropriate procedures are in place to protect the health and safety of everyone in the home. EVIDENCE: The manager’s certificate, of passing the NVQ level 4 in management earlier in 2005, was on display in the office. She stated that she also has a certificate in learning disabilities, gained from a local college three years ago, and an impending outcome for a psychology degree. These are considered to be very suitable qualifications for the role. Records and feedback showed that the manager runs the home appropriately. Recent certificates of professional health and safety checks for the gas, the electrical appliances, and the fire extinguishers, were seen to be in place. The assessment of risk from household chemicals (COSHH) was up-to-date and available in the laundry area. It included pictures of each item for ease of use. 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 4 4 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 4 3 4 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 3 x 2 Standard No 11 12 13 14 15 16 17 4 4 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x 4 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 3-5 High Worple Score x 3 2 x Standard No 37 38 39 40 41 42 43 Score 4 x x x x 3 x G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13(2) Requirement To ensure that all medicines received into the home are recorded and signed for. Timescale for action 18/9/05 2. 3. 20 23 13(2) 13(6) 4. 24 16(2)(j), 23(2)(b and c) (Timescale of 18/1/05 partially addressed) The manager must ensure that 1/9/05 all medications are appropriately signed for when administered. The manager must ensure that 1/9/05 the revised protection from abuse policy is easily accessible to staff at all times. Due to the general wear and tear 31/3/06 of the area as a whole, the kitchen is judged as needing refurbishment. (Timsecale of 1/6/05 not met) The dining room table must be kept clean of ingrained stains and loose food, to minimise hygiene risks to anyone eating off it. 1/9/05 5. 30 16(2)(j) 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 24 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 4 Good Practice Recommendations The admissions checklist, for ensuring that all appropriate action has taken place once a new service user has moved in, should be signed off by the new service user in addition to the keyworker and manager. The licence agreement between each service user, the care provider organisation, and the housing association, would benefit from removing reference to ASRA’s other homes, and from listing the furnishings expected within each room. The protection from abuse policy should include details about the actions that the organisation will take, should any staff member be accused of abuse, to protect service users and the accused staff member pending investigation outcomes. 2. 5 3. 23 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH National Enquiry Line: 0845 015 0120 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 3-5 High Worple G62-G11 S17539 3-5 High Worple V240640 220705 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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