Inspection on 23/01/07 for 3 Salmon Street

This inspection was carried out on 23rd 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Salmon Street 11/11/08

3 Salmon Street 08/02/06

3 Salmon Street 01/09/05

3 Salmon Street 16/03/05

3 Salmon Street 01/06/04

3 Salmon Street 05/02/04

Similar services:

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

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

CARE HOME ADULTS 18-65 Brian Ward House Brian Ward House 3 Salmon Street Kingsbury London NW9 8PP Lead Inspector Andreas Schwarz Key Unannounced Inspection 23rd January 2007 09:00 Brian Ward House DS0000054415.V325281.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 Brian Ward House DS0000054415.V325281.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. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brian Ward House Address Brian Ward House 3 Salmon Street Kingsbury London NW9 8PP 020 8200 6718 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) Walsingham Manager post vacant Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th February 2006 Brief Description of the Service: Brian Ward House is one of 40 care homes operated by Walsingham since 1986 to provide accommodation and care support to adults with learning disabilities. The home is located in Northwest London close to Wembley with easy access to a range of public transport services, shopping, leisure and community facilities and services. The home is also close to a range of health and social care facilities and services. It is a detached property with single room accommodation for up to 5 residents. One bedroom has en-suite facilities. At the time of this inspection, there were five residents living at the home. There is also a staff sleeping room for night duty cover. The home provides 24 staffing cover with on-call support from the manager. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place during a day in January 2007. The manager Ms Andrea Cully was available throughout this key inspection. During this key inspection the home was visited by Margaret Dunbobbin (Operation Manager Central and Southern) for a monthly unannounced provider visit (Regulation 26). The inspector spoke to the Operation manager, three members of staff and observed staff interacting with residents. The inspector viewed a range of files and documents during this key inspection. All the above assisted the inspector in making an objective quality judgement on the home. The inspector would like to thank all involved during this key inspection for being helpful and open. What the service does well: What has improved since the last inspection? The home has met four of the five requirements made during the last key inspection. The home has employed Ms Andrea Cully as the permanent manager. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Brian Ward House DS0000054415.V325281.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 Brian Ward House DS0000054415.V325281.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New prospective service users receive detailed information about the home, prior to being assessed appropriately, to establish if the home is able to meet the needs of new prospective residents. EVIDENCE: The home did not have any new referrals since the last key inspection. The inspector viewed two needs assessments, which have judged to be of good standard and compliant with National Minimum Standards. The home has a moving in and out policy in place and the manager demonstrated good knowledge and understanding of the assessment process. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are of good standard and service users involvement is evident throughout the care plans. Residents can make choices of they want to do, this was observed during this inspection. The home has detailed risk assessments in place. EVIDENCE: The inspector viewed two care plan files and case tracked one resident during this key inspection. Care plans viewed by the inspector have been detailed and the home is using the Person Centred Planning Approach. Care plans are available in a user-friendly format. The manager informed the inspector that care plans are reviewed internally and residents are involved depending on their ability. The inspector informed the manager that care plans have not been signed and dated following a review, which is required. The care plan has been reviewed in July 2006 and the social worker has been involved in this process. The home is using a key worker system. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 10 Residents are encouraged taking part in the community, records showed that the home is supporting residents in the community, i.e. one resident went to a carol service for Christmas, some residents did some personal shopping, etc. All staff spoken to informed the inspector that they do find it difficult due to the number of staff on shift to give service users a full choice, or do activities spontaneous. The inspector discussed this with manager and staffing rotas confirmed, that on average two staff work in the morning and two staff work during the evening. The manager informed the inspector that she is currently exploring the option of a middle shift, which is seen as a positive decision for residents and staff. The inspector recommends exploring a higher staffing ratio to support service users in activities, etc. The inspector viewed service users financial records, which have been of good standard. The manager informed the inspector that she is still in the process of opening bank accounts for residents, which was recommended previously. The home has detailed risk assessments for residents in place, which have been reviewed and updated when required. Service users are involved in this processes depending on their abilities. All risk assessments have been signed and dated by key workers and/or risk assessor. Residents with physical disabilities have a manual handling assessment in place, which was undertaken by the physiotherapist. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is supporting residents to live a full, culturally appropriate and stimulating life. Residents can choose where to go, what to do and what to eat and are involved in the planning of activities. EVIDENCE: Residents living at the home attend local day services. Staff accompanies residents to the day centres and local taxi firms provide transport. The inspector noted that the transport costs are very high and recommends exploring more economic transport alternatives. Day centres provide structured learning opportunities for residents and day service staff is involved within the care planning processes. None of the residents are in any formal employment; the manager however informed the inspector that the home is currently exploring this for one resident. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 12 Residents access the local community by using public transport or taxis. Daily records demonstrate that residents go to do personal shopping, visit the Royal Albert Hall for a concert, visit the library, etc. As raised earlier a higher staffing ratio would give residents more choice in this area. The home does not have their own vehicle. Residents are registered to vote and the staff team reflect service users cultural and ethnic background. Some residents attend the local church on Sunday for worship and the manager informed the inspector that the home did offer in the past to visit the temple, but service users showed no interest in this. Residents are able to maintain friendships and relationships in daycentres and by attending social clubs in the evening. Family’s involvement in service users live and care is encouraged and supported by the home. The organisation has a relationship policy in place. All residents living at the home have their own key, which most of the residents keep in their purse. Staff were observed treating residents with respect and have been seen knocking before entering a room. Service users have been observed of staying in their room and listen to music for relaxation after a busy day in the daycentre. The inspector observed service users moving around freely during this visit and depending on their ability residents are involved in household chores such as washing up, clearing the table, putting away dishes, etc. The home has clear rules about smoking in place. The home has a varied menu in place, which is discussed with service users regularly. The fridge was well stocked and temperature is taken daily. The home is providing high calorie food for some residents and dieticians are and have been involved. The home is recording individual choices and a picture menu is used for residents to choose what they would like to eat. Breakfast was observed and residents are not rushed and the mealtime was a social occasion between staff and residents. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users health is managed appropriately and residents are encouraged to be as self-managing as possible. EVIDENCE: Residents have detailed personal care guidelines in care plans and staff demonstrated good knowledge of service users wishes regarding their care plan. One resident is using a wheelchair, which has been serviced. The home can access specialist services via the Brent Learning Disabilities Team. All residents have a designated key worker and likes/dislikes are recorded in service users files. All residents are registered with a local GP and the inspector has viewed detailed records of these visits. The GP has reviewed service users medication and service users continence is assessed and monitored. The manager informed the inspector that residents have visited a chiropodist, but records of these visits have been incomplete. The manager must ensure that all staff Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 14 maintains service users health records. Residents can be visited by a health professional in their room if they wish. None of the residents living at the home self medicate and all residents have a detailed medication care plan in place. The homes medication policy is compliant with National Minimum Standards and is available in pictorial format. The home is using the Boots Monitored Dosage System and records have been of very high standard. The inspector viewed clear guidelines for staff in how to dispose of medication. Medication Administration Sheets did not have any gaps and service users allergies are recorded. The home has detailed guidelines in place for the administration of rectal diazepam and liquid medication bottles are signed and dated after opening. All staff has attended medication training. The inspector recommends using syringes, when measuring liquid medication. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to raise their satisfaction and dissatisfaction of services and support received at the home and are protected from abuse neglect and self-harm. EVIDENCE: The home has a complaints policy in place, which is available in pictorial form and is compliant with National Minimum Standards. No complaints have been received since the last inspection. The inspector viewed very positive compliments from visitors, “ Home is relaxed and comfortable”. The home has a detailed Protection of Vulnerable Adults policy in place. The manager informed the inspector that she has misplaced Brent’s Protection of Vulnerable Adults procedure, which must be obtained. Staff has attended Protection of Vulnerable Adults training. The home did not have any Protection of Vulnerable Adults issues since the last inspection. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely but dated environment, which is clean and free of any offensive odours. Service users are encouraged to bring their personal possessions. EVIDENCE: The premise is a two storey detached house, with a large well-maintained garden. On the ground floor is a kitchen, dinning room, lounge, one service users room and shower room. On the first floor are the remaining bedrooms and a spacious office. The inspector noted that there was a crack on the kitchen ceiling, which must be repaired. Service users rooms are spacious and service users pictures and possessions are on display. The inspector noted that one of the headboards in a residents bedroom does look very shabby and must be replaced and some of the draws are loose, which must be repaired. The paintwork throughout the home shows a higher than usual amount of wear and Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 17 tear including scratches and flakes, the inspector informed the manager that the whole home must be redecorated. The utility room is outside the home and is located in the garage and a semi professional washing machine and dryer are in place. The home as well as the utility room was clean and free of any offensive odours. The floor finishes in the utility room are impermeable and are easy to clean. Hazardous materials are locked away and appropriate infection control procedures are in place. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a committed and enthusiastic staff team, however staffing numbers and a higher number of permanent staff should be given consideration. Appropriate recruitment policies and procedures protect residents from unsuitable staff. EVIDENCE: The home has currently four permanent team members, excluding the manager, employed. Staff spoken to demonstrated good knowledge about service users needs and lots of enthusiasm regarding working with this particular client group. The manager is currently working towards her assessor award and two staff are assessed by the manager to achieve their National Vocational Qualification in Care. The home employs agency staff to fill vacancies, which has been addressed in previous inspections. The home does not employ staff under the age of 18. Personnel files are kept in the organisations head office, which has been authorised by the Commission for Social Care Inspection Provider Relationship Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 19 Manager. Files viewed by the inspector are organised and contained supervision records, appraisals, and a copy of Criminal Records Bureau disclosures. Previous inspections demonstrated that the home has good and safe recruitment procedures in place. Staff informed the inspector of having received a wide range of training and referred to the organisation as a good training provider. The organisation has achieved their Investors in People Award, which is assessed regularly to maintain training standards. All staff have a personal development plan in place, which is reviewed within supervision and appraisal sytem. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home manager is experienced to manage a care home, but must register with the Commission for Social Care Inspection. Residents are regularly involved and consulted in the running of the home. Residents Health and Safety is not compromised and safe working practices are in place. EVIDENCE: The manager Ms Cully has been in post for one year, staff gave very positive feedback and informed the inspector that the manager is supportive and approachable. The manager demonstrated confidence during this inspection and has excellent knowledge of service users needs. The manager is currently Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 Page 21 undertaken her Registered Managers Award. The inspector informed the manager that she must register with the Commission for Social Care Inspection. The home has good quality assurance procedures in place. A current business plan was available for inspection and regular Provider visit reports are send to the Commission for Social Care Inspection. The manager informed the inspector that the organisation is sending out surveys to service users, families and significant others and a regular Health and Safety audit is undertaken by an independent company. The home has a detailed Health and Safety policy in place, which has been reviewed. The fire procedure and risk assessment is of good standard and fire alarm tests are undertaken weekly. Staff has attended fire training and four fire drills have been recorded for the past year. The fire system has been serviced on 03/01/07. The Landlords Gas Safety Certificate expires on 13/07/07, the Portable Appliances Test Certificate expires on 29/09/07, the electrical installation certificate expires on 28/06/07 and a maintenance system for regular repairs and renewals is in place. Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 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 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 4 X 2 X 3 X X 3 X Brian Ward House DS0000054415.V325281.R01.S.doc Version 5.2 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 YA6 Regulation 15(2)(c) Requirement Following a review Care plans must be signed and dated by the people involved The manager must ensure that all staff maintains health records. The home must obtain the hosting boroughs Protection of Vulnerable Adults guidelines. The crack on the kitchen ceiling must be repaired. The broken headboard in one of the residents’ rooms must be replaced. The broken draws in one of the residents rooms must be repaired The home must be repainted throughout. The provider must ensure that the home has an adequate complement of care support staff available to provide continuity of DS0000054415.V325281.R01.S.doc Timescale for action 28/02/07 2. YA19 17(1)(a) 28/02/07 3. YA23 13(6) 15/03/07 4. 5. YA24 YA24 23(2)(b) 23(2)(c) 28/02/07 28/02/07 6. YA24 23(2)(c) 28/02/07 7. 8. YA24 YA32 23(2)(d) 18, Sch 4.6,4.7 31/03/07 31/03/07 Brian Ward House Version 5.2 Page 24 care and support to residents at all times. (The Timescale of 30/05/06 has not been met) 9. YA37 8; 9 The manager must register with the Commission for Social Care Inspection. 31/03/07 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. Refer to Standard YA8 Good Practice Recommendations The provider should continue the effort and work with residents to help them open their individual bank accounts and have some level of personal control over their personal finance where possible. The inspector recommends for the home to explore more economic transport alternatives for residents. The inspector recommends using syringes, when measuring liquid medication. 2. 3. 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