Inspection on 29/10/07 for 6 Harrow View

This inspection was carried out on 29th October 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

6 Harrow View 07/10/06

6 Harrow View 22/02/06

6 Harrow View 05/10/05

6 Harrow View 04/02/05

6 Harrow View 03/08/04

6 Harrow View 27/02/04

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 6 Harrow View 6 Harrow View Harrow Middlesex HA1 1RG Lead Inspector Clive Heidrich Key Unannounced Inspection 29 October & 1st November 2007 15:30 th DS0000041653.V346913.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 DS0000041653.V346913.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. DS0000041653.V346913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 6 Harrow View Address 6 Harrow View Harrow Middlesex HA1 1RG 020 8723 0660 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) Clover Residents Mrs Deborah Joy Selley Care Home 3 Category(ies) of Learning disability (3) registration, with number of places DS0000041653.V346913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users who can easily negotiate the stairs without physical assistance should reside on the second floor. 7th October 2006 Date of last inspection Brief Description of the Service: 6 Harrow view is a semi-detached house providing accommodation for up to three people who have learning disabilities. It is part of a local care-providing organisation whose services include both care homes and domiciliary care for people with learning disabilities. At the time of the inspection, there was one vacancy and two male service users living in the home. The vacancy is sometimes temporarily filled through the stay of a specific service user on respite. Another person was about to have a trial visit. The home is situated on a busy road in Harrow, near the main Harrow shopping centre. The accommodation comprises of three bedrooms, all of which are located on the first and second floors. The second floor bedroom has an ensuite bath and toilet, whilst there is a separate bathroom and toilet on the first floor. The ground floor accommodation comprises of a lounge, dining room, shower room, and kitchen. There is a well-kept garden, and a converted building that is used as an art-workshop, at the rear of the property. Fee information was made available to the CSCI about people currently living in the home. The manager explained that fees depend on the needs of each person, and are negotiated with the funding authority. Charges and exceptions are recorded about in the Service User Guide, which is available on request from management. DS0000041653.V346913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There has been no regulatory work with this service since the last inspection. The manager kindly provided the CSCI with an Annual Quality-Assurance Assessment (AQAA) document in advance of this unannounced inspection. The AQAA provides pertinent details of the service, including any changes since the last inspection. CSCI Surveys were then sent to the manager to distribute, to relatives, health professionals, staff, and people living in the home. In total, just one survey was returned, from a relative. Their comments are included throughout the report. The inspection visit took place across autumn two days. It lasted around seven hours in total. The first day specifically included meeting with staff and people living in the home, looking at the environment, and observing care. The second day of visiting involved the viewing of a number of records, and discussions with the manager. It should be noted that the people living in the home at the time of the inspection do not speak, and hence their views could not be directly incorporated into this report. However, their actions to support the inspection process are noted. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: People live in a comfortable and pleasant home that is kept suitably clean. It has an additional facility of an art and sensory room located in the garden, along with all usual facilities. People living in the home are well supported by experienced staff who know their individual needs and able to provide appropriate support, including in respect of people who do not talk. Survey feedback about this was very positive, noting that the care and support expected is always provided, and hence their relative “has built a trusting relationship with the staff and very extensively with the manager.” People living in the home can expect to receive good support with household tasks, any personal care needs, and with going out. There are always enough staff available for this. A wide variety of community activities and occupations are found for people, depending on individual preferences. Visits to and from family are also welcomed, and the service works with family members to their satisfaction. DS0000041653.V346913.R01.S.doc Version 5.2 Page 6 What has improved since the last 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. DS0000041653.V346913.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 DS0000041653.V346913.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): 2, 3 and 4. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The needs of prospective residents are sufficiently assessed before offering trial visits. The service works to ensure that it can meet the needs of anyone offered trials and placements. EVIDENCE: Discussions with staff found them to be aware of the imminent moving-in of someone on a trial basis. They reported that they had had discussions with management about this person, and that there was paperwork to be read about the person. They were also aware of visits of the person and the social worker. Staff also reported that another person had continued to stay occasionally for respite care. The admissions process for this new person was considered in detail. This person was due to move in for a trial overnight stay shortly after the inspection. The manager could clearly explain about the processes involved in reaching this stage. This was generally supported by documentation, including a detailed report by the social worker on the person’s needs and a progress report by the manager on what had happened throughout the process. There were also partially-completed assessment forms by the manager. It was evident from feedback that the manager had gained much more information DS0000041653.V346913.R01.S.doc Version 5.2 Page 9 about the person than these forms alone suggested. The manager explained that she was considering adapting the organization’s assessment forms to better suit their purpose, and that the process of completing these needs assessments was ongoing. Better practice would be for a clear record of the information acquired from each assessment visit, to help clarify about the information acquired. This is for consideration. It was also noted that a draft care plan and risk assessment had been devised for the prospective new person, well in advance of their first visit. The plans addressed identified needs. The manager clarified that these would be adjusted as needed. This is good practice. The home continues to meet the needs of the people who have been living there, according to records, observations and feedback. For instance, survey feedback included “We are very happy with the care provided at Harrow View”, and a statement of ‘always’ in response to the question of whether the home meets the needs of people living there. As noted later, there is also a strong ethos of providing staff with ongoing training, and staff are sufficiently knowledgeable about the individual needs of people living in the home. DS0000041653.V346913.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. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service There are appropriate and frequently-reviewed individual care plans in place for everyone living in the home, to help ensure that people receive good care. Staff reasonably support people living in the home with making choices about their lives, and manage risks appropriately to enable people to be more independent where possible. EVIDENCE: The care files of two people, one living at the home and one about to move-in, were checked through. Their care plans were in place and up-to-date. The detail of care plans was appropriate, including through reflecting the individuality of the person. Plans were written in an informal manner, explaining both strengths and preferences of the person, giving staff guidance on the support required, and establishing goals. For the person living in the home, there had been three care plan reviews so far this year. The most recent had been signed by the person’s next-of-kin, in DS0000041653.V346913.R01.S.doc Version 5.2 Page 11 the absence of the person’s ability to do this themselves. The manager clarified that this involved meeting with the next-of-kin to discuss the content and any changes. There was survey feedback that next-of-kin always get enough information from the service to help make decisions. The files also had up-to-date risk assessments in place. The risk assessments were comprehensive and individual, clarifying actions to minimise the impact of hazards. Night care needs are now included in these, as previously required. There were also regular CPA review meeting minutes available, which next-ofkin, a psychiatrist, and home management attended, which generally tallied with care plans. Staff feedback matched aspects of the care plans, and staff meeting records clearly showed that key changes are discussed and communicated. It is therefore seen that care plans and associated records actively promote appropriate and individual care for people living in the home. People living in the home were seen to have the freedom of the communal areas of the house during the visit. The manager noted that people living there mainly communicate choice through refusals, due to their lack of verbal communication and learning disabilities. Recent staff meeting minutes noted how these refusals can become behaviours that challenge the service, and hence what can be done to support the person making the refusal. There was also clear feedback from staff about enabling people living in the home to be as involved as possible with everyday tasks such as laundry and sweeping up leaves in the garden. Significant risks about the individual behaviours of people living in the home are addressed, such as with keeping the chemicals cupboard locked and using only hand-pump soap to minimise ingestion risks. There was discussion with some staff during the inspection about keeping people safe around hot drinks. Staff were all aware of a minor injury to one person in this respect from late 2006, and were able to describe appropriate actions to ensure that there would not be a repeat. DS0000041653.V346913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The service enables people living there to have appropriate occupational pursuits, to access the community for variety of activities, and to pursue leisure activities in the home. There is good support to keep in touch with family. People’s rights and responsibilities are reasonably recognised. Appropriate and nutritional meals are provided. EVIDENCE: Both people living in the home are funded for the service at the home to provide day care. This is achieved through community trips and sessions at the home. It is noted that there was specific praise for the day services provided, within the survey received. When the inspector first arrived at the home, both people who live in the home were in. Staff explained that they had all been out to Watford earlier in the day, and that at least one person would be going to a local recreational club DS0000041653.V346913.R01.S.doc Version 5.2 Page 13 that evening. Staff noted that they have a car that is shared with the organization’s other homes for this purpose, and that the house has three drivers who are rostered on when there is planned use of the car. Daily records showed that people living in the home attend local recreational clubs, go for drives and lunches out, and go swimming. They also have art therapy sessions and karaoke. The manager and staff also fedback about trying out reflexology and horse-riding without success. It was noted that the prospective new person’s draft care plan contained appropriate information about activity and occupation. One person who lives in the home kindly took the inspector to the separate art room in the back of the garden. The room contained a wide variety of attractive artwork produced by people who live in the home. Staff explained that an art therapist continues to visit, between three and four times a week, to work with one or other of the people who live in the home. One staff member noted that there is now a visiting karaoke person who comes fortnightly. People living in the home join in with the singing and seem to enjoy the visits. Staff noted that both people who live in the home visit their families on a regular basis. Records and survey feedback confirmed this. Staff confirmed that they continue to encourage home-living skills for people living in the home. Examples given were about putting ironed clothes away, and setting the dinner table. A dinner of chicken in rice with mixed vegetables was prepared during the first day of inspecting. One staff member sat with the people who live in the home, to provide support with eating. One person had an adapted plate, to better enable their independence with eating. The meal was fully eaten. Staff explained that they record the meals eaten by people who live in the home. There are separate records kept for this, to capture any differences, and to ensure that the regular snack routine of one person is followed. This routine was documented within the person’s care plan, and was discussed within a recent staff meeting. The meal records found a varied and nourishing range of meals based around meat and fish dishes. There was sometimes clear evidence of home-cooked food, for instance with a home-made soup and with a stewed beef dish. Weekend breakfasts were noticeably more substantial, reflecting the time available. The records also showed that different meals are occasionally cooked at the same time, to reflect the known preferences and dislikes of people living in the home. DS0000041653.V346913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service Personal care is appropriately provided to people living in the home, to help uphold dignity. There are strong standards of supporting with individualised healthcare, and sufficient standards of supporting with medication. EVIDENCE: People who live in the home, who both need significant support with personal care, were found to be appropriately dressed in casual clothing from the start of the inspection. Both people had had recent haircuts. Their finger-nails were of appropriate length. One person was supported to have a bath before going out for the evening. Checks of one person’s bedroom found that they have a good supply of clothing that is appropriately kept in cupboards and drawers. Survey feedback includes praise for the personal care that the home provides. Staff explained about providing support to people at night. One person clearly indicates to staff about when they want to go to bed, whilst the other often stays up well into the evening watching television. In terms of continence support at night, different programs have been tried, and one has now been found that helps the applicable person to better retain continence. DS0000041653.V346913.R01.S.doc Version 5.2 Page 15 Care files records documented health professional involvement. This was mainly in the form of specific health appointment records, augmented by summary notes within care plans and CPA review meetings. There was also written evidence of health training for staff, for instance in foot care by the local Primary Care Trust, in respect of a person who refuses treatment by chiropodists. There were regular records of weight monitoring. It was encouraging to note that one person had achieved a weight-gain goal with the support of the home. There was much documentation about progress towards this. One person living in the home proceeded to show the inspector their foot at the start of the inspection. Discussions with staff found that this person has some pain there due to a minor ailment. It is being treated with over-thecounter medication from the pharmacist. Checks of CSCI notifications against house records, for one person, confirmed that health professional advice for injuries or illnesses had been promptly acquired. Medication prescribed from this had also been promptly acquired and appropriately provided. A check of the medication was undertaken. No-one self-medicates. The medication was appropriately and tidily stored. Administration records were up-to-date. Checks are made at each handover of the amount of medication in stock, which enables any discrepancies to be quickly and accurately pinpointed. There were no gaps in the medication records. The records include statements of the person’s allergies if any, and a key to link staff names to their signatures. A record is kept of the medication coming in, and of any returns. The one as-needed (PRN) medication has guidance notes to staff on when to offer it to the applicable person. A medication policy was available in the medication records file, along with individual homely-remedy guidance notes as signed by the GP. One person’s prescribed directions for one medication did not match the guidance on the administration sheet. There was clear evidence that the administration sheet guidance matched recent psychiatrist instructions, however from a legal perspective medication must be provided as prescribed. The service should refer to the pharmacist and/or the prescriber if they think the medication supplied has an incorrect prescription label. Staff noted that they received medication training through a professional organization, including a test of ability at the end of the day-long course. Records confirmed this. DS0000041653.V346913.R01.S.doc Version 5.2 Page 16 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): 22 and 23. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The service has an appropriate complaints process that has not been put to use since the last inspection. The service ensures that people are protected from abuse, through staff training, policies, and appropriate care processes, although the local borough’s updated safeguarding procedures are not yet in place in the home. EVIDENCE: The service has previously been judged as having an appropriate complaints procedure. The survey received confirmed that the relative knows how to make a complaint if needed, and that the service responds appropriately. The complaints book during the visit was seen to have no entries. There have been no complaints accepted by the CSCI about the home. The manager stated that there have been no allegations of abuse, and no restraints, since the last inspection. An appropriate abuse policy has been previously copied to the CSCI. A copy of the current Harrow Social Services safeguarding guidance was not in place in the home however. The manager must ensure that this guidance is acquired, to help inform everyone about current expectations should an allegation of abuse occur. The manager noted that there had been recent training on abuse-prevention through a professional training agency. It was very encouraging that staff were able to clearly and correctly explain what they would do if they witnessed an abuse scenario. DS0000041653.V346913.R01.S.doc Version 5.2 Page 17 The accident book contained no entries. The manager explained that all clear injuries to people are recorded about separately in designated incident forms, which are generally forwarded to the CSCI as notifications. These forms are stored within the relevant person’s file. There was discussion about how to work with one person who can self-injure. It was positive to have one staff member explain that, for the person’s protective head-gear in this scenario, they show the person the head-gear and ask if he would allow it to be put on. Another staff member explained about a reasonable procedure to help the person to calm, noting that it sometimes worked. There was discussion about what caused the concerning behaviour, noting that the person is non-verbal and is difficult to understand communication from. Records and care plans also help to evidence that appropriate responses take place in response to challenging behaviour. Checks were made of one person’s bank-books against house records and spending. Money withdrawn by the person with support from management has been appropriately recorded about in their house records. There was also evidence of the home loaning money to the person when they ran out of money in the home, and of this being repaid when the bank was accessed. There were no concerning expenditures in the person’s house records. DS0000041653.V346913.R01.S.doc Version 5.2 Page 18 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, 26, 27, 28 and 30. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home continues to be kept appropriately clean and homely, both communally and within bedrooms. There are appropriate facilities throughout. However a few décor issues need to be addressed. EVIDENCE: A tour of the communal areas of the home, and some bedrooms, was undertaken, with the help of staff and one person who lives in the home. The home continues to be kept appropriately clean and in a good state of repair overall. Staff explained that an electrician had been out across the weekend to fix issues in the activity building in the garden. The issue of poor lighting in the dining room from the last visit had been rectified. The manager noted that internal paintwork has been redecorated throughout much of the home since the last inspection. There were however a few areas of the environment that could be improved on. A rug in the dining room has a significant upturned corner. This presents a DS0000041653.V346913.R01.S.doc Version 5.2 Page 19 tripping hazard. It needs taping down or removing. The stairway carpet was also noticeably bare at the tip of two steps. This should be considered for improvement, to present a more homely image. Finally, the plaster wall above the small radiator in the laundry area was significantly cracked and warping. The cause of this must be investigated, so as to return the wall to an appropriate standard of décor. One person’s room was checked on. It was tidy and clean, and had suitable bedding, blinds, furnishing and carpeting, along with a good amount of space. The covered radiator was providing sufficient warmth, and the house felt sufficiently warm overall. Checks were made of the hot taps of the wash-basin in the downstairs toilet area. Thermostats ensured that the temperature is suitably regulated. All toilet areas were sufficiently clean. The laundry area was seen to be sufficiently clean and maintained. Disposable gloves were available. The home has an appropriate system for disposal of soiled waste. The manager stated that all staff have had recent training on infection control. The manager was not aware of the new ‘Essential Steps’ Department of Health guidance on infection control. She was advised to ensure that the guidance is acquired and used. DS0000041653.V346913.R01.S.doc Version 5.2 Page 20 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, 35 and 36. People who use the service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are provided with excellent standards of updated training, to enable better services for people living in the home. An significant proportion of the staff team have NVQ qualifications. They receive good support from management. Consequently, staff are effective and capable in their work with people living in the home. The home also has appropriate recruitment practices. EVIDENCE: Staff were generally seen to treat people respectfully. One staff member made a clear point of saying goodbye to the people who live in the home as they departed from work. Requests were made of people in a generally calm and polite manner, using language that people living in the home could respond to. Survey feedback included that a person receiving services “has built a trusting relationship with the staff.” All staff spoken with could discuss the individual needs and strengths of each person living in the home. Staff reported receiving regular supervision sessions with management. These meetings include personal development needs within the workplace, and about DS0000041653.V346913.R01.S.doc Version 5.2 Page 21 needs of people living in the home. Records confirmed this. Support is also provided through monthly team meetings, which staff clarified are for the organization but which include clear discussion about this home and the needs of each person living there. This for instance helps staff who only occasionally work in the home, to be aware of current practices. The home does not use agency staff, and provides cover where needed through offering extra shifts to their employees. A training grid showed when each staff member had had specific training. There were few gaps in this, and most training was from within 2007. This includes for food hygiene, risk management, infection control, fire safety, emergency first aid, medication, and health & safety. There were other records, and staff feedback, to confirm the significant amount of training that has taken place. The manager noted that the organization funds most of this. Survey feedback also highlighted training as a strength of the home. Checks of the training grid and discussions with the manager established that three current staff have NVQ qualifications at level 2, and three at level 3, from the nine staff that usually work at the home. One other person was undertaking an NVQ course. This exceeds the expected standards, of 50 of staff having a relevant NVQ. Staff reported that two staff always work throughout the day, with one at night. Staff reported that one staff at night is quite sufficient. Checks of the roster confirmed that two staff work throughout the day, at latest from 10am and always until 9pm, when two people are living there. A third staff member was allocated to work across the day and evening for when the new person was scheduled to stay. The manager explained that a fourth person would work to assist this person with community activities initially. The survey received by the CSCI praised the home in respect of its staff retention. The manager noted that a few staff have left the organization, generally for personal reasons that are not to do with the organization. Replacements have been found from within the organization, and hence there has been only one new person employed at the home since the last inspection. The recruitment records of this person were checked. These found that appropriate records were in place before their contracted start-date, including two written references, identification checks, and a Criminal Record Bureau disclosure. The manager confirmed that an interview of the applicant had taken place, and explained that the person had been present in the home on a student placement before this. It was also noted that there were ongoing induction records for this person, including much writing from the person to show their understanding of the induction issues. The induction booklet itself is based on the National Training Organization’s guidance. The manager noted that the process takes at least 12 weeks. Staff noted that new staff shadow experienced staff for between two and four weeks. DS0000041653.V346913.R01.S.doc Version 5.2 Page 22 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, 39, 41 and 42. People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service The home is appropriately managed, to the clear benefit of people using the service. Quality-control systems help to ensure that the service continues to meet the needs of people living there. Health and safety systems sufficiently protect people in the home. Records about people using the service are adequately kept. EVIDENCE: The manager has nine years’ experience in the role, including from when this home opened. She completed an NVQ level-4 in care course 2005, along with a HNC in managing care previously. She was appropriately focussed on the individual needs of people living in the home, and supportive of staff, during the inspection. Staff reported received good support from management. Survey feedback was also encouraging about management, noting for instance DS0000041653.V346913.R01.S.doc Version 5.2 Page 23 that they are always kept up-to-date about important issues affecting their relative in the home, and that their suggestions are always responded to my management. The home has an Investors In People placard on display dating from January 2006. This is an award in respect of staff development and involvement. This is good practice. A quality audit report, based on the views of relatives of people living in the home, and separately of staff members’ views, was in place from September 2007. There was also a detailed 2007/08 service-development plan. It included about previous CSCI findings, general plans, and specific goals for individuals living in the home to be supported with. There were appropriate monthly records of the proprietor’s visits to the home to consider the care provided. A sample week of the daily records of one person who lives in the home were checked. Records were appropriately factual, addressing a requirement from the last inspection. Daily activities were however not always recorded about. Discussions with the manager confirmed that there is an expectation to make these records, the shortfall from which the manager will address. There was a fire-safety risk assessment in place from 2006. The manager stated that, to comply with changed fire-safety law, she had acquired a professional company to review fire safety in the home. A report from this was imminent. She gave examples of the findings of that visit. There was professional documentation to show that checks of the electrical wiring and portable appliances were up-to-date. There was also documentation relating to a recent professional fire-extinguisher check, and regular internal fire checks and drills. There was a certificate on display to show that the Food Standards Agency had given the home top ratings at their visit of late 2006. This is in respect of food hygiene practices. DS0000041653.V346913.R01.S.doc Version 5.2 Page 24 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 3 4 3 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 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 4 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 3 X 3 X 3 X 2 3 X DS0000041653.V346913.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Medication prescription labels must always be correctly recorded in the administration sheets (MAR), so that prescribed instructions are accurately followed. A copy of the current Harrow Social Services safeguarding guidance must always be in place in the home. This is to help inform everyone about current expectations should an allegation of abuse occur. The rug in the dining room has a significant upturned corner. This presents a tripping hazard. It needs taping down or removing. The plaster wall above the small radiator in the laundry area was significantly cracked and warping. The cause of this must be investigated, so as to return the wall to an appropriate standard of décor. Daily records about people living in the home must always include about the activities they were supported with, to help evidence that they were provided with appropriate occupational DS0000041653.V346913.R01.S.doc Timescale for action 01/12/07 2 YA23 13(6) 15/01/08 3 YA24 13(4) 01/12/07 4 YA24 23(2)(b) 15/02/08 5 YA41 16(2)(m, n) 01/02/08 Version 5.2 Page 26 support. 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 Refer to Standard YA2 YA24 YA30 Good Practice Recommendations There should be a clear record of the information acquired from each assessment visit to prospective new residents, to help clarify about the information acquired. The stairway carpet was noticeably bare on two steps. This should be considered for improvement, to present a more homely image. The new ‘Essential Steps’ Department of Health guidance on infection control should be acquired and used. DS0000041653.V346913.R01.S.doc Version 5.2 Page 27 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 DS0000041653.V346913.R01.S.doc Version 5.2 Page 28 - 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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