Inspection on 05/10/05 for 6 Harrow View

This inspection was carried out on 5th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

6 Harrow View 29/10/07

6 Harrow View 07/10/06

6 Harrow View 22/02/06

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 Unannounced Inspection 5th October 2005 01:35 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Only service users who can easily negotiate the stairs without physical assistance should reside on the second floor. To accommodate a named service user under the age of 18 years old. Date of last inspection 4th February 2005 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. At the time of the inspection, there was one vacancy and two male service users. 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 floor. The ground floor accommodation comprises of a lounge, dining room and kitchen. There is a well-kept garden and converted out-house at the rear of the property. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across one afternoon in early October. It lasted until 6:40pm. The inspector met with both the service users, although due to both of them being non-verbal, feedback from them was limited. The inspector also met with two staff members, the manager, and the manager of another of the organisation’s homes. Additionally, some records were checked, care practices were observed, and most of the home’s environment was inspected. One immediate requirement was left at the end of the visit that related to auditing the service users’ kept-money due to variations that were found. The inspector thanks all at the home for their patience and helpfulness throughout the inspection. What the service does well: What has improved since the last inspection? The majority of requirements from the last inspection have been addressed. This includes a tightening of the medication systems, better clarity of service users’ individual plans, and better recording and monitoring of service users individual daytime activities. The conversion of the out-house into an art and sensory room is of particular benefit to the service users, allowing them more choice of activities and a further room to use. Sofas in the lounge have also been replaced, which improves in the furnishings significantly. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 the following standard(s): None of them. There have been no new service user admissions since the last inspection. EVIDENCE: 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Service users’ changing needs are reflected within regularly reviewed individual plans, risk assessments, and formal review meetings. One minor improvement is needed. The service users are enabled to make decisions about their lives, with assistance from staff in terms of risk management and with respect to the service users’ complex needs. EVIDENCE: Staff and the management have to handle complex needs and limited communication skills of the service users. Staff explained that they support service users to make choices such as through visual cues. This might for example involve showing a service user both rice and pasta and asking them to point to their preference. They also take note of service users’ behaviour as a method of the service user communicating what they would like, staff giving detailed examples of the communications that each service user might use. Management also capably gave examples of how the service users communicate. The service users were observed during the visit to make decisions about their lives. One took food and drinks as they wanted to, whilst another communicated through noises an impatience with staff to go out. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 10 Checks of one service user’s file found that their individual plan, risk assessment, and formal review meeting were all up-to-date and regularly reviewed. The service user’s family had attended the formal review meeting. Most of the improvements required to service users’ individual plans from the last inspection were found to have been addressed. This included clearer guidance to staff on how to work with the service users’ challenging behaviours. Goals from formal review meetings had also been incorporated into the plans, to make the plans more up-to-date. It remained only for the clothing needs and preferences of the service users to be recorded, which management agreed to attend to. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13, 14 and 16. Service users are supported to be part of the local community. They take part in leisure activities that are appropriate to their needs and abilities. Service users’ rights and responsibilities are generally recognised in their daily lives, but guidance about any restrictions on their rights needs to be fully clear. EVIDENCE: There were clear records in support of service users using the local community widely, such as for shopping, park walks, swimming, and visiting places of interest. Plans for service users’ individual daytime activities were evident. Both service users went out later in the inspection, with one planning with staff support to end up at the local cinema. Both service users have free transport cards for the wider local area, and they are both supported by individual staffing during most hours of the day. Management noted that trips out for the service users are planned by the staff team in advance, and that they review the success of the outing so as to plan for trips that the service users appear to enjoy more. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 12 Both service users went for a joint seven-day holiday to the coast of Kent in early September with staff support, according to management and staff feedback. One staff member explained that the circumstances enabled one service user to go swimming, an activity that the service user has not been able to undertake locally recently for behavioural reasons. The out-house in the garden has now been turned into a workshop and sensory room for the service users. It has a great many art-based resources for the service users, and has much of their artwork on the walls. One service user was seen to be working intensely with a staff member in this room for a period of the inspection. The manager stated that the service users may use this room at any time. There have been improvements to the guidance under which staff may lock doors to prevent service users from gaining access to rooms such as the kitchen. This practice is to prevent risks associated with certain behaviours. The guidance did not however clearly explain when the locking may take place, but gave instead the impression that it can happen all the time. This must be further clarified. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Service users are suitably supported by staff with upholding reasonable standards of personal hygiene and appearance. Staff support service users with the correct administration and safekeeping of prescribed medications. EVIDENCE: Both service users were seen to be wearing appropriate and individual clothing from the start of the visit. They were supported to change to more appropriate community-wear later on before going out. Records showed that management regularly remind staff about the standards of clothing expected for service users to be supported with. The inspector had no concerns with service users’ nail or hair care. Staff were clear on the personal support needs of service users. None of the service users self-medicate. Checks of the medication systems and records used in the home found no concerns arising. Regular checks by the local pharmacist are undertaken. Requirements relating to medication matters from the last inspection were seen to have been addressed, including recording the circumstances when staff may offer service users as-needed medications. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 23 Service users’ challenging needs are positively supported by staff and management through training, guidance, and communication. Service users are therefore protected from abuse in this respect. Service users’ looked-after finances were found to have some variations that the registered people were formally required to investigate at the end of the inspection. EVIDENCE: The inspector found, at the start of the inspection, that a two-day training course in challenging behaviour was being led in the home by a member of the local social services department. Both the trainer and management separately explained that the course looks amongst other things at the staff team’s values in respect of service users’ challenging behaviours, which is fundamental to the appropriate and positive support of service users at such times. Staff and management were able to reasonably explain the triggers that may cause each service users to exhibit challenging behaviour. They explained their responses in a manner that was respectful to the service users. The responses include efforts to pre-empt the behaviours, such as for avoiding food areas for one service user when in public, and of ignoring destructive behaviours within a safe context where possible. The guidance to staff on how to work positively with one service user’s challenging behaviour was dated from July 2005, which shows recent consideration. Management noted that the guidance would be further updated following the training, as is appropriate. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 15 The inspector made routine checks of both service users’ personal money records that the home looks after. There were variations within these records particularly for one service user. Following discussions with management about this, an immediate requirement notice was issued before the end of the inspection, for the manager to formally explain the variations. A serious concern letter was then sent, as is CSCI practice, to the responsible individual of the organisation following the inspection, in which it was required that the recent finances of each service user in the home be audited to account for the variations, and to ensure that all personal finances are accounted for. The registered people have supplied information in response to both the notice and the letter. Consideration of the information is ongoing. The registered people must ensure that fully accurate records are in future kept for all service users’ looked-after money. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Service users live in a comfortable and pleasant home whose décor is upgraded when needed. The conversion of the out-house into an art and sensory room is of particular benefit to the service users. The home is kept suitably clean and hygienic. There is sufficient provision of bathrooms and toilets. EVIDENCE: The home has a first-floor bathroom, with fitted-shower and toilet, and a recently-refurbished ground-floor toilet and shower area. The second-floor bedroom is en-suite including bath and shower. Toilets and bathrooms are lockable with an overriding device in place for emergencies. The separate lounge and dining areas provide adequate and comfortable space for service users. The lounge has had new sofas since the last inspection. The dining room overlooks the rear garden. The garden has a significant amount of decking to walk on, along with comfortable and shaded seating, and a large trampoline. As per standards 11-17, the garage at the back of the garden has now been converted into an art and sensory room for service users’ use. There is therefore a significant amount of communal space overall for service users’ use. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 17 There were no issues of poor cleanliness or offensive odours observed during the inspection. Staff provide a lot of support to the service users in terms of upholding good standards of cleanliness throughout the home. There are a couple of issues of minor maintenance that need to be dealt with. The old sofas need to be disposed of from their storage area in the open garden. The visibility strip on the floor, where there is a slight step between the kitchen and the dining room, must be refitted as it is coming away through wear and tear. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35. Service users are supported by a competent staff team that have received a good standard of training for their roles. Previously-agreed staffing levels are adhered to from amongst the staff employed for the home. Recruitment practices for the home were found to have minor improvements needed, to ensure that service users are fully protected by the practices. EVIDENCE: Staffing levels previous agreed at the home are of two staff working in the home generally between 9am and 9pm, with one person sleeping-over. The rosters for the period from 25/9/05 to 8/10/05 were checked through. They found that two staff always work between 9am to 9pm, with management also being present during the week, with one exception on a Sunday after 4pm according to checks of the staff logging in/out book. Checks further back on Sundays found that this was an isolated exception. Management are therefore upholding the expected staffing levels. Management noted that there are no staffing vacancies. Management said that all staff have either completed, are undertaking, or are about to start, a relevant NVQ course. Training records were not checked on, on this occasion, as they were considered to be sufficient at the previous visit. It was however noted that there were suitable and detailed induction records for the newest staff member. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 19 The recruitment records of the one new staff member since the last inspection were checked through. The Criminal Record Bureau check for this person was suitably in place prior to their start date. One written reference of the two on file was dated a month after the start date. The manager must ensure that two suitable references are received in writing before allowing anyone to start work in the home, to uphold the required statutory pre-employment checks. One reference was from the most-recent professional care employer, as is now required. Identification checks were also suitably in place. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 and 42. Service users benefit from conscientious and reasonably experienced management of the home. The leadership of the home is supportive to staff but also sets clear standards of care expected for service users. Health and safety practices in the home generally protect service users and staff. EVIDENCE: The manager has seven years’ experience in the role. She completed an NVQ level-4 in care course during the summer. She explained that she completed a HNC in managing care a few years ago. She came across generally as knowledgeable about the home, and as conscientious. Staff noted that they receive good support from management, citing for instance that management will come to the house quickly if there are any difficult incidents. There were records of three staff meetings since April 2005. They included guidance from management to staff to ensure that standards for service users are upheld. The minutes also included issues raised by staff for discussion. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 21 Management noted that they are actively pursuing the Investors in People award, a national standard for good employment practices. Fire check records were being recorded about weekly. Records also showed that there were three fire drills during 2005. These records showed reasonable attention to fire safety and prevention. Fire extinguishers were professionally tested a month prior to the inspection, and there was a suitable fire safety risk assessment dated from July 2005. This overall showed reasonable standards of fire safety within the home. There were no concerns with the appropriate household equipment needed to uphold health and safety standards on this occasion. Key professional safety checks, such as for the gas and electrical wiring, were generally seen to be upto-date at the last inspection, and are still valid at the time of this inspection. 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 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 X X X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 3 4 X 3 LIFESTYLES Standard No Score 11 X 12 X 13 3 14 3 15 X 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 6 Harrow View Score 3 X 3 X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 X DS0000041653.V256653.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 1 6 15 The individual plans of service users must also clarify, where applicable: ….. • the agreed clothing needs and preferences of the service 15/12/05 user. Timescale of 1/6/05 for the complete requirement partially addressed. Brief documentation (including about risks, rights, and staff guidance) about restrictions on service users though the use of locks on doors is needed (including clear statements about when the locking is permitted). Timescale of 1/6/05 partially addressed. The registered people must ensure that the finances of each service user in the home are audited, at least from 1/4/05 to the date of inspection, to account for the identified variations, and to ensure that all the service users’ personal DS0000041653.V256653.R01.S.doc 2 16 12, 13(4) 15/12/05 3 23 13(6), 17(2) s4 pt 9 07/10/05 6 Harrow View Version 5.0 Page 24 4 23 13(6), 17(2) s4 pt 9 23(2)(o) 5 24 6 24 23(2)(b) 7 34 19 s2 pt 3 finances are accounted for. A report of this audit must be provided to the local CSCI office (achieved). The registered people must ensure that fully accurate records are in future kept for all service users’ looked-after money. The old sofas need to be disposed of from their storage area in the open garden. The visibility strip on the floor, where there is a slight step between the kitchen and the dining room, must be refitted as it is coming away through wear and tear. The manager must ensure that two suitable references are received in writing before allowing anyone to start work in the home. 07/11/05 01/12/05 15/12/05 07/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard 34 Good Practice Recommendations It is recommended that the staff employment application form be revised to include a question about spent convictions, as applicants must legally declare these before working in care homes. It is recommended that the manager ensure that the personnel files of all staff provide sufficient written proof of each staff member’s legal right to work in the UK. 1 2 34 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow 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 6 Harrow View DS0000041653.V256653.R01.S.doc Version 5.0 Page 26 - 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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