Inspection on 14/08/07 for 6 Honister Gardens

This inspection was carried out on 14th August 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

6 Honister Gardens 04/11/09

6 Honister Gardens 14/10/08

6 Honister Gardens 23/05/06

6 Honister Gardens 28/02/06

6 Honister Gardens 04/11/05

6 Honister Gardens 17/03/05

6 Honister Gardens 07/09/04

6 Honister Gardens 26/02/04

6 Honister Gardens 06/01/04

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 Honister Gardens 6 Honister Gardens Stanmore Middlesex HA7 2EH Lead Inspector Clive Heidrich Key Unannounced Inspection 14th August 2007 15:30 DS0000017582.V342931.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 DS0000017582.V342931.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. DS0000017582.V342931.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 6 Honister Gardens Address 6 Honister Gardens Stanmore Middlesex HA7 2EH 020 8907 0709 020 8907 0709 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) Striving For Independence Group Homes Mrs Deborah Whittick Care Home 5 Category(ies) of Learning disability (5), Learning disability over registration, with number 65 years of age (1) of places DS0000017582.V342931.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) service user over the age of 65 can be accommodated. Date of last inspection 23rd May 2006 Brief Description of the Service: 6 Honister Gardens is a care home providing personal care and accommodation for up to five people who have a learning disability. The home is owned and run by the Striving For Independence organisation, a local private and independent care service provider. The home has 24-hour staffing. The home is located within a residential area on the edge of both Stanmore and Belmont, in the borough of Harrow. It is a few minutes from bus links, and around ten minutes’ walk from local shops. Parking restrictions do not apply on the road outside the home. The drive has space for two cars. The premises are a two-storey building in keeping with other homes in the street. All bedrooms are single rooms, fully furnished, and with built-in washbasins, both upstairs and downstairs. One bedroom has an en-suite toilet. The home has one bathroom with adapted shower facility upstairs, and a shower room downstairs. The home has a kitchen, a lounge leading into a dining area, a spacious activities room upstairs, and a garden. There is also a passenger lift. Management stated that information about the fees, and a copy of the service user guide, are available in the home on request. There was one vacancy in the home at the time of the inspection, which was being temporarily filled by a respite care placement. DS0000017582.V342931.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last key inspection in May 2006, there have been two shorter, ‘random’ unannounced inspections at the home, in July 2006 and February 2007. These were both to check on the specific information supplied by anonymous complainants, and to ensure that resident safety was being upheld. The information was generally not substantiated, and there were no significant concerns about safety. This is referred to further under standard 23. Some requirements of the key inspection were found to be addressed, although many were not checked on at those points. Additionally, a few other areas for improvement were identified. Some aspects of these ‘random’ inspections are referred to within this report, and any requirements from them have been considered. The manager kindly provided the CSCI with a detailed Annual QualityAssurance Assessment (AQAA) document in advance of this unannounced inspection. Surveys were then sent to the manager to distribute. In total, two resident and two relative surveys were returned. Their comments are included throughout the report. The inspection took place across two warm days in mid-August. It lasted just over six hours in total. The first day specifically included meeting with staff and residents. This process was supported by an Expert-by-Experience, someone who has experience of using care services. They were accompanied by a support worker for their couple of hours’ involvement at the home. They provided the inspector with feedback at the end of their visit. Some of their comments are also included in the report. The second day of visiting involved checks of the environment, the viewing of a number of records, and discussions with the manager. It is also noteworthy that the home was undergoing extensive redecoration within corridors, the lounge and the dining room, during the week of the inspection. The service and residents appeared to cope well with the inconveniences of this process. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: Relatives’ survey feedback about the home was very positive. A typical quote is, “The needs and demands of the resident are well provided for.” In particular, the service strongly supports residents to maintain contact with family. DS0000017582.V342931.R01.S.doc Version 5.2 Page 6 There are very good standards of providing residents with support to follow individual occupations and activities. Residents also benefit from the organization’s day centre at another of their homes, if they wish to use that service. There is a good standard of acquiring health professional support where needed. What has improved since the last inspection? What they could do better: There are broadly four areas for the home to improve at. The key amongst these is to provide medication systems that sufficiently protect residents in practice. There were shortfalls with security of medicines, effectiveness of medicines, and recording of medicines. Although none of this has been known to affect any resident so far, there is potential to put residents at risk through these shortfalls. The Expert-by-Experience noted some shortfalls in relation to enabling choice for residents. The inspector established that staff lack sufficient skills in enabling more-dependent residents to make lifestyle choices. Residents must also be better enabled to influence the menu-planning process. There were a couple of shortfalls with hygiene practices. The shower area had a lingering musty odour due to not being cleaned properly, and there was a lack of soap in the laundry area and one toilet. This fails to uphold suitable infection control practices. DS0000017582.V342931.R01.S.doc Version 5.2 Page 7 Finally, whilst suitable actions had been taken to minimise the chances of a repeat of one resident injuring another through an aggressive act, the injured resident’s funding authority had not been informed of the incident as required. This could compromise the safety of the resident. There is a complete list of requirements and recommendations available at the end of this report. 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. DS0000017582.V342931.R01.S.doc Version 5.2 Page 8 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 DS0000017582.V342931.R01.S.doc Version 5.2 Page 9 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 and 3. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s management meets with prospective residents and other applicable people, before a decision about offering placement is made. This process includes assessing and considering the needs of the person. EVIDENCE: One person had recently moved into the home temporarily on respite. Due to limited communication skills, they could not provide verbal feedback about the process. There was however suitable pre-admission assessment information available in the home about this person from the funding authority. Management noted that they had met with the resident before their admission, despite it being an emergency placement, and hence a care plan had already been set up containing reasonable detail about the services needed. The plan was available for staff use, and there was evidence of it being followed from observations at this visit. Feedback from residents and relatives, including through surveys, found there to be satisfaction overall with the services provided. Relatives’ surveys all noted that the home always meets the needs of their relative, including in DS0000017582.V342931.R01.S.doc Version 5.2 Page 10 terms of diversity. Comments included that they have always been satisfied with the quality of care provided. Combined with this feedback, the overall standard of training, acquisition of health and social care professionals where needed, and attention to individual resident needs, suggests that prospective residents that match the home’s registration category can be confident of being provided with a service at this home that meets their needs. DS0000017582.V342931.R01.S.doc Version 5.2 Page 11 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can be confidant that their care plans reflect their individual strengths and needs, and that the plans are up-to-date. The service endeavours to enable residents’ independence within a risk management framework. Assertive residents are enabled to make decisions about their lives. Residents with greater needs lack sufficient opportunity to express and be supported with their choices. EVIDENCE: The care plans available for staff and resident use were now being kept in one file, for ease of access. The plans for one established resident and the new resident were considered. In themselves, they identified each resident’s strengths and needs, and explained about the support needed to address DS0000017582.V342931.R01.S.doc Version 5.2 Page 12 needs. They came across as up-to-date, an issue that was highlighted for improvement during a ‘random’ inspection but which is therefore now addressed. Each also had specific goal details, as agreed at recent formal review meetings. Whilst the care plans captured key information about the individual resident effectively, they were not in formats that enabled understanding for the resident. The plans should be made more user-friendly. It was identified during the ‘random’ inspections that formal review meetings for individual residents were not being kept up-to-date. Checks made through this key inspection confirmed that the meetings were now happening sixmonthly, with the involvement of the resident, their family, and sometimes a social worker. There were suitable and up-to-date risk assessments in place for each resident. The assessments highlighted areas of specific concern as applicable, such as for road safety, kitchen support, shaving, and going out alone. The outcomes respected the risks but aimed to enable independence where possible. The CSCI was suitably notified about one resident going missing from the home earlier in the year. Appropriate missing-persons procedures were followed, and the person was found safely. Records and feedback have demonstrated that the risks of this happening again have been reduced, without significantly impinging on the rights of other residents. Records are being suitably kept about the rare occasions when one independent resident returns home to an empty house. The scenario has been risk assessed, and is discussed at formal review meetings. The records were not evident at one of the ‘random’ inspections, hence a requirement was made at that point, but it was clear that this has now been addressed. Comments from residents and relatives, including through surveys, found that residents can reasonably live the lives they choose in the home. Observations during the visit found that assertive residents are indeed able to make their own choices, and that staff discuss things such as activities and meals with them. There was less evidence of enabling choice for more-dependent residents, who tended instead to be left in the lounge with the television on. The Expert-byExperience also noted that there was evidence of staff supporting residents who decided to do things, but that if a resident just sat there, staff would not work proactively to enable choices. Staff must pro-actively enable choices for more-dependent residents. DS0000017582.V342931.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with opportunities to use community facilities of their choice regularly. Each resident has a weekly occupational plan based around their abilities, whilst the service can provide every resident with a day care package through their own day centre. Residents are provided with good support to keep in touch with families and friends where applicable. They are provided with a good standard of nutritious food. Menus however tend not to be sufficiently resident-influenced. EVIDENCE: All residents may attend the specifically-adapted building and feedback found that the were currently following this organizations day service that is held in a at the back of another home’s garden. Records majority of residents including the respite person option. This includes with the usual day trip on DS0000017582.V342931.R01.S.doc Version 5.2 Page 14 Wednesdays, which was to Brighton the week before the inspection. However, one resident has an ongoing placement at a specific separate day centre with an additional day at college, and one other resident chooses to follow their own pursuits daily. The manager noted that some residents are being supported to apply for college places for the upcoming term. One resident has had support to enrol with an employment agency, and had so far spent a day on placement. The Expert-by-Experience’s feedback included noting positively that most residents were out at the start of the visit, and that residents fedback positively about the activities that they pursue. One resident fedback to the inspector about what their plans are for the week, noting that they couldn’t make the weekend barbeque being hosted by the organization as they would be with their family. They also noted satisfaction with the activities provided. It was encouraging that residents’ activity requests from a recent residents’ meeting, such as for going to a local recreational club and to a zoo, had been acted upon according to feedback and records. The Expert-by-Experience noted that there was little in the way of stimulation for residents at home. For instance, games in the activity room did not appear to match the interests and abilities of residents. The manager noted that this area would be refreshed shortly, which is recommended, and that there is also a karaoke machine that is often used by some residents. Checks of daily records found that community activities are regularly recorded about, for instance that some residents went swimming during the previous weekend. However, in-house leisure and domestic pursuits tended not to be captured. The manager was confident, from visits and phone calls, that residents are engaged at all times, and noted that the issue of recording about this had been recently discussed at a staff meeting. It is strongly recommended that home activities are properly recorded about for each resident, as evidence of engagement and to help identify preferences and skill developments. Relatives’ surveys noted that the home always helps their relative to keep in touch. One resident noted that they visit family most weekends; records showed that a similar set-up is in place for another resident. A communication book between the home and one family was seen to help both parties keep upto-date about the resident. It was found, including through the Expert-by-Experience, that much information around the home was not provided in a format that makes it more easily-readable to residents. Rather, documents like rosters, menus, and the service user guide were written only in text. Depending on the abilities of each individual residents, key documents such as these should be developed into DS0000017582.V342931.R01.S.doc Version 5.2 Page 15 more accessible formats, for instance through the use of pictures or photos. The manager noted that she had recently acquired useful tools to start enabling this process. Records and feedback found that some residents have keys to the front door and their rooms. Risks prevent others from holding such keys. Two weeks of menu were checked through. They were found to be nutritious and reasonably varied. Each evening meal usually provided a choice of two similar meals, for instance tuna or salmon pasta bake. Alternatives were planned for, where one resident is planned to follow a low-fat diet as per community dietician advice. Feedback from residents and relatives about the food provided was positive. One resident noted that they are occasionally involved in cooking, for instance making cakes. One relative noted that they have visited at mealtimes and have had no reason to doubt the quality or quantity of food. There was ample food available in the kitchen from the start of the inspection visit. A chicken and pasta dish with salad was prepared during the first visit. Residents appeared to enjoy it, and a sample taste by the inspector confirmed that it tasted fine. Staff had earlier discussed with some residents about what the meal was and whether it would be alright. The Expert-by-Experience noted, from discussions and observations, that there lacked evidence of residents being involved in the planning of the menu. The manager noted that residents meetings are used for this, however these have been intermittent until recently. A system of ensuring that residents have a strong say in menu planning must be set up and sustained. DS0000017582.V342931.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home continues to provide residents with a good standard of healthcare support, including through accessing relevant community health professionals. Residents generally receive individualized personal support as needed, however shortcuts that provide inappropriate wheelchair support were also noted. The overall medication support provided to residents, although structured, had some shortfalls identified. These could lead to administration errors, although there was no evidence that this had actually happened. EVIDENCE: The new resident’s care plan appropriately made note of some key personal care and physical support needs. Another resident had a dry-cleaning receipt in respect of their applicable clothes. Staff were seen to speak to residents in a respectful and friendly manner during the visit. Clothing and personal care needs were attended to. DS0000017582.V342931.R01.S.doc Version 5.2 Page 17 It was positively noted that there was evidence of supporting some residents to walk, as per their care plans. Conversely, there was evidence of pushing residents in wheelchairs without footplates, so putting residents at unnecessary risk of foot injury. Footplates must be used unless clearly documented within care plans. A check of the health records for an established resident found these to be upto-date in respect of routine health appointments such as with the optician and the chiropodist. There were also records of specific health input, for instance with the GP and the dietician. One resident noted to the inspector that they had a cough, saw the GP, and were better afterwards. Feedback and records confirmed that health professional support is acquired for individual residents as needed. Weight records are routinely kept for established residents. The new resident’s weight had also already been checked. The service looks after the medication for applicable residents. The AQAA notes that all staff have received accredited medication training. Medication was seen to be stored securely in a designated area, albeit that the area could be kept more tidy. Checks of two residents’ medications found that records are reasonably well-kept, in stock, and that medicines are generally provided as prescribed. The medication for the newest resident matched the pre-admission documentation. A few areas for improvement with medication were established. The key to the medication cupboard was not held securely, rather left in a designated place for use when needed. This compromises the security of medicines. If the key is not held securely by staff, it must be kept within a secure area, for instance a code-operated key box that can be kept close to the medication area. It was noted that although medications provided in the home to residents were being signed for, the earlier lunchtime medications that were taken to the day service had not been signed out. A specific code is applicable to show that medications have been removed pending being given at the correct time. There was also one case of the medication being signed for as if support were provided, despite the resident being with family. Medication records must accurately reflect what has happened to the medication, to help with auditing and to prevent medication errors. The date of opening of liquid medications was not being recorded about. Opened liquid medications have a limited shelf-life, as they cease to be fully effective after a period of time that depends on the contents of the medication. Without recording the date of opening, it can be impossible to tell whether the medication remains fully effective. This must be addressed. DS0000017582.V342931.R01.S.doc Version 5.2 Page 18 Some as-required (PRN) medicines are kept. Guidance on the individual administration of these medicines were not easily available at the time of checking the medicines. They were later made available by the manager. They ought to be easily available for staff, to help facilitate the correct individual procedures. DS0000017582.V342931.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Both of them. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s complaints procedures allow residents to expect their concerns and complaints to be listened to and addressed. The home generally has suitable procedures for ensuring that residents are protected from abuse and feel safe in the home, both in respect of injury and looked-after money. Actions are taken to aim to prevent a repeat of any aggressive incidents, although the expected reports to the injured person’s funding authority are not always made. EVIDENCE: Survey feedback from residents and relatives found that everyone knows how to make a complaint, and that responses have been appropriate from the organization. The AQAA notes that all residents have a copy of the complaint procedure in user-friendly format. The CSCI has received two complaints about the service since the last key inspection. Both were about care practices in the home, and both were raised anonymously. One was forwarded to Harrow Social Services for consideration under their Safeguarding Adults procedure. Both resulted in shorter, ‘‘random’’ inspections. Neither found the issues to be upheld overall. It is noted that the organization provided suitable assistance within these complaint processes. DS0000017582.V342931.R01.S.doc Version 5.2 Page 20 The AQAA notes that the service has received three complaints since the last key inspection. These are the two complaints referred to above, and a further anonymous complaint made directly to Brent Social Services. This latter issue has not yet been fully resolved, however it does not relate directly to care practices at the home. The manager noted that applications have been made for all newer staff to attend Brent Council abuse-awareness training, in addition to consideration of this subject during induction. The induction process includes the use of a video, and a written test to establish whether knowledge is suitably or not. The AQAA notes that all established staff have received training in this area through Brent. The first ‘random’ inspection found shortfalls in relation to reporting and recording about accidents and incidents. There were however no concerns about standards of recording, or about communication of accidents to management, during this visit. The manager has usually suitably notified the CSCI about incidents of aggression affecting residents. This included about actions being taken to prevent reoccurrence, including acquiring the involvement of community health professionals such as psychologists. Records showed a recent case of one resident receiving a superficial injury from another following an incident of aggression. It was positive to see that this was discussed in a staff meeting shortly afterwards, including on how to prevent reoccurrence, and that the aggressor’s social worker was informed. However, the issue was not reported as a Safeguarding Adults issue to the relevant local authority, as is now the established practice to help ensure that the safety of the injured resident is maintained as much as possible. The manager agreed to attend to this, and following the inspection confirmed that this had happened. All incidents of aggression, that result in injuries to a resident, must be reported to the injured resident’s funding authority. Specific guidance was available with respect to responding appropriately to challenging behaviours of residents, for instance at college. There was a focus on being aware of triggers. One resident was using a positive-reinforcement chart that was devised following professional input, and which it is reported that their family also use. The manager confirmed that it rewards positive behaviour but does not incorporate the use of sanctions, and that the resident themselves discussed and agreed about how it is used. It was noted that the challenging behaviour guidance for one resident that was available to staff dated from 2004. Whilst it appeared relevant, it would benefit from being reviewed and updated so as to confirm that the current expectations around support are being provided. DS0000017582.V342931.R01.S.doc Version 5.2 Page 21 It is noted that established staff have had training through Harrow Social Services on challenging behaviour. The manager is planning further training in this respect for newer staff. It was strongly recommended, from the first ‘‘random’’ inspection in terms of information and transparency, that there be clarity on what service users are expected to pay for within the home’s statement of purpose, service user guide, and contracts. This has yet to be addressed, although the AQAA makes reference to this be an action to pursue. The recommendation is therefore repeated. The looked-after money records of one resident were checked through in detail. The regular expenditure was backed with receipts, and there was evidence of weekly checks of records by management. Another resident’s records included their signing for receiving money on a daily basis. There was also evidence of the organization providing money on a temporary basis to one resident when their looked-after money had run out. There was evidence of family involvement in the bank accounts of most residents, and of one resident themselves holding some bank books. Overall, there were no concerns with the record-keeping and the procedures for looking after residents’ monies where applicable. Procedures were individual with respect to each resident’s abilities and circumstances. DS0000017582.V342931.R01.S.doc Version 5.2 Page 22 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, 27 and 30. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are provided with a suitably homely environment that is kept reasonably comfortable. Refurbishment programs take place. Many areas of the home are kept clean and hygienic. However during the visit shortfalls with respect to cleaning the shower room suitably, and with providing soap in some areas, were noted. EVIDENCE: There has been no change to the structure of the home since the last key inspection. The shower room now has a fixed shower seat. There were new sofas in the lounge. Records showed that two residents have had their bedrooms redecorated. Redecoration of the corridors and downstairs living areas was taking place at the time of the inspection. The manager noted that further redecoration, of the upstairs lounge and some bedrooms, is planned for DS0000017582.V342931.R01.S.doc Version 5.2 Page 23 later in the year. This all shows good attention to cyclical maintenance and aiming to meet residents’ needs. Feedback from relatives and residents about standards of cleanliness was overall positive, including one person saying that it is always clean when visiting. There was a reasonable standard of cleanliness throughout the house, notwithstanding that much of it was undergoing redecoration. The redecoration process was starting to be completed on the second day of visiting, and outcomes looked promising. It was noted during the afternoon visit that there remained a sodden mat in the shower room. The mat would have been used for helping the person using the shower to step onto and to dry from, which is appropriately dignified. However, as it remained there in the afternoon, it was providing a lingering musty odour. The hallway carpet next to the shower entrance was also damp. It is necessary for the shower area to be tidied after use, to uphold hygiene standards and enable residents to return home to a suitably homely environment. The laundry room was seen to be in use during the visits. It contained a domestic washing machine and tumble-drier. The room lacked soap when inspected, which means staff have to go elsewhere to properly wash their hands. Similarly, the downstairs toilet lacked soap during the visit, an issue that had already been highlighted within recent staff meeting minutes. All this can potentially cause poor hygiene, and so must be addressed. The manager noted that the home has an infection control policy, and has enrolled in the government’s new Essential Steps program. Established staff have infection control training certificates through Brent, and new staff receive training through the induction program. DS0000017582.V342931.R01.S.doc Version 5.2 Page 24 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 this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents receive a reliable staff team in sufficient numbers to meet their needs. The team are relatively consistent in personnel, and are working towards overall achievement of a suitable NVQ ratio. Recruitment processes suitably protect residents. Suitably prompt and detailed induction processes are provided to new staff, with formal training being provided or planned for amongst the wider staff team. EVIDENCE: Surveys and feedback, from relatives and residents, confirmed satisfaction overall with how staff treat the residents, and with the skills and experience of the staff. A couple of relatives particularly noted the staff to be welcoming and friendly. Observations, during the visits and previous ‘random’ (short) inspections, found staff to generally be respectful to residents, such as through talking with them before providing support, and through providing support in an encouraging manner. Some practice improvements are however noted elsewhere in this report such as with ensuring footplates are used on wheelchairs. DS0000017582.V342931.R01.S.doc Version 5.2 Page 25 The manager noted that two of the current staff team have NVQ qualifications in care, with a third being a qualified nurse. A further four have now started working towards the qualification, following acquisition of training funds by the organization. Consequently sufficient work is currently being undertaken overall to ensure that the standard, of 50 of the staff team being suitably qualified, will be met in due course. Induction training records for one new staff member were seen. The range of topics included about abuse, medication, health & safety, and diversity/equality. The service continues to use the same induction pack that is provided through a training organization. It is a 12-week program that includes video presentations and written knowledge tests. The manager stated that the tests are reviewed during supervision. Records provided an example of a newer staff member having supervision within a month of starting work. The manager also noted that they have a standard 3-month probationary period for new staff, which can be extended if needed. The AQAA notes that both manual handling and food hygiene training is provided internally, as the manager is qualified to provide these through external training courses. Other key training is provided to staff externally, such as for infection control, understanding learning disability, and fire safety. An overall training plan, and training grid, for the home were seen. These raised no significant concerns. There are some gaps for formal training of newer staff, however this is reasonable given the shorter period of employment. Plans are in place to address individual gaps. Recent supervision records for ‘randomly-chosen staff were seen. They contained suitable discussion points. The AQAA notes that the standard of bimonthly supervisions is upheld. The manager noted that there has been some turnover of staff since the last inspection, however with occasional use of agency staff, sufficient staffing has been provided. At the time of writing the AQAA, the manager noted that agency staff had not been used for two months. They planned now to recruit more bank staff. The two ‘random’ inspections across the last year have included focus on staffing levels. On both occasions, staffing levels were found to be sufficient to meet the overall needs of residents, noting that there may be less staff if certain residents are not present. Requirements were made about providing clarity on the roster, and about providing in writing a statement about the staffing levels that will be provided. These issues have been addressed. It would now be useful if the staffing levels are added to the service user guide so that everyone can be clear on the expectations. DS0000017582.V342931.R01.S.doc Version 5.2 Page 26 Staffing levels at the time of this visit were for two staff all the times, due to the additional person being at the home on respite. There were no concerns about meeting overall resident needs through this. During the previous week, before the new resident, two staff continued to work during the evenings and across the weekend. There was also independent feedback about levels being sufficient. Hence staffing levels are overall seen to be suitably provided. The recruitment files of two newer staff were checked through. They showed that suitable recruitment checks are generally made in good time. This includes for identification documents, work permits where applicable, written references, and Criminal Record Bureau disclosures. One person did not provide dates of employment within their application form, but the manager was able to suitably show how she had explored these gaps. Recruitment process feedback was also found to be suitable during one of the ‘random’ inspections. DS0000017582.V342931.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents benefit from a home that increasingly run in residents’ best interests. The manager is reasonably experienced and qualified. The home has systems to enable residents to be involved in its development, although these were not being consistently used at the time of the inspection. There are suitable health and safety systems in operation at the home. EVIDENCE: The manager has managed this home since shortly after it opened about four years ago. She is finishing an appropriate NVQ level 4 qualification, and she has a degree in management in another field. DS0000017582.V342931.R01.S.doc Version 5.2 Page 28 The manager showed good awareness of individual needs of residents, and could describe how the service has changed at key stages since the last key inspection. She also showed willingness to adapt the service to better meet residents’ needs. Relatives fedback positively about the management of the home. One noted for instance that management are ‘friendly and welcoming’, and survey findings were that relatives are always kept up-to-date with important issues. It was apparent that some key requirements from previous inspection have been addressed. There was also written evidence of management working with staff to ensure that resident outcomes are better addressed. Good detail was noted within the minutes of a recent staff meeting. Of particular focus was the individual care needs of residents, and on health and safety. The ‘random’ inspections found similar information about staff meetings. The manager noted that there is now better communication within the service at the home. This is through the use of the handover book for instance. A communication book continues to be used, within which appropriate messages were evident. The manager stated that an annual development process has been started through the sending of surveys to relevant people. This includes care professionals, relatives, and staff. She planned to revise the resident surveys, to enable the surveys to be more easily understood, before distributing them. Outcomes from all of these will influence the forthcoming annual development plan. CSCI surveys were suitable distributed by the home’s management following receipt of the AQAA. However, requests to receive regular copies of monthly proprietor reports have only intermittently been responded to, and so a requirement is made in this area. Those reports received showed good consideration of how the service is operating, including through observations of care practices, although feedback from direct discussion with residents was not evident. It was however evident that the proprietor knows the residents well and is clearly at the home regularly. The last resident meeting in the home, from July 2007, included appropriate discussions with residents on preferred activities and meals. The preceding meeting dated from December 2006. The manager explained that the gap was due mainly to changes in staff, and that monthly meetings are aimed at. The meetings should be consistently held monthly. DS0000017582.V342931.R01.S.doc Version 5.2 Page 29 Comprehensive risk assessments about the home, dating from March 2007, were seen. These included about fire safety, front door use, and environmental issues. The fire authority last visited the home in May 2007. A report of the visit noted that the home “complies with the Regulatory Reform (Fire Safety) Order 2005” and hence provides a suitably safe environment in terms of fire safety. The local environmental health department visited the home in March 2007, in respect of food hygiene practices. A few requirements were made, including around updating food hygiene training and ensuring that the new food hygiene documentation packs are used. There was no evidence from this inspection to suggest that these issues were no being complied with. A sample of professional health and safety documents were seen to be up-todate. These included for the lift, and for portable electrical appliances. The AQAA and other records received by the CSCI note that all such relevant checks are kept up-to-date. DS0000017582.V342931.R01.S.doc Version 5.2 Page 30 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 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 3 25 X 26 X 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 3 3 2 X X 3 X DS0000017582.V342931.R01.S.doc Version 5.2 Page 31 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. 1 2 Standard YA7 YA17 Regulation 12(2, 3) 12(2, 3) Requirement Staff must pro-actively enable choices for more-dependent residents. A system of ensuring that residents have a strong say in menu planning must be set up and sustained. Footplates must be used on wheelchairs unless clearly documented within care plans. If the key to the medication storage area is not held securely by staff, it must be kept within a secure area, for instance a codeoperated key box that can be kept close to the medication area. Medication records must accurately reflect what has happened to the medication (e.g. taken to the day centre), to help with auditing and to prevent medication errors. The date of opening of liquid medications must be recorded about, as opened liquid medications have a limited shelflife. All incidents of aggression, that result in injuries to a resident, DS0000017582.V342931.R01.S.doc Timescale for action 01/12/07 01/11/07 3 4 YA18 YA20 13(4, 5) 13(2, 4) 01/10/07 01/11/07 5 YA20 13(2) 01/10/07 6 YA20 13(2) 01/11/07 7 YA23 13(6) 01/10/07 Version 5.2 Page 32 8 YA30 16(2)(k) 9 YA30 13(3) must be reported to the injured resident’s funding authority. It is necessary for the shower 01/10/07 area to always be tidied after use, to prevent lingering damp odour, and to uphold hygiene standards. Soap must always be available in 01/10/07 the laundry area, and the downstairs toilet, to help prevent the spread of infection. Timescale of 20/3/07 in respect of the laundry room not met. Regular copies of monthly proprietor reports must be promptly provided to the CSCI as previously requested. 10 YA39 26(5) 01/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA14 YA14 Good Practice Recommendations Facilities in the activity room should be updated, to help ensure that they match residents’ interests and abilities. It is strongly recommended that home activities are properly recorded about for each resident, as evidence of engagement and to help identify preferences and skill developments. Depending on the abilities of each individual resident, key documents such as the Service User Guide, their care plan, the roster and the menu should be developed into more accessible formats, for instance through the use of pictures or photos. Guidance on the individual administration of PRN (asneeded) medicines should be easily available for staff, to help facilitate the correct individual procedures. It was noted that the challenging behaviour guidance for one resident that was available to staff dated from 2004. Whilst it appeared relevant, it would benefit from being reviewed and updated so as to confirm that the current DS0000017582.V342931.R01.S.doc Version 5.2 Page 33 3 YA16 4 5 YA20 YA23 6 YA23 7 8 YA33 YA39 expectations around support are being provided. It is strongly recommended that there be clarity on what service users are expected to pay for within the home’s statement of purpose, service user guide, and contracts. Recommendation repeated from the last ‘random’ inspection. It would be useful if the staffing levels were added to the Service User Guide so that everyone can be clear on the expectations. Resident meetings should be consistently held monthly, to regularly enable residents to influence how the home operates. DS0000017582.V342931.R01.S.doc Version 5.2 Page 34 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 DS0000017582.V342931.R01.S.doc Version 5.2 Page 35 - 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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