Inspection on 11/01/07 for 65 Charlton Road

This inspection was carried out on 11th January 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 no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

65 Charlton Road 09/02/06

65 Charlton Road 09/08/05

65 Charlton Road 13/12/04

65 Charlton Road 06/05/04

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 65 Charlton Road 65 Charlton Road Kenton Middlesex HA3 9HR Lead Inspector Clive Heidrich Key Unannounced Inspection 11 and 12th January 2007 1:15 th 65 Charlton Road DS0000017527.V325622.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 65 Charlton Road DS0000017527.V325622.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. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 65 Charlton Road Address 65 Charlton Road Kenton Middlesex HA3 9HR 0208 204 2191 020 8204 0020 general.enquiries@heritagecare.co.uk www.heritagecare.co.uk Heritage Care 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) Daphne Gayle Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: 65 Charlton Road is a care home providing personal care and accommodation for up to 7 people who have a learning disability. The people living at the home at the time of the inspection were all female, though the service is not gender-specific. There were no vacancies at the time of the inspection. The registered provider of services at the home is Heritage Care, a national not-for-profit organization operating since 1993. Paddington Churches Housing Association owns the building. The home is located within a residential area of Kenton, within the London Borough of Harrow. It is around ten minutes walk from shops, pubs, parks and bus links. The home has a driveway that can take about five vehicles, including the house van. Parking restrictions do not apply on the road outside the home. The home was opened in 1998. It is a two-storey building that was purpose built for residential care. It blends in reasonably with surrounding homes. All the homes bedrooms are single, all fully-furnished with built-in sinks. The home has two bathrooms and two shower rooms, all of which have toilets. One further toilet is available on the ground floor. Access to the first floor is by stairs or a lift. The home has a kitchen/diner, a main lounge focused around a TV and DVD, and a small second lounge available for private use. The home has a reasonable-sized garden, much of which is paved for easier access. The service user guide, and range of fees, are available from the manager on request. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place across two weekdays in mid-January. It lasted just over eleven hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke with most service users during the visit, all of whom were able to provide some degree of feedback about the services in the home. Three service users additionally provided feedback, sometimes with support from relatives, through CSCI surveys that were sent to a number of homes early in 2007. The inspection process also involved observations of how staff provide support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. The manager was present throughout, and was provided with overall feedback at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? The few requirements from the last inspection have been addressed. This includes fire-safety training and an updating of the fire-risk assessment by a professional fire organisation. Written risk assessments in respect of each service user’s lifestyle have been updated. Some recommendations have also been addressed, including the reviewing and updating of care files, to make them easier to use. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 65 Charlton Road DS0000017527.V325622.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 65 Charlton Road DS0000017527.V325622.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 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users can be sure that their needs will be assessed in advance of a placement in the home being offered. They are given opportunities to try out the home before committing to moving-in. EVIDENCE: One person has moved into the home since the last inspection. Records showed that the manager, using the organisation’s standard forms, undertook a comprehensive needs assessment of this person. This took place well in advance of the service user moving into the home. Information was acquired from the service user, staff from their previous home, and the social worker. There was verbal feedback to show that the person visited the home in advance, including for overnight stays, to try out the services before committing to move-in. Records showed that review meetings were held in advance of the person moving into the home, to check on progression and suitability, and within six weeks of the placement beginning. The overall process is therefore judged as suitable. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good support with making decisions about their lives where needed. Their decisions are respected by the home. They are consulted about many aspects of life in the home. Their independence is promoted, with risk assessments undertaken as necessary. Each service user has a succinct care plan that details about their key needs and the support needed. Improvements are needed with current plans to enable service users to be involved in the development of the plans, and to provide the plans in a format that allows the service user to have a copy of their plan. EVIDENCE: The care files of two service users were selected by the inspector for consideration. Each had a succinct care plan dating from within the last seven months. The plans make pertinent comments about the needs of the service user, such as with transportation details for regular clubs they attend, and 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 10 with focussing on individual behaviours including how staff are to respond appropriately. Separate guidelines are set up where additional detail is required. Care plans lacked evidence of the involvement of the service user, either through records of discussion, or by being signed by the service user or their representative. There was evidence of Person-Centred Planning (PCP) starting to happen, including through an upcoming meeting for the staff team with the organisation’s PCP co-ordinator. This is encouraging, as it will enable service users to take much more ownership of their care plans. The manager must consequently ensure that PCPs are set up for each service user, with clear evidence of service user consultation and approval of the plan, and service users being enabled to have a copy of the plan if so wished. Monthly reviews of each service user’s support are undertaken. Whilst these updated suitably, when viewed over longer timescales, they were found to lack updates on care-plan goals and review-meeting goals, such as with ensuring that dental support is provided or with providing support to pursue key friendships. Discussions with the manager established that progression was being made. It would be useful to keep a regular report on goals, to show how they are progressing. Each service user had had a formal review meeting within the last six months, with appropriate people being invited. Records and feedback showed that further meeting are planned for shortly. Two service-user surveys stated that they are always able to make decisions about what they do each day, with one stating sometimes. They all noted that they can all do what want to do during the day, the evening, and at weekends, including that they can choose to stay at home instead of going to the day service. Verbal feedback from service users supported this. One service user said that they can stay in bed until they’re ready to get up. Staff and the manager fedback that service users chose their holiday destinations and who they wished to go with, and that some service users went along to help choose and buy sofas and a new television recently. The inspector also observed service users being enabled to make decisions. For instance, service users were asked about what they each wanted served to them once the evening meal was ready to be served. One service user was noted to decide not to take the bed-rest that is part of their ordinary routine, another not to go to their day services for the day. Importantly, staff still provided this person with support during the day, including with going shopping. It was also observed that where staff requested service users to do something, such as to push their chair under the table, that staff respected the service user’s decision if they continually refused the request. There were records of service-user meetings that are held monthly. Each service user is given the space to state their comments, including on food, 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 11 activities, and shortfalls with the service. It is recommended that the minutes be put on display, so that service users can easily read about the last meeting in advance of the next one. The manager confirmed that service users continue to be offered opportunities to be involved in staff recruitment. Two service users were involved in the recent recruitment of a service manager, for which they were paid. Files showed that risk assessments about each service user were updated within the last six months. The assessments covered a comprehensive range of hazards, and detailed the actions to minimise risks from these. This includes for such things as manual handling, community support, and against falling. Two service users confirmed to the inspector that they have the equipment they need to help with their independence and minimise risks. These include trolleys, wheelchairs, and remote-controls for televisions. Staff confirmed that they encourage service users’ independence with manual handling where possible, and that there is occupational therapy involvement where needed. Training records showed that four staff recently attended training on promoting service users’ independence. One staff member spoke about providing support on holiday for a service user, including adjusting the environment on a trip out there to help the service user to enjoy it. The standard on enabling service users to take risks within an independent lifestyle is consequently judged as suitable. 65 Charlton Road DS0000017527.V325622.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): 11, 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with excellent standards of community support, for attending established clubs and with pursuing their own choices of community activity including holidays. They also receive appropriate support to attend day services, and to pursue and uphold personal and family relationships. Service users have good personal development opportunities in the home. They are given opportunities to be independent where possible. Their rights are overall respected. Service users are provided with nutritional and enjoyable meals. Improvements are needed with reviewing the menu to reflect current preferences, and with keeping appropriate records of the meals that each service user ate. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 13 EVIDENCE: All service users have day services that they attend on a planned basis. Different service users however attend different services. Transportation is provided within the package in each case. Staff were observed to support service users to organise appropriate things to take with them, for instance packed lunches and money where appropriate. Day services are invited to contribute to formal review meetings, as is appropriate. The manager noted that they have supported some service users with work placements and college courses in the past, and will consider for the future, however none are in place at present. There was evidence of service users being supported with personal development. For instance, service users were seen to be present whilst dinner was being cooked, one service user peeling potatoes. Staff spoke of supporting one service user with independent-living skills as part of a long-term plan. Some service users are undertaking Makaton sign-language classes at their day centre. They used some signs with staff during the inspection, some of which staff understood. There was nothing in place to help develop the use of Makaton within the home. Setting-up communication profiles in conjunction with the day service for each service user, and providing staff with training, could help to enable some service users to be better understood in the home. The manager agreed to pursue this recommendation. There are strong standards of supporting service users with community activities. This includes through the continuing involvement of the Community Link-Up organisation at the home, who for instance supply a volunteer driver to some of their events, and who were involved in the past with providing the home with their current wheelchair-accessible van. Staff and service users reported no difficulties with service users being able to access other transportations, such as taxis through the local Taxicard service. However there was some evidence that relying on independent transport can cause service users to be late to events. There are very few approved van-drivers within the staff team, which should be improved on, to assist with service users getting to events on time. It was evident, from discussions with service users and from records, that service users decide if they wish to attend a community activity of not. Additional staffing is provided if needed. Individual service users are reported to attend church, evening clubs, Birthday parties, go out for meals, go to beauticians, and go to the cinema. One service user told the inspector that they now go to the pub, which they are pleased about. Service users and staff noted that all service users went on a week’s holiday in 2006 with staff support. Three service users went to three different foreign locations, including Tenerife and Majorca, whilst others chose English 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 14 destinations such as the Lake District. It was noted that some of the destinations were organised through a company that provides appropriate access and facilities for wheelchair users. There was feedback from staff and service users about being able to visit and keep in contact with friends and family. For instance, one service user books and uses a taxi independently, to visit people. Personal relationships are supported. Service users discussed with staff about when they would next be having visits from family. Support networks are considered within care plans and formal review meetings. Some service users have keys to the home. One was seen to use it on return from a trip out. Some also have keys to their rooms, but staff reported that they do not use them. As previously discussed, staff respect service users’ decisions. One service user was also seen to tell staff that they wanted to speak with the inspector alone, which was accommodated by the staff member. Service users fedback positively about the food provided in the home. One said that it is lovely, another that they can get meals in their room in they want, a third that the food is alright. One service user was pleased that staff provide them with a cup of tea in bed before they get up. There was a reasonable amount of food available in the home at the start of the inspection. Further shopping was undertaken during the visit. The evening meal during the inspection was seen to be home-cooked lamb chops with mash and vegetables. Service users ate together at the table, and were provided with a good-sized serving of the meal. Cutlery was provided according to each service user’s needs. Staff provided support where needed. One service user decided not to eat the meal, and chose a ham sandwich instead. The mealtime was seen to be a suitably friendly and lively occasion. Staff and service users confirmed that they can choose to eat elsewhere or at a different time if they want. Staff and service users explained that meals are discussed within service users’ meetings, as confirmed by records of these. Menus were found to be a rolling 5-week template dating from January 2006. They provided reasonable nutrition overall. They are occasionally changed according to service users’ wishes. A full review of the meals, including with respect to the new service user’s and anyone else’s changed preferences, is required, to ensure that choices are up-to-date. A record of what each service user chose to eat must also be kept, to help monitor the nutrition supplied to each service user. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 15 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive good standards of medication, personal, and health support, through the home and via healthcare professionals as needed. Improvements are only needed with the recording about health professional input, as this was sometimes not up-to-date within some service users’ files. EVIDENCE: Service users were seen to be well-dressed in casual clothing from the start of the inspection. Some service users had had their nails varnished, some their hair styled, which they confirmed was in some cases at their day service, in others through the home. One service user said that when in their room, staff check on them lots and provide them with support where needed. The inspector observed staff check on a service user who retired to their room, and staff discussing between themselves to ensure that service users who need continence support get that support. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 16 There was some evidence of service users receiving good healthcare support. Staff could explain service users’ key health needs and professional involvements. Some records showed attention to individual health needs such as with a dietician, a psychiatrist, and a chiropodist. Service users’ files however lacked evidence of recent check-ups in some cases, such as for the dentist and the chiropodist, despite other evidence to show that the support had been acquired in practice. Without such records, an inaccurate picture of health needs can be presented for individual service users, which could result in incorrect support. The manager agreed to address this. Service users additionally lacked a Health Action Plan within their files. The manager noted that these had been archived during tidying of the files. They should be stored as a live record, to enable them to be continually used. The home uses the Boots monitored-dosage system of medication. None of the service users self-medicate. Medication was seen to be securely and hygienically stored with no excess stock evident. The process of reordering medications was seen to be suitable, including with GP liaison. There were records of recent independent pharmacy audits that raised few concerns. Medication records were seen to be up-to-date and appropriate. There are records of quantities of individual medicines received, and of any medicines returned to the pharmacy. Sample checks of medication records against stock found no concerns. Guidance notes to staff included about each medication’s side-effects, and about circumstances in which to offer as-needed (PRN) medications to individuals. The manager confirmed that staff must have received the organisation’s medication training, and then be assessed internally as capable of following procedures correctly, before they can provide service users with medicines. Consequently, they have to plan ahead to ensure that there is always someone capable of providing medication working at all times of medication administration. The only suggested improvement is for PRN medications to be accurately reflected on the administration sheets in all cases. There were a few occurrences of medications being on these sheets as daily rather than asneeded. In practice, staff capably followed the as-needed guidance. The manager agreed to attend to this. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are procedures and practices in place to ensure that service users are protected from abuse, including with respect to how staff respond to behaviours that challenge. Service users’ views, including complaints, are generally listened to and acted on. Minor improvements are needed to ensure that all complaints are recorded about within the complaints book. EVIDENCE: All three service user survey stated that the service user knows who to speak to if they are not happy. Two stated that they always know how to make a complaint, one stating sometimes. Comments included that staff know if the service user is not happy. This all reflected the verbal feedback received from two service users during the inspection. There have been no complaints made to the CSCI since the last inspection. The home’s complaints folder showed three complaints and one compliment since the last inspection. The complaints were from one service user and two people involved with service users, however only two were about the service provided by the home. Reasonable actions were taken in both cases. The complaint file was available for staff to access, including some information that the inspector judged as potentially confidential. The manager had however made some other information from this file secure. It is 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 18 recommended that the complaint file be kept secure and confidential, with just the initial complaints book left available within which to record complaints. The inspector also came across a letter from a person involved with a service user, expressing frustration about an activity they had organised on behalf of the service user that had not being supported by the home. The manager explained that she had resolved this with the person involved and through guidance to staff. The manager must ensure that all complaints about the service are recorded within the complaints book and file, including actions taken as a consequence of the complaint, to show transparency about dealing with complaints. There had been one notification of alleged abuse since the last inspection. Suitable procedures were followed by the manager and the provider organisation. An action plan arising from the findings were found to have been followed according to records seen. Staff spoken with confirmed that they have received training in abuse awareness. They showed reasonable understanding of whistleblowing procedures in respect of witnessing abuse. There were brief details within service users’ care plans in respect of responses to any behaviours that challenge. These support plans were suitably positive, recognising the behaviour as a communication to be listened to. There were also risk assessments in place in respect of behaviours that challenge, as appropriate. Records showed that most staff have received training on behaviours that challenge. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 19 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, 25, 27, 28, 29, and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are provided with a homely and clean environment with many adaptations to meet individual needs. There are suitable toilets and bathrooms, and reasonable communal living space. Service users have individualised bedrooms. Improvement is needed with keeping fire-safety devices on doors fully functioning. One door was found to be faulty during the visit. EVIDENCE: The home is a purpose-built accommodation that is almost ten years old. It is in keeping with local homes. Each service user has their own bedroom. Some service users invited the inspector to view their rooms. From this it was seen that service users have comfortably-furnished rooms that reflect their individuality. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 20 The home has two bathrooms and two shower rooms along with one further toilet. These provide a variety of adapted equipment to support service users with accessing facilities suitably. There were no concerns about the equipment seen during the visit, and service users confirmed that equipment was suitable. The home also has a lounge with new sofas centred around a new television, a small private area with comfortable seating, and a combined kitchen/diner that can seat all service users together. Communal space has previously been judged as just able to meet National Minimum Standards. The home has benefited from new flooring in some communal areas, which was fitted during the summer of 2006. Staff also reported that the communal areas had been repainted since the last inspection. The communal doors in the home have devices to allow them to be safely held open but which release on activation of the fire alarm. The device on the door in the corridor near the front door was not working, with the door being propped open by a door wedge. This can compromise the fire safety of the building, and so must be promptly addressed. During the inspection, a maintenance worker, from the Housing Association that owns the property, visited to fix minor faults with radiators. The passenger lift between floors was also serviced with minimal disruption to service users. The manager explained a reasonable system for reporting maintenance issues. One service user survey stated that the home is hardly ever fresh and clean, but that the staff clean the house every day. Another survey stated that the home is always fresh and clean, whilst the third declined to comment. The home was seen to be suitably clean and hygienic from the start of the inspection. Staff used disposable gloves and aprons suitably, to help prevent cross-infection. Soap was available in all toilet areas. Staff are overall responsible for the cleanliness of the home, with service users assisting where possible. There were additionally no lingering offensive odours in the home. The home has a suitable washing machine and separate tumble-drier within a laundry area. The home is therefore judged overall to be kept clean and hygienic. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 21 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 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent staff team who know the service users individually. The majority of staff have suitable NVQ qualifications, and other training is provided appropriately. Minimum staffing levels are complied with, with the support of bank and agency staff where necessary. Service users are protected through, and involved in, suitable recruitment processes. EVIDENCE: The three service user surveys received stated that staff always treat them well, and that carers always listen and act on what they say. This generally reflected feedback from service users during the visit. Discussions with staff found them to have good knowledge of individual service users’ strengths and needs. Staff were observed to generally treat service users in a friendly manner, and with effort to listen to what service users were communicating. One service user confirmed that staff do understand her. A 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 22 record of an external professional, complimenting the relationship between service users and staff, was also seen. The manager noted that four staff have NVQ qualifications in care at level 2, three at level 3, and one other has a relevant diploma. This represents the majority of the staff team, which is encouraging. A new staff member was found to have attended a number of training courses, including on challenging behaviour, abuse awareness and food hygiene. This is encouragingly prompt. Suitable induction packages, based on the national framework, were also seen to be in place. Another staff member noted that the organization’s training department ensure that they are updated where refresher courses are needed. Records of staff training were available on the organisation’s computer systems. Checks of these raised no concerns about staff being provided with suitable training, including in such particular areas as encouraging service users’ independence. The rosters for the first two weeks of January were analysed. A basic staffing provision of two people in the morning and afternoon, and three from the early evening, plus a waking-night and a sleep-over, were found to be provided as expected. At the weekends and on Bank Holidays, there were generally three staff throughout the day. Additionally, an extra staff member was provided for pre-planned evening clubs. The home relies on the use of some bank and agency staff in addition to the ten permanent employees and the manager. The manager stated that they have their own bank team within those employed by the provider organisation (Heritage Care), and that agency staff must be only from those agencies approved of by the provider organisation. Rosters in practice showed that the same such staff, and additional hours from within permanent staff team, are generally used. Consequently, the standard on staffing levels is met. The manager noted that the majority of recruitment records are held centrally, but confirmed that the process includes application forms and interviews. Records on site showed that suitable identification checks are made including in respect of work permits, and that Criminal Record Bureau (CRB) checks are made through the organisation before employment begins. Phone discussions with a member of the organisation’s personnel department confirmed the CRB arrangement, and that two appropriate written references are obtained. There was also information on the organisation’s secure intranet IT site to show that all permanent employees have had CRBs obtained. It is consequently judged that recruitment processes are suitable. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 23 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, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from an established manager, a clear management approach that is suitably service-user led, and a staff team that works together to support service users. Improvements are only needed with the timely completion of internal investigations into service failures, as there was one shortfall in this respect. There are processes within which service users’ views can influence the running of the home. However, improvements are needed to formalise this. The standard of health & safety in the home is generally suitable, including through professional input and suitable internal systems. Improvements are needed based on a very recent local council Environmental Health department input, and with updating the records of professional legionella checks. EVIDENCE: 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 24 The manager has been in post in the home since August 2003. She was formally registered with the CSCI in September 2004. She has previous experience of care and management within similar homes. Records and feedback found that she is continuing with the NVQ level-4 in management and care award, as required. Qualification should be completed this year. The last staff meeting on record dated from 21/12/06. It included for instance good planning for one service user’s Birthday, and on supporting another service user with personal care issues. Previous minutes showed staff meetings taking place at a monthly frequency. Communication book records were also suitable, showing evidence of staff working together in service users’ interests, such as with reporting maintenance issues. There was also feedback from staff about there being good team and management support. Service users are able to influence the development of the home through monthly residents’ meetings. The minutes of the last meeting included activity and menu planning, and had one of the service users chairing the meeting. Minutes showed that service users also take part in staff interviews, including bank staff. In terms of quality auditing systems, the operations manager noted that a formal quality assurance system is currently being drafted within the organisation. Such a system is needed, to ensure that all people involved in the home are asked about their views on the care provided. A report of this must then be made available, including plans to address any areas for development. The provider organisation must ensure that such a system is set up and operating for this home in due course. There were records of the monthly formal check of the home by a representative of the provider organisation. These were suitable detailed, showed service user input, and included plans for the manager to address. Professional health & safety checks were in place and up-to-date in respect of the gas systems, portable electrical appliances, the lift, the tail-lift in the van, the fire systems, the emergency lighting, and the fire extinguishers. The checks in respect of legionella were from 2004 and hence were not up-to-date. This could allow risks to arise in this respect. The manager must ensure that the checks are kept up-to-date. The previous requirements in respect of providing staff with fire training, and of updating the fire risk assessment, had been promptly addressed. The assessment was undertaken in detail by a professional organisation and focussed clearly on practical issues. There was evidence of shortfalls with fire safety within this assessment having now been addressed. There were also records of weekly checks of the fire system, and of five fire drills in 2006. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 25 The home’s bound, numbered and carbonated accident book was checked through. There were four entries across the previous three months, three of which documented about service users having falls. The other was an incident of aggression between two service users that caused a minor injury. The manager was able to explain actions taken in all cases. Records and staff feedback showed that the local council’s Environmental Health department had visited the home just before this CSCI inspection. This was in respect of food hygiene. It was reported that standards were generally suitable, but that improvements were needed in a few areas. This includes in relation to taking accurate temperatures of the fridge and freezer, and checking that the temperature of hot foods are suitable. The manager must ensure that these requirements are addressed, to help uphold suitable standards of food hygiene. The CSCI has been kept notified about significant incidents in the home as required. This includes one medication error from early November. The manager noted that those service users involved did not receive any adverse effects in practice. At the time of the inspection however, the investigation into how the error occurred and how to ensure prevention of similar occurrences had not been completed. This puts service users at risk of a further error, as no safeguards had yet taken place to prevent a repeat occurrence. The registered provider must ensure that investigations of this nature are undertaken and concluded without delay. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 4 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 3 2 X X 2 2 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement The manager must ensure that PCPs are set up for each service user, with clear evidence of service user consultation and approval of the plan, and service users being enabled to have a copy of the plan if so wished. A full review of the meals, including with respect to the new service user’s and anyone else’s changed preferences, is required, to ensure that choices are up-to-date. A record of what each service user chose to eat must also be kept, to help monitor the nutrition supplied to each service user. The manager must ensure that records about health professional’s advice are kept up-to-date within each service user’s file. The manager must ensure that all complaints about the service are recorded within the complaints book and file, including actions taken as a consequence of the complaint. DS0000017527.V325622.R01.S.doc Timescale for action 1 YA6 15 01/05/07 2 YA17 12(3), 17(2) s4 pt13 01/04/07 3 YA19 17(1)(a) s3 pt3(m) 01/03/07 4 YA22 17(2) s4 pt11 01/03/07 65 Charlton Road Version 5.2 Page 28 5 YA24 23(2)(c) 6 YA39 24 7 YA42 23(2)(c) 8 YA42 16(2)(j) 9 YA43 10(1), 13(2) There was a case where this had not happened. The manager must ensure that the fire-safety device, on the door in the corridor near the front door, is promptly fixed. A formal quality assurance system is needed, to ensure that all people involved in the home are asked about their views on the care provided. A report of this must then be made available, including plans to address any areas for development. The manager must ensure that the professional checks against legionella are kept up-to-date. The manager must ensure that the requirements of the recent Environmental Health report are addressed, to help uphold suitable standards of food hygiene. The registered provider must ensure that investigations about significant service shortfalls are undertaken and concluded without delay. 01/03/07 01/09/07 01/04/07 01/04/07 01/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations It would be useful to keep a regular report on individual service users’ care plan goals, to show how the goals are progressing. It is recommended that minutes of service-user group meetings be put on display, so that service users can easily read about the last meeting in advance of the next one. Setting-up communication profiles in conjunction with the DS0000017527.V325622.R01.S.doc Version 5.2 Page 29 2 3 YA8 YA11 65 Charlton Road 4 5 6 7 YA13 YA19 YA20 YA22 day service for each service user, and providing staff with training, could help to enable some service users to be better understood in the home. There are very few approved van-drivers within the staff team, which should be improved on, to assist with service users getting to events on time. Service users’ Health Action Plans should be stored within live files, to enable them to be continually used. PRN (as-needed) medications should be accurately reflected as PRN, not daily-use, on the administration sheets. It is recommended that the detailed complaint file be kept secure and confidential, with just the initial complaints book left available for staff to record complaints in. 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 30 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 65 Charlton Road DS0000017527.V325622.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!