Inspection on 19/03/08 for 93-95 Canning Road

This inspection was carried out on 19th March 2008.

CSCI found this care home to be providing an Good service.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

93-95 Canning Road 21/09/06

93-95 Canning Road 15/11/05

93-95 Canning Road 05/09/05

93-95 Canning Road 02/12/04

93-95 Canning Road 28/09/04

93-95 Canning Road 23/03/04

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Edenvale

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Chatsworth Care - Dawson House

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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 93-95 Canning Road 93-95 Canning Road Wealdstone Middlesex HA3 7SP Lead Inspector Julie Schofield Key Unannounced Inspection 19 and 26th March 2008 08:15 th 93-95 Canning Road DS0000017522.V360958.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 93-95 Canning Road DS0000017522.V360958.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. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 93-95 Canning Road Address 93-95 Canning Road Wealdstone Middlesex HA3 7SP 020 8424 8186 020 8424 0879 canning_road@yahoo.co.uk 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) Support for Living (Harrow) Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st September 2006 Brief Description of the Service: 93-95 Canning Road is a registered care home providing personal care and accommodation for up to 6 adults aged 18-65, who have learning disabilities. At the time of the inspection there were no vacancies in the home. The Registered Provider is Support for Living (Harrow) and the Responsible Person is Mr Nigel Turner. The Registered Manager’s post is currently vacant after Patience Dohnji completed her acting manager duties and Caroline Stockwell was appointed as the new acting manager. Paddington Churches Housing Association (that takes responsibility for its maintenance) owns the building. Harrow Mencap is the care agency that employs the staff working in the care home. The home is located in a quiet residential road in Wealdstone, on the outskirts of central Harrow. There are parking restrictions in the road outside the home and in the immediate vicinity. Car parking is only allowed to permit holders between 10 and 11 am and between 2 and 3 pm. The home is close to shops, pubs, transport and other community amenities. All the home’s bedrooms are single, and none have en-suite facilities. The home has a garden to the rear of the property that is accessible through the lounge and kitchen. The weekly placement fee for the service is determined by an assessment of the needs of the potential resident. Residents currently contribute a rent element towards the total cost of their placement. Information about the service provided and the level of fees may be obtained, on request, from the acting manager of the home. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection was carried out over 2 days in March. It began on the 19th of March when 2 visits were made to the care home. The first visit began at 8.15 am and finished at 12.45pm. We called back at 4.05 pm and then left at 6.10 pm. On the 26th March another visit was made to the home. This started at 10.05 am and finished at 4.50 pm. In the afternoon we left the home and went to the head office to inspect staff records. During the inspection we examined files and records, looked at the premises, spoke with the manager, members of staff and 5 of the 6 residents, checked compliance with the statutory requirements identified during the last inspection, observed care practices and case tracked the care of selected residents. What the service does well: When we talked with one of the residents they said “I am very happy living in this house” and that “no house is as good as this one”. They enjoyed the meals and said that the staff were good and helped the resident out. The resident said, “They are the best staff I’ve ever had”. Although one resident wanted to move into more independent living they said that they would miss the members of staff and the other residents. Another resident said that it was “fine living here” and that their key worker was “really good” and easy to talk with. All of the residents and the members of staff that took part in the inspection praised the support given by the manager. We observed the offering of choice to residents during the inspection and saw that it was part of every day living. Choice was offered in a clear and helpful manner so that the resident was able to express their wishes. Members of staff spoke of the need to support residents in such a manner that the resident is able to do as much as they can for themselves. Members of staff displayed patience and tact and there was a good rapport between residents and the members of staff on duty. There is a good team spirit within the staff team and there are opportunities for training. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are still issues with the shower rooms and an immediate requirement form was issued during the inspection to resolve the outstanding problem of black mould on the walls and ceiling of the first floor shower room. The cause of an odour of dampness in the ground floor shower room needs to be investigated. A minor repair is needed in the kitchen. The timing of the review meetings needs to be co-ordinated so that the local authority meeting and the home’s own meeting are not held so close together with a long gap developing before the next round of meetings. As monthly evaluations of the care plan are to help identify quickly changes in the needs of residents so that adjustments can be made, they must be kept up to date and accessible to all members of staff. If residents are not happy with any aspect of their care they must have up to date information about agencies involved in the complaints process and the procedure needs to have timescales so that the complainant knows when to expect a response. An enhanced CRB disclosure must be present on each staff file to assure residents that their safety is protected. Safety within the home depends on valid servicing/inspection certificates for equipment and systems in use in the home and evidence of some of these has been requested. The person who was the registered manager no longer is the acting manager of the home and an application for the registration of the new acting manager is needed. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 7 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. 93-95 Canning Road DS0000017522.V360958.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 93-95 Canning Road DS0000017522.V360958.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, 4 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. An assessment prior to admission to the home assures the prospective resident that the home is able to provide a service that can meet their needs. Opportunities to visit the home prior to admission assure the resident that this is where they want to live. EVIDENCE: We looked at the case file of a resident that had recently moved into the home. An OT had viewed the premises to check their suitability as the prospective resident has mobility problems. An advocate supported the prospective resident during the pre-admission process. There was evidence that referral details had been taken and that an application form had been completed. The previous acting manager and the acting operations manager had visited the prospective resident at the care home in which the resident was living when the application was made to carry out an assessment. (The prospective resident was living in another of the company’s care homes). Minutes of planning meetings were on file and dates of visits to the home were recorded. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 10 A record was kept of what happened during the visits and of the views of the existing residents to the proposed acceptance of a new resident. We spoke with the resident that moved into the home about 3 months ago and he said that he had wanted accommodation local to Harrow and said that Canning Road compared well with other care homes. He gave an example of visiting another care home before choosing Canning Road and gave some of the reasons for his choice. He confirmed that he had visited Canning Road as part of the pre-admission process and that he had looked at the room offered. He said that he had been given a paint colour chart and had chosen a cream colour for the walls of his new room. 93-95 Canning Road DS0000017522.V360958.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, 9 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. Reviewing the suitability of the placement on a regular basis and evaluating the care plans on a regular basis would ensure that changes in the needs of residents are promptly identified and addressed. The residents’ right to exercise choice in their daily lives is promoted and respected. Staff support residents to take responsible risks so that residents can enjoy an independent lifestyle. However, the risk assessments need to be kept under regular review so that residents are assured that their personal safety is not compromised. EVIDENCE: Three case files were examined. Each file contained a care plan in the new, user-friendlier format. Residents were involved in drawing up the plan and the 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 12 sections contained in the plan identified what the resident wanted and what action was required to achieve this goal. Residents signed the care plan and they had been reviewed. Each file also contained either a 2007 or a 2008 FACS Eligibility and Care Plan. However, the reviews convened by the home were held close to the dates of the review meetings convened by the funding authority. In addition monthly up dates are kept, although copies of these were not on each file for up to and including February. Residents were aware of who their key worker was and were able to name them. The manager said that there had been changes recently, after looking at the needs of the residents and the strengths of individual members of staff, to achieve “a better match”. When we talked with a resident we were told that residents’ meetings are held and that residents were asked what they would like to do. He suggested that minutes of the meetings and other important items of information e.g. notice of forthcoming outings be posted on a notice board in the dining area but that the format of the notice needed to be considered so that it met the needs of all residents. A resident confirmed that at a meeting he had attended outside the home he said that he was “fed up with all this choice”. Residents have access to advocacy services. Residents’ financial records were checked. Each resident has their own individual account and records were up to date and satisfactory. Case files contained risk assessments that were appropriate for the individual life styles of residents. They included the risk of seizures, travel training, going on holiday and taking part in activities in the community. However, some had not been subject to regular reviews and the manager said that she was looking to review all risk assessments and then to put in place a system of six monthly, recorded reviews. 93-95 Canning Road DS0000017522.V360958.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, 3, 14, 15, 16, 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. Attending day centres and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. Residents are encouraged to maintain contact with their families and friends so that their need for fulfilling relationships is met. The residents’ right to privacy and independence are respected and promoted by staff. Menus respect the religious, cultural and dietary needs of residents. EVIDENCE: At the start of the first day of the inspection some of the residents were getting ready to attend day care centres. The manager said that there have been changes to day care programmes recently as residents have decided that they would prefer other options to attending a day centre, either on some or 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 14 all of the days of the week. Their choice of activities form the basis of the new person centred plans. One of the residents said that he would like to have a paid job and the manager said that he is receiving support to achieve this goal. Options were discussed with the resident and his parents during the inspection. Another resident is being encouraged to lead a more active life and when he did not want to do the activity on his programme he was asked what his alternative was. He said that he would like to go into London and this was arranged. Where a resident expressed an interest in doing a computer course the home has found a drop in style computer course that he can attend. One resident preferred to do more activities based in the home and arts and crafts sessions and fun baking have been introduced. Residents use facilities in the community and examples were given to us. They included the cinema, restaurants, sports centres and parks. One resident is to join the library. One resident said that he went to church on Sundays. The manager has business use insurance for her car and uses this to transport residents, when needed. Residents also use public transport, dial a ride and taxis. Residents confirmed that they went out to do their shopping and chose what they wanted to buy. They said that they went to the pub and out for a meal and one resident said that they went out with one of the support workers to play pool. Another resident said that they met their friends at the weekend. One of the residents said that they had been on holiday to Portugal last year and that he had enjoyed the holiday but not as much as when he had gone to Alton Towers or to Euro Disney. An Asian resident attends a club for Asian members and attends religious and cultural events with his family. The home has an open door policy and encourages families to visit the residents. Families are also encouraged to keep in touch by telephone. During the inspection the parents of a resident were visiting and they took the resident out for lunch. When family members visit the members of staff on duty make them welcome and visits take place in the privacy of the resident’s room. We noticed that there was a good rapport between the manager and the family members and that, with the resident’s agreement, the home worked in partnership with the family. Residents said that they did their chores and gave examples of laundry, cooking and keeping their room clean and tidy. One resident agreed that this was part of the preparation needed before they moved into more independent living. One resident said that they were unable to take their clothing to the laundry room on the first floor because they could not use the stairs. Copies of the menu were on display on the notice board in the dining area. The manager said that residents are involved in menu planning. A resident’s name is attached to the menu for the main meal on a Monday to Friday and a member of staff said that the named resident would help to prepare this meal. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 15 Residents enjoyed a take away meal on a Saturday and a roast dinner on a Sunday. Residents prepare their own breakfast and packed lunch, if required. The manager said that they each have their own budget to purchase food items and their own storage areas in the cupboards, freezer and fridge to help promote their independence. Residents are able to have meals that meet their religious and cultural needs. A resident said that they liked the meals served in the home and we noted that the meals that they particularly enjoyed appeared on the menus. 93-95 Canning Road DS0000017522.V360958.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, 20 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 assistance with or prompting with personal care in a manner, which respects their dignity and privacy. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the resident’s GP. EVIDENCE: Support is provided with personal care tasks at a level that reflects the independence of the individual resident. Assistance may take the form of prompting. There are female and male members of staff so that a resident can request assistance from a staff member of the same gender as the resident. Times for bathing, meals, going to bed at night or getting up in the morning are those agreed with residents according to their individual life styles and preferences. We saw that residents were clean and tidy in appearance and 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 17 smartly dressed. The home has a system of key working. A resident said that there was respect on both sides (between residents and members of staff). When we looked at resident’s case files we noted that they contained a record of regular health care appointments including appointments with the dentist, optician and chiropodist. A record of appointments with the GP was kept and we saw that medication reviews had taken place. There was evidence that referrals are made to health care professionals e.g. the speech therapist, when necessary. Support is given to residents to attend out patient appointments at clinics or hospital, if necessary. The general health of residents is monitored and there was evidence on the case files that timely assistance is sought for residents, when needed. We noted that the storage of medication was safe and that within the medication cabinet the storage was orderly and controlled. The home uses blister packs for the administration and one of the residents self medicates. When the packs were examined we noted that the blisters had been opened and the tablets removed according to the time of day and the day of the week that they were examined. Records were up to date and complete although it is recommended that any known allergies be recorded on the MAR sheet. The home has policies and procedures for the storage and administration of medication and for the use of medication on a PRN basis. It also has guidelines for each item of medication prescribed for a resident that is to be administered on a PRN basis. The use of homely remedies for each individual resident has been agreed with the GP and the GP has signed the guidelines. Medication training has been included in the programme of refresher training currently being carried out and a member of staff on duty confirmed that she had received medication training. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 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. A complaints procedure is in place to protect the rights of residents but a format that is helpful to residents, with details of the CSCI, is needed so that residents know what to do. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: There was a user friendly poster on the notice board in the dining area advising residents who to contact if they were worried or had a complaint. It referred to the “Harrow Registration and Inspection Unit”. This ceased to exist in 2002. The manager removed this before the second day of the inspection and kept a note of contact details for the CSCI so that a new poster can be drawn up. Mencap has a user-friendly form for use by residents and a copy of the complaints procedure was in the policies and procedures manual. This did not include timescales. Residents have easy access to the manager, and to her line manager (who used to be the registered manager of the home in the past and who still visits the home). Residents said that if something was wrong they could talk to a member of staff or to the manager and we noticed during the inspection that residents felt comfortable to share their problems with members of staff and with the manager. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 19 A member of staff on duty confirmed that she had received training in protection of vulnerable adults procedures. The manager confirmed that protection of vulnerable adults training had been included in the programme of refresher training and would be taking place in May. This topic is also part of NVQ training. The home has a policy on safeguarding adults and for whistle blowing and the policy drawn up by Mencap is also in the manual. A copy of the interagency guidelines in the event of an allegation of abuse is available in the home. Residents said that they felt safe in the home. When asked if there was someone they could talk to if they felt worried or if something was wrong they said that they would talk to staff, or to their key worker or to the manager. A resident reported an incident that had occurred in the community to the police and the home notified the CSCI of this matter. They supported the resident by exploring personal safety issues. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 20 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, 30 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. Generally residents live in a home, which is comfortably furnished and provides a pleasing environment for residents to relax in and enjoy. The refurbishment of the bathing facilities in the home, including the eradication of mould, would assure residents of facilities that are pleasant to use. Residents live in a home that is kept clean and tidy. EVIDENCE: During the inspection a tour of the premises took place. Residents said that they liked their bedrooms and that there was enough space to fit their personal items e.g. stereo or computer, in the room. We spoke with a resident that used a wheelchair and with a resident that walked with the aid of a pair of 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 21 crutches. They both said that due to level access to the property at the front and at the back of the building they were able to enter and leave without any problems and they were able to use and enjoy the garden at the back. All ground floor communal areas were accessible to them and they each had a bedroom on the ground floor. However, the office is now on the first floor of the house and neither resident can reach this. The manager said that one of the residents in particular enjoys the company of staff and when the office was on the ground floor he would drop in for a chat. The manager is considering an intercom system for times when staff are working in the office, and not on the ground floor, and a resident wants to call them. Where possible, members of staff have been asked to work downstairs on their paperwork so that contact can be maintained with the residents. During the tour of the premises we noted that improvements have taken place to the hallway, the ground floor toilet, the kitchen and laundry room since the last inspection. The carpet in the hallway has been steam cleaned to remove stains and the walls of the ground floor toilet have been painted and the flooring replaced. The cracks in the laundry walls have been made good and the wall repainted and the sink unit in the laundry has been repaired. A section of guttering had been replaced. Although the kitchen cupboard door has been repaired the lower kitchen cupboard edges remain damaged. We noticed a fridge freezer standing in the garden. We discussed the ground floor shower room with the resident that uses a wheelchair and he confirmed that the space within the room and the positioning of the fittings enabled him to use this room safely. A member of staff explained that marks on the wall in the ground floor toilet were as a result of a resident that had mobility problems, holding onto the wall. It is recommended that the provision of grab rails be considered. It is also recommended that the provision of call alarms in the ground floor bathing and toilet facilities be considered. We noted that improvements have been made to the bathing and toilet facilities in the home since the last inspection. These included the replacement of the damaged shower seat and replacement of stained grouting in the ground floor shower room. The manager said that shortly after she began to work in the home she arranged for the ground floor shower room to be steam cleaned. However relatives visiting the home said that they have continued to notice a smell in this room and we noticed small spots of mould on the ceiling and walls. We noted that the first floor bathroom and the toilet had been redecorated but the black mould on the walls and ceiling of the first floor bathroom was still present and there were drops of water on the ceiling and on the beam, close to the light fitting. The corner of the ceiling above the shower appeared to be starting to bow inwards. An immediate requirement form was left and confirmation was required that the room was safe for use by residents. The day after the first visits to the home confirmation was received that the room was safe to use and that a number of repairs to the room had been 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 22 identified. (The company gave the date of the 30th of April for the repairs to be completed). A tour of the premises confirmed that the home was kept clean and tidy. However, relatives commented on an odour in the ground floor shower room and attributed this to mould or damp. There is a separate laundry room in the home that does not require soiled clothing to be carried through any areas where food is stored, prepared or consumed. We discussed infection control procedures with the manager. She said that this formed part of the food hygiene training. One of the staff files examined contained an attendance certificate for an infection control training course and a member of staff on duty confirmed that she had received infection control training. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 23 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 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. NVQ training enhances the general skills and knowledge of carers and the home has exceeded the target of at least 50 of carers achieving an NVQ level 2 or 3 qualification and should be commended. Staffing levels are sufficient to meet the individual needs of the residents and assure residents of choice of activities. Recruitment practices, which include checks and references, protect the welfare and safety of residents and the home needs to demonstrate that all of these have been carried out. The home has a training and development plan, which is linked to the aims of the home and new staff receive induction training. EVIDENCE: A member of staff working in the home on a care bank basis confirmed that she had an NVQ level 3 qualification and said that the other member of staff on 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 24 duty, the shift leader, was an NVQ assessor. She added that all the permanent members of staff are studying for or have completed their NVQ level 3 training, except a new member of staff, and that the home has exceeded the target of 50 of support workers achieving an NVQ level 2 or 3 qualification. The manager said that the percentage of members of staff with an NVQ qualification is approximately 70 . During the inspection visits 2 support workers were on duty in addition to any manager(s) on duty. A member of staff said that 2 support workers were on duty at all times during the day, Monday to Sunday, and that a night 1 member of staff was in the home. There is an adjustment to the working hours of members of staff at the weekends to give residents a lie in, if they wish. A resident said that the staff were patient and kind and that he liked the fact that “they have a joke with me”. Members of staff on duty confirmed that they had received training in epilepsy and in managing challenging behaviour. Three staff records were examined at head office. Each staff file contained proof of identity (passport details), 2 references (including 1 from the most recent employer), an application form (with work history) and details of previous training etc. Two of the files contained an enhanced CRB disclosure but the third file contained a disclosure that was not portable. The manager said that a CRB application had been made and received although the evidence of this was not present on the file. After the new acting manager was appointed she carried out a training audit and developed individual training profiles. She identified the need to update mandatory training and at the time of the inspection the programme for this was almost complete. As part of a group of care homes within the company she has provided a list of each individual member of staff’s training needs so that a plan can be developed for approval, and implementation, by the company. Training for each member of staff begins with their induction and foundation training and new members of staff have a workbook to record this. A copy of the annual development plan, March 2008-March 2009, was provided. The need for further training in certain areas has been identified as a key component for achieving the objectives listed. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 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. The registered manager has developed her knowledge through training and this contributes towards understanding the needs of residents and staff. Giving residents opportunities to comment on the quality of the service assures them that they can contribute towards the development of the service. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use and certificates must be available to demonstrate this. EVIDENCE: 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 26 Although the name of the previous acting manager for the home is recorded on the registration certificate as the registered manager this person has reverted to their substantive post and a new acting manager was appointed in September 2007. A letter has been sent to the company asking them to forward an application for the registration of the new acting manager, Ms Caroline Stockwell. The new manager told us about her skills, knowledge and qualifications. She said that she has 17 years experience in the care sector, particularly supporting clients with learning disabilities and autism, in both a residential and in day care setting. She has many years experience working as a manager and has successfully completed the Advanced Management in Care qualification. Both residents meetings and family meetings take place on a regular basis. When it was proposed to move the office from a room on the ground floor to a room on the first floor this was an agenda item. Staff development meetings are held on a fortnightly basis. Mencap holds regular forums (the last being in December 2007) and sends survey forms to the people attending. The manager said that they support as many of the residents to attend the forums as possible. There are opportunities for residents to give feedback on an informal basis as a representative from Mencap visits the home and talks with residents privately. Mencap has also devised a quality control tool that the home will use to gauge customer satisfaction. The topics include relationships, day care opportunities, health, food and communication. The manager said that at the moment a programme of refresher training for safe working practice topics was taking place and a member of staff on duty confirmed that she had undertaken fire safety, food hygiene and first aid training and that she would be doing manual handling training later in the week. A member of staff on duty confirmed that they were carrying out the daily check of the temperature of fridge and freezers. The fire risk assessment was reviewed at the beginning of 2008. Records for the servicing and testing of equipment and systems in the home were examined. Although the fire alarm system has been tested on the 25th March the records did not demonstrate testing on a weekly basis. Fire drills are carried out every 3 months and include an evacuation of the home. There were valid certificates for the Landlord’s Gas Safety Record, the air conditioning system, the fire precautionary system, the magnetic door closures, the fire extinguishers and the fire alarms. The certificates for the electrical installation and for the testing of the portable electrical appliances were not available. There was a copy of the letter from the LFEPA dated the 19/9/07 that confirmed “compliance” with fire regulations. There was a copy of a letter 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 27 from Harrow food safety department awarding the home a rating of 3 stars or good for their practices. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 28 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 3 25 X 26 X 27 1 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15(2) Requirement To assure residents that their care plans are reviewed on a six monthly basis the dates on which review meetings are convened by the funding authority and convened by the home need to be monitored. Monthly evaluations of the care plan need to be up to date and a copy placed on the resident’s case file so that the home demonstrates that the changing needs of residents are identified and that the service provided is amended so that the new needs can be met. Risk assessments must be kept under review as part of the home’s care planning arrangements so that residents are assured that promoting independence does not compromise their personal safety. (Previous timescale of the 13th November 2006 not met). Timescale for action 01/07/08 2 YA6 14(2) 01/06/08 3 YA9 13(4) 01/07/08 4 YA22 22(1)(2)(7) Residents must be provided DS0000017522.V360958.R01.S.doc 01/05/08 Version 5.2 Page 30 93-95 Canning Road with up to date information regarding whom to contact if they want to make a complaint to ensure that their views are heard. 5 YA22 22(4) To assure residents that complaints are dealt with in a timely manner the complaints procedure needs amending to include timescales for action. In order for residents to enjoy using bathing facilities in the home the black mould on the walls and ceiling of the first floor bathroom must be removed. (Previous timescales of the 15th February 2006 and the 13th November 2007 not met) In order for residents to enjoy using the bathing facilities in the home the cause of the smell in the ground floor shower room must be investigated and remedial work undertaken. To ensure that the surfaces of the lower cupboard doors remain impermeable the parts that are damaged need to be repaired or replaced. (Previous timescale of the 3rd December 2006 not met). To demonstrate that unsuitable persons are not employed to work in the home, evidence of a satisfactory enhanced CRB disclosure for the 3rd member of staff whose file was examined must be forwarded to the CSCI. To assure residents that the acting manager has the skills, DS0000017522.V360958.R01.S.doc 01/06/08 6 YA27 23(2) 30/04/08 7 YA27 16(2) 01/06/08 8 YA24 23(2) 01/06/08 9 YA34 19(1) 19/05/08 10 YA37 9(2) 01/07/08 93-95 Canning Road Version 5.2 Page 31 knowledge and qualifications needed to run the home the acting manager must complete an application for registration and forward this to the CSCI. 11 YA42 13(13(4) To assure residents, members of staff and visitors to the home that portable electrical appliances are safe to use the home must forward a valid certificate for their satisfactory testing to the CSCI. (Previous timescale of the 3rd December 2006 not met) To assure residents, members of staff and visitors to the home that the electrical installation is in a satisfactory state of repair the home must forward a valid certificate of testing to the CSCI. To assure residents, members of staff and visitors to the home that the fire alarm system is working in a satisfactory manner a record of weekly fire alarm tests must be kept. 19/05/08 12 YA42 13(4) 19/05/08 13 YA42 23(4) 01/05/08 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 That, where possible, there is a gap of 6 months between the review meeting convened by the funding authority and the meeting convened by the home. The 2 meetings are to take place within a 12-month period. That information for residents is prominently displayed in a suitable place and in a format(s) that meets the needs of DS0000017522.V360958.R01.S.doc Version 5.2 Page 32 2 YA7 93-95 Canning Road 3 4 5 6 7 YA16 YA20 YA24 YA27 YA27 8 YA30 individual residents. That a review of the use of facilities on the first floor by all residents living in the home takes place. That known allergies are recorded on the MAR sheet or “none” is recorded. That any items being stored in the garden that are no longer needed or are broken and cannot be repaired are to be removed. That the provision of grab rails in the ground floor bathing and toilet facilities is reviewed, with the assistance of an occupational therapist. That the ground floor bathing and toilet facilities are subject to a review where the safety of residents when using the facilities is determined and the use of a call alarm system is considered. That a review is carried out to determine whether all members of staff have undertaken infection control training and if not that this is added to their individual training profile as a training need. 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 33 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 93-95 Canning Road DS0000017522.V360958.R01.S.doc Version 5.2 Page 34 - 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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