Inspection on 03/04/07 for Dimensions 2 Lindsay Drive

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Dimensions 2 Lindsay Drive 09/02/06

Dimensions 2 Lindsay Drive 01/08/05

Dimensions 2 Lindsay Drive 16/02/05

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 MIXED CATEGORY MAJORITY ADULTS 18-65 Adepta 2 Lindsay Drive 2 Lindsay Drive Kenton Middlesex HA3 0TB Lead Inspector Judith Brindle Key Unannounced Inspection 08:30 3rd and 20th April 2007 DS0000062633.V333275.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 DS0000062633.V333275.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 Older People and 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. DS0000062633.V333275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Adepta 2 Lindsay Drive Address 2 Lindsay Drive Kenton Middlesex HA3 0TB 020 8905 0645 020 8903 7607 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) www.pentahact.org.uk Adepta Manager post vacant Care Home 5 Category(ies) of Learning disability (3), Learning disability over registration, with number 65 years of age (2) of places DS0000062633.V333275.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: Lindsay Drive is one of number of homes in Harrow and Brent for people with learning disabilities. PCHA Housing owns the house and Adepta provides the care. The care home provides care and, accommodation for five people with learning disabilities, two of who are over 65. Accommodation is provided on two floors. There are three bedrooms on the ground floor and two on the first floor. There a designated day care room with keep fit equipment for the resident’s use. There is a spacious lounge and large kitchen/dining room on the ground floor of the care home. The property is located on the corner of a quiet road in Kenton and a busy main road. It is approximately 10 minutes walk to the nearest tube station (Kingsbury), and main bus routes are close by. There are shops and restaurants close by as well as a range of leisure facilities in Harrow town centre. Documentation/information about the care home is accessible to residents and visitors. Information in regard to fees can be obtained by contacting the registered provider. DS0000062633.V333275.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout two days during April 2007. The first day consisted of talking to people living in the care home, talking to staff and inspecting a variety of records. The second day included assessing National Minimum Standards not covered during the first day of the inspection, providing feedback to the manager and deputy manager, and talking with people living in the care home. There were no vacancies at the time of the inspection. The inspector was pleased to meet and talk with all the people living in the care home, some of whom have varied communication needs. The inspector also spoke with staff. Staff were very helpful during the inspection, and supplied all documentation and information asked for by the inspector. The registered manager was present for the second day of the inspection. The inspection included a tour of the premises, and a significant focus of the inspection was communicating with people living in the care home, and observing their interaction with staff and with other residents. Assessment as to whether requirements from the previous inspection had been met, also took place. Documentation inspected included, all the resident’s care plans, complaints and accident/incident records, the staff rota, staff personnel files and medication records. 26 National Minimum Standards (including key Standards) for adults were inspected. What the service does well: The care home has a very welcoming, warm, and calm atmosphere. Staff and people living in the care home make visitors feel very welcome. People living in the care home confirmed that they were happy residing in the care home. People living in the care home are significantly involved in the care home. They complete household duties including cooking and housework. Residents are supported and encouraged to be as independent as they are able. Staff have a good knowledge and understanding of resident’s needs, and were observed to be very sensitive, and respectful to residents during the DS0000062633.V333275.R01.S.doc Version 5.2 Page 6 unannounced inspection. Residents spoke highly of staff and described them as helpful and caring. People living in the care home who kindly spoke with the inspector were very positive about the manager of the care home, and spoke of him working hard to improve the service provided by the care home. It was evident during the inspection that the new manager was motivated and is very keen to develop and improve several aspects of the quality of the service. Staff receive varied, and appropriate training. Staff receive regular 1-1 staff supervision to ensure that they receive support to carry out their roles. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000062633.V333275.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) DS0000062633.V333275.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live. These documents should be reviewed. Arrangements are in place to ensure that prospective resident’s needs are assessed. EVIDENCE: The statement of purpose and the service user guide documents include information about the service provided by the care home. Copies of these documents were accessible in the care plan documentation of the three DS0000062633.V333275.R01.S.doc Version 5.2 Page 9 resident’s care plans that were inspected. The documents include some pictorial formats. The manager spoke of plans to further develop the format of these documents (particularly the service user guide) to improve their accessibility to people living in the care home. The service user guide needs to include information in regard to the change in manager and name of provider, and include the amount and method of payment of fees, and of how people living in the care home can obtain (if it is not attached to the document) a copy of the most recent inspection report. Following the last inspection (February 2006), the care home provided the Commission for Social Care Inspection with copies of the statement of purpose. This document includes comprehensive required information about the service provided by the care home, but it needs to be reviewed to include the new manager’s name, the change in the registered provider’s name, The care home has an admissions procedure. There have not been any admissions to the care home for almost two years. The care plan of the most recently admitted resident was inspected. This recorded evidence of a completed referral and assessment form, and included recorded evidence of a comprehensive initial assessment of the prospective resident’s needs having been carried out by the previous home manager. This assessment included information in regard to medical, health, physical, social, financial and cultural needs of the prospective resident. It was evident that comprehensive information had been obtained from the previous placement, family and the prospective resident. Placement agreements from the purchasing authority were recorded in care plans inspected. DS0000062633.V333275.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all residents have a plan of care, with recorded personal goals, but some development in care plan records should be carried out. Residents are supported and encouraged to make decisions. Residents are supported to take risks as part of an independent lifestyle. DS0000062633.V333275.R01.S.doc Version 5.2 Page 11 EVIDENCE: Three care plans were inspected. These included individual recorded assessment of needs of the people living in the home, which included personal relationships, culture, community living, health, personal care needs, social needs, communication needs, everyday living skills, and money management. The care plans recorded a number of needs, with basic staff guidance to meet these needs, and includes information about who will support the resident to meet these needs. There is a section in the care plan which records when the identified need needs evaluating. The record in this section generally recorded ‘on-going’. Care plans should record timescales for action to be taken to achieve a goal/need, and there should be a recorded date for review for each goal/need. The care plans inspected recorded evidence of being reviewed annually. There was also a monthly report completed by the key worker. This included review of health/medication, social activities, general activities, contact with family and friends, progress of personal care, incidents and comments. There was some evidence of resident’s participation in their plan of care. This could be further developed. Records confirmed that some staff had received training in Person Centred Care planning, (which aims for residents to be central to their plan of care). There could be further development in the person centred care planning approach within the care home. This should include review of the format of the care plan including more pictorial formats (due to the varied communication needs of residents). The manager spoke of his plans to review and develop care plans to ensure that they are individual and person centred. Residents confirmed that they had a key worker, whom they spoke positively about; “my key worker is very nice”, “my key worker helps me”. Staff who kindly spoke with the inspector were knowledgeable of their role of key worker. The inspector was informed that all residents have a key worker and a co key worker. The manager spoke of action being taken to ensure that all people living in the care home have the opportunity to attend regular meetings with their key worker. Resident’s daily progress records were fully recorded and included positive and comprehensive information about each person living in the home. Residents spoke of making choices. These include shopping for clothes, toiletries and choosing preferred activities. Staff were observed to consult residents and to enable them to make choices during the inspection. It was evident that staff had knowledge and understanding of the varied communication needs of residents. Records confirmed that some staff had received Makaton (signing) training. DS0000062633.V333275.R01.S.doc Version 5.2 Page 12 Residents had individual financial assessments. The inspector was informed that all residents receive support in regard to the management of their finances. Two residents’ financial records and monies were inspected. Appropriate records of incoming and outgoing payments, and receipts are maintained. Two staff check residents’ ‘monies’ following each purchase. Records confirmed that residents are involved in their finances. Residents who kindly spoke with the inspector had an awareness of their finances and spoke of saving for particular items that they wished to buy. Records confirmed that residents were informed of the amount that they needed to contribute towards their rent. The care plans inspected recorded evidence of risk assessment in resident’s care plans. These risk assessments included, road safety, purchasing goods, bathing, travelling, and falls. These risk assessments include some information in regard to action to be taken to minimise risk, but this guidance could be further developed. For example it is recorded that a resident could exhibit significant challenging behaviour at times, and the staff guidance recorded is ‘staff be familiar with his mood and move away from him when he is angry’. This guidance should include information about what makes the resident angry and what could be done to minimise this risk, as well as ensuring that it is documented that staff record and report any incident. The care home has a missing persons procedure. DS0000062633.V333275.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 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. DS0000062633.V333275.R01.S.doc Version 5.2 Page 14 Residents have the opportunity to take part in a variety of activities including those promoting personal development, and being community based. Arrangements are in place to enable residents to maintain contact with family/significant others as they wish. Resident’s rights and cultural/religious needs are respected and responsibilities recognised in their daily lives. Meals are varied and wholesome. EVIDENCE: Residents spoke of the variety of activities including evening activities that they chose and enjoyed. These included ‘in house’ and community based activities. Several residents regularly attend a day resource centre during weekdays. Residents were observed to participate in household duties during the inspection. These included helping to prepare the evening meal. A resident spoke of enjoying shopping, and holidays. Several residents had been on holiday abroad in 2006. A resident spoke of being in the process of choosing a holiday abroad for this year. A person living in the care home spoke of a day trip that they participated in. Another resident spoke of her love of music, and how she enjoyed regular music therapy sessions. Records confirmed that residents attended clubs, went on walks, church, enjoyed parties, and participated in art and music sessions. A person living in the home spoke of attending church. Residents each have a travel pass entitling them to free local public transport. A staff member reported that residents also participate in a ‘taxi card’ scheme, and have access to ‘dial a ride’ transport Records, staff and residents confirmed that the diversity/cultural needs of residents were being met. A resident spoke of having enjoyed celebrating a Jewish festival with his family. The care home has a visitors’ policy/procedure. Records confirmed that visiting times were flexible. The care home has a visitor’s recording book. Residents spoke of the contact that they had with family, friends and significant others. There is an accessible telephone, which residents can use. A person living in the care home showed the inspector his personal telephone that he kept in his bedroom. It was evident that family contact with residents is encouraged and supported (if agreed by the resident). Records confirmed that family members attended care plan review meetings. A resident spoke of the numerous friends that he had within the community and at the day resource centre that he attends. DS0000062633.V333275.R01.S.doc Version 5.2 Page 15 Visitors are able to see residents in their own room or in the communal areas of the home. There is a designated room that can be used to entertain visitors. Staff were observed to respect resident’s privacy, and knocked on resident’s bedrooms doors prior to entering. A resident informed the inspector that he locked his door when he was out of the home. Service users were seen to choose when to be alone or in company, and made choices whether or not to participate in an activity. Residents were observed to freely access their own bedrooms and communal areas of the care home. The home has a smoking policy People living in the care home spoke of choosing meals on a weekly basis, and of participating in the process of food preparation. Food eaten is recorded. Resident’s specialist dietary needs are met by the care home. A resident spoke of choosing her own breakfast, and spoke of having had porridge, and some cereal. The residents confirmed that meals provided meet their cultural needs, and preferences. A variety of dried, fresh and frozen foods were stored. Fresh fruit was accessible during the inspection. All the residents who kindly spoke with the inspector said that they enjoyed the meals provided. Fresh vegetables were seen to have been prepared by residents and staff for the evening meal. Records confirmed that the care home ensures that fresh produce is used in the preparation of meals. The people living in the care home have their weight monitored. DS0000062633.V333275.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s personal and healthcare needs are met. Assessment of moving and handling needs could be further developed. Medication is stored and administered safely. EVIDENCE: The care plans included a record of residents’ personal care needs. Residents spoke of the support that they received in regard to meeting these needs. DS0000062633.V333275.R01.S.doc Version 5.2 Page 17 Another resident spoke of choosing their own clothes and spoke of it being important to her that she ‘looked nice’. She reported that she had attended a local hairdresser recently, who she said ‘always cuts her hair nicely’. Records confirmed that residents have access to physiotherapy. It is recommended that the home be assessed by an occupational therapist in regard to the mobility needs of several residents. The installation of handrails in some communal areas of the care home should be considered. A resident spoke of his walking frame being broken, which is limiting his mobility. The manager spoke of physiotherapy involvement in regard to replacing this frame, and that the manager would explore further avenues in regard to getting it repaired or purchasing a new frame. This walking equipment should be repaired or replaced as soon as possible. This person living in the care home was observed to use a walking stick during the inspection. The care plans inspected recorded little evidence of comprehensive moving and handling assessments having been carried out. Residents (particularly those with mobility needs) need to have a comprehensive moving and handling assessment. Records confirmed that residents have their health needs monitored by having access to care and treatment from a variety of healthcare professionals. These include GP and community nurse appointments, optician, dentist, chiropody and psychiatric care. Residents as needed access additional specialist support and advice. Records confirmed that residents have received flu vaccinations. The care plans recorded evidence that residents had received a health care assessment. These assessments were dated 2005 and should show evidence of having been reviewed. Records confirmed that a resident had received a routine health check in 2006. Records in regard to keeping ‘healthy and safe’ were recorded in written and pictorial format. Records confirmed that residents attend hospital appointments as and when required. The medication storage and administration systems were inspected. Staff informed the inspector that the care home had recently changed its pharmacist, and that the new medication system was working well. Records and staff confirmed that the new pharmacist had provided some medication administration training. The inspector was informed that all staff receive medication training in their induction, and receive general medication training which includes an ‘in house’ assessment of competency prior to administrating medication to residents. Medication administration records were fully recorded and signed by two staff. DS0000062633.V333275.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure. This is included in the service user guide documentation. This contains information in regard to timescales in which action will be taken in response to the complaint. There are no recorded complaints since 2005. Records confirmed that appropriate action had been taken to investigate and resolve complaints. It is recommended that the registered person develop systems to ensure that any residents ‘concerns’ are recorded and acted upon as required. A resident spoke of speaking to the key worker or a family member if they had a complaint or ‘concern’. DS0000062633.V333275.R01.S.doc Version 5.2 Page 19 The care home has appropriate required policies and procedures in regard to responding to any suspicion or allegation of abuse. There is an accessible recorded whistle blowing policy. There was recorded evidence that staff had received Protection of Vulnerable Adults training. A staff member who kindly spoke to the inspector was aware of reporting and recording procedures in regard to an allegation of abuse. DS0000062633.V333275.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24, 26,27 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely and comfortable. The premises are suitable for the care home’s stated purpose, but there are several areas in the care home, which need redecoration. The home has some maintenance needs and an outstanding maintenance requirement needs to met. Residents bedrooms are individually personalised, meet their individual needs. DS0000062633.V333275.R01.S.doc Version 5.2 Page 21 The care home has sufficient bathroom facilities. Some areas of these facilities should be redecorated. The care home is generally clean, and is odour free. EVIDENCE: The home is located in a residential street in Kenton near Kingsbury. The home is in keeping with the other houses in the area. The home is close to a variety of amenities that include shops, restaurants, cafes and banks. Local transport facilities that include train and bus services are within a few minutes walk from the home. The inspection included a tour of the premises. The home is furnished in a homely manner. The manager reported that the hallway, lounge and a resident’s bedroom had been recently redecorated. Some carpets are worn and stained in some areas, including some bedrooms, the staff room passageway. The lounge carpet is particularly worn in the doorway, and could be a trip hazard (tape covering this area was loose and ruffled). This carpet should be cleaned and needs to be repaired or replaced. Until the carpet is repaired or replaced, there needs to be a risk assessment in regards to the carpet in the doorway being a possible trip hazard. The manager spoke of plans to replace the lounge, hallway and a resident’s bedroom carpets. Four fence slats in the back garden need to be repaired. The manager spoke of having communicated (during the week of the second inspection), with the housing association (responsible for general maintenance issues) about the fence being repaired. The front and back garden should be better maintained. Staff spoke of efforts being made by the care home to obtain a gardener. A staff member spoke of plans to fully involve people living in the care home in cultivating an area of the garden to grow vegetables and other plants. This is positive. There was a leak in the shower room at the time of the inspection. Staff responded appropriately to this during the first day of the inspection, but the leak was still apparent during the second day of the inspection. This leak needs repair. The extractor fan in the shower room should be cleaned. An upstairs bathroom (at the top of the stairs) is in need of redecoration, the bath panel is ‘shabby’ and should be replaced, and the walls repainted. There should be a light pull handle on the light cord, and the shower curtain could be replaced. The toilet handle is loose and needs replacing. The second bathroom also should be redecorated. A hot tap in the washbasin of a bathroom upstairs only provided a trickle of water when turned on. This needs to be repaired. DS0000062633.V333275.R01.S.doc Version 5.2 Page 22 Staff reported that there are plans to carry out redecoration within the care home, which included redecorating bathrooms. Three residents kindly showed the inspector their bedrooms. Each bedroom was individually personalised and airy. The residents spoke of being happy with their room. The bedrooms were warm. The radiators in the bedrooms and elsewhere in the care home were not covered, and felt very warm to the touch. The requirement from the previous inspection to cover the radiators has not been met. The unprotected radiator located beside a resident’s bed was not on (so there was not a risk of scalding), but this radiator was not covered. Staff spoke of that action was being taken to cover the radiators. These requirements need to be met. (See standard 42, requirement in regard to other radiators in the care home). The care home was generally clean. The laundry facilities are located away from food storage and food preparation areas. The facilities include an industrial washing machine and dryer. The laundry room had cobwebs in places, which should be removed. This room should be redecorated. A resident spoke of being involved in the laundering of their clothes. DS0000062633.V333275.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. Arrangements are in place to ensure that staff receive regular 1-1 supervision that they need to carry out their jobs. DS0000062633.V333275.R01.S.doc Version 5.2 Page 24 EVIDENCE: The inspector was informed that staff have worked in the care home for several years and know the residents well. Staff who spoke to the inspector were knowledgeable and understanding of residents needs including cultural/religious needs. Residents spoke positively about staff, and knew who their key workers were. Records and staff confirmed that staff have the skills and experience necessary for the tasks they are expected to do. Staff were observed to interact in a respectful manner with residents. Records confirmed that regular staff meetings take place. Records and some verbal feedback informed the inspector that care home has had issues in regard to staff teamwork. The manager spoke of the strategies that he had put in place and planned to put in place to continue to improve and develop some aspects of staff teamwork in the care home. This is positive. It is recommended that all staff attend equality and diversity training. Staff spoke of receiving regular staff supervision. Records confirmed that supervision of staff had been carried out in March 2007. Staff personnel files that were inspected confirmed that regular staff supervision is carried out in the care home and that the frequency is increased when staff need 1-1 supervision more often. Records confirmed that staff appraisals take place. Two staff spoke of being in the process of completing an NVQ level 2 in care course, but at present did not have an assessor. Arrangements should be in place to ensure that these staff have an NVQ assessor to enable them to complete their NVQ. Staff reported that several staff had completed NVQ level 2 care courses. The care home has a recruitment and selection procedure. Three staff personnel files were made available for inspection. These personnel files confirmed that the staff had received an enhanced Criminal Record Bureau check, and that required recruitment and selection procedures had been carried out. The staff personal files could be reviewed and be in better order. The manager spoke of his plans to do this. Staff and records confirmed that staff receive appropriate training to enable them to meet the needs of the residents. This training includes statutory training such as 1stAid, moving and handling, health and safety training, food and hygiene training. Records informed the inspector that staff had also completed equal opportunities training, fire safety training, infection control training and medication training, and some key working and care planning training. An annual training plan and individual staff training programmes were available for inspection. Staff spoke of receiving ‘lots of training’. A staff member confirmed that she had completed an induction programme when she commenced working in the care home. DS0000062633.V333275.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. DS0000062633.V333275.R01.S.doc Version 5.2 Page 26 Residents’ benefit from the home being managed by an experienced manager. Arrangements are in place to monitor, and continue to improve the quality of the service provided to residents. The health and safety of residents is generally promoted and protected, but there needs to be a risk assessment in regard to radiators in the care home. EVIDENCE: The inspector had the opportunity to speak with the manager during the second day of the inspection (he was on annual leave during the first day). The manager reported that this was his first care home management post, though he had been an assistant manager in a care home for adults with learning disabilities and physical disabilities. He has been employed as manager of the care home for approximately six months. Prior to this post he was acting manager of a supported living project run by his present provider, Adepta. He confirmed that he had been involved in care work with adults with a learning disability for ten years. The manager reported that he had completed qualifications of NVQ level 3 in care, NVQ level 4 in management, and has plans to complete the Registered Manager’s Award. The manager confirmed that he undertakes periodic training and development to maintain and update his knowledge, skills and competence while managing the care home. The manager reported that he had received an application form from The Commission for Social care Inspection (CSCI) in regard to being registered as manager. The manager needs to be registered. People living in the care home who kindly spoke with the inspector were very positive about the manager, and spoke of him working hard to improve the service provided by the care home. The home has a quality assurance procedure, which includes significant information and documentation in regard to quality assurance monitoring systems used in the care home. This includes the process of review of the service provided by the care home, and includes questionnaires being supplied to stakeholders and others. The manager and the operations manager conduct audits of the service provided by the care home. The manager then completes a development plan. Documentation of a service review carried out in 2005 was available for inspection. The manager spoke of an up to date annual development plan, which was in the process of being completed, and that he would supply the Commission for Social Care Inspection with a copy once it has been completed. It was evident from inspection of records and from talking to staff that there were systems within the care home that monitored the service that it provided to people living in the care home. Residents have the opportunity to participate in regular resident meetings. Staff meetings also take place. Records confirmed that required monthly visits to the care home from a representative of the provider were carried out. DS0000062633.V333275.R01.S.doc Version 5.2 Page 27 Certificates of worthiness in regard to servicing of electrical and gas safety systems in the care home were inspected. Records informed the inspector that the electrical portable appliances used in the care home were last tested in August 2005. There needs to be evidence of recent electrical portable appliance testing to ensure that all electrical equipment used in the care home meets required safety standards. Radiators located in the care home do not have a protective cover, and several radiators do not have a temperature control, and were very warm to the touch. There needs to be a risk assessment carried out in regard to the radiators being uncovered, and a previous requirement in regard to radiators being covered in the bedrooms needs to be met. Other radiators located in the care home need to be covered if there is more than minimal risk of injury to residents and others from them. Fridge and freezer temperatures were recorded. It was unclear in some of the records which temperature record was for which freezer. Several freezer recordings (i.e. all week commencing 19/3/07, and 26/3/07) were of a temperature of – 10oc, which is too warm for a freezer. Staff need to have knowledge and understanding of the safe range of freezer temperatures, and to take appropriate action if temperatures recorded are not in that range. The care home has a fire risk assessment, which recorded evidence of having been regularly reviewed. Recorded fire action guidance was accessible. A copy of this guidance was observed to be located in a glass picture frame, which was cracked. The inspector informed a staff member of this, and she removed it during the inspection. Some doors within the care home were propped open. These included the kitchen door, which was propped open with a ceramic pot, and also the sitting room door. Doors in the care home must not be propped open. The registered person needs to seek advice from the fire service in regard to putting in place safe mechanisms, which enable doors to be open during the day. A staff member reported that a resident prefers that her door be left open. This needs to be included in her care plan and recorded in the fire risk assessment, an appropriate safe mechanism for keeping the door open (as recorded above) needs to be in place. The door in the passageway near the front entrance did not close appropriately on the first day of the inspection. Action was taken following the first day of the inspection to ensure that this door shut properly. Routine maintenance checks of the fire safety equipment, fire systems, and fire drills are recorded. The registered person should record the names of all staff and residents who participate in a fire drill. Accidents/incidents are appropriately recorded. Staff who spoke with the inspector had a good understanding of the accident procedure. DS0000062633.V333275.R01.S.doc Version 5.2 Page 28 The certificate of employers liability insurance was up to date and displayed. A recent incident in regard to a resident needed to have been reported to the Commission for Social Care Inspection. The care home has a health and safety policy/procedure. Records and staff confirmed that regular health and safety checks are carried out. DS0000062633.V333275.R01.S.doc Version 5.2 Page 29 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 2 38 X 39 3 40 X 41 X 42 2 43 X 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X DS0000062633.V333275.R01.S.doc Version 5.2 Page 30 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 YA1 Regulation 4 (1)(c) 5 (1)(b)(d) • Requirement Timescale for action 01/08/07 2 YA19 13(4)(5) 3 YA24 23(2)(b) The service user guide needs to include information in regard to the change in manager and name of provider, and include the amount and method of payment of fees, and of how people living in the care home can obtain (if it is not attached to the document) a copy of the most recent inspection report. • The statement of purpose documents need review to ensure that all required information, including manager changes, and the company name change are recorded Residents (particularly those 01/07/07 with changing mobility needs) need to have a comprehensive moving and handling assessment. • The carpet in the lounge 01/08/07 doorway area needs repair. • Until this carpet is repaired DS0000062633.V333275.R01.S.doc Version 5.2 Page 31 4 YA26 13(4) 5 YA27 23(2)(b) 6 YA37 CSA 2000 Part ll (11)(1) 13(4)(a) 7 YA42 or replaced, there needs to be a risk assessment in regards to the carpet in the doorway being a possible trip hazard. • Four fence slats in the back garden need to be repaired. Staff must ensure that resident’s beds are not placed directly beside radiators that do not have a protective covering over them. Radiator covers must be provided in all bedrooms. Timescale 30/04/06 not met • The leak in the shower room needs repair. • The hot tap in an upstairs bathroom needs repair to ensure that there is an adequate flow of hot water from it. • The toilet handle in an upstairs bathroom needs repair or replacing. The manager of the care home needs to be registered with the Commission for Social Care Inspection (CSCI). • There needs to be a risk assessment carried out in regard to the radiators being uncovered. • All radiators located in the care home need to be covered if there is more than minimal risk of injury to residents and others from them. • All radiators that do not have a temperature control mechanism insitue need too, (and be included in the radiator risk assessment) to ensure the temperature of all radiators can be DS0000062633.V333275.R01.S.doc 01/08/07 01/07/07 01/10/07 01/08/07 Version 5.2 Page 32 8 YA42 13(4) 9 YA42 13(4) 10 YA42 13(4) individually controlled. Staff need to have knowledge 01/08/07 and understanding of the safe range of freezer temperatures, and to take appropriate action if temperatures recorded are not in that range. 01/08/07 • Doors in the care home must not be propped open. • The registered person needs to seek advice from the fire service in regard to putting in place safe mechanisms, which enable doors to be open during the day. • Doors kept open during the day need to be recorded in the fire risk assessment and residents care plan (if relevant/appropriate) There needs to be evidence of 01/08/07 recent electrical portable appliance testing to ensure that all electrical equipment used in the care home meets safety standards. 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 Care plans should record timescales for action to be taken to achieve a goal/need, and there should be a recorded date for review for each goal/need. • There could be further development in the person centred care planning approach. This should include review of the format of the care plan including more pictorial format. Risk assessments should be further developed. • It is recommended that the home (including DS0000062633.V333275.R01.S.doc Version 5.2 Page 33 • 2 3 YA9 YA18 4 5 6 YA19 YA22 YA24 7 YA27 8 YA32 9 10 YA34 YA42 bathrooms) be assessed by an occupational therapist in regard to the mobility needs of several residents. The installation of handrails in some communal areas of the care home should be considered. • A resident’s walking equipment should be repaired or replaced as soon as possible. Residents’ health assessment documentation should record evidence of recent review. It is recommended that the registered person develop systems to ensure that any residents ‘concerns’ are recorded and acted upon as required. • The front and back garden should be better maintained. • The extractor fan in the shower room should be cleaned. • Cobwebs in the laundry room should be removed. • In an upstairs bathroom (at the top of the stairs) the bath panel is ‘shabby’ and should be replaced, and the walls repainted. There should be a light pull handle on the light cord, and the shower curtain could be replaced. • The second bathroom also should be redecorated. • Arrangements should be in place to ensure that staff have an NVQ assessor to enable them to complete their NVQ. • It is recommended that all staff attend equality and diversity training. The staff personal files could be reviewed and be in better order. The registered person should record the names of all staff and residents who participate in a fire drill. DS0000062633.V333275.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. DS0000062633.V333275.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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. 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