Inspection on 11/09/07 for Athelstan House

This inspection was carried out on 11th September 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 11 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Athelstan House 18/06/09

Athelstan House 17/07/08

Athelstan House 22/11/06

Athelstan House 27/04/06

Athelstan House 13/12/05

Athelstan House 21/02/05

Athelstan House 13/08/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Athelstan House Athelstan House 42 Hanworth Road Feltham Middlesex TW13 5AY Lead Inspector Ms Jean Bovell Key Unannounced Inspection 11th September 2007 11:00 Athelstan House DS0000051552.V349088.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 Athelstan House DS0000051552.V349088.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. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Athelstan House Address Athelstan House 42 Hanworth Road Feltham Middlesex TW13 5AY 020 8890 3957 020 8844 0457 athelstanhouse@talktalk.net 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) Mr Paul Martin Harrington Mrs Rosemary Wairimu Harrington Mr Brian Robert Bailey Care Home 5 Category(ies) of Learning disability (5), Physical disability (2) registration, with number of places Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd November 2006 Brief Description of the Service: Athelstan House is a registered care home for five younger adults with learning disabilities. It is situated on a residential street and is within short walking distance to local amenities, buses and trains. There are five bedrooms in the home all fitted with en suite facilities. Two of the bedrooms are on the ground floor and three are on the first floor of the house. There are also separate bathroom facilities on each floor. There is one separate lounge and a lounge/dining area for service users. There is a large garden at the rear of the home. Fees in the home range from £900 to £1150. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out between 11:00am and 3:30pm on Tuesday 11th September 2007. Two care support workers and two residents were present. The Inspector was informed by a care support worker that there were three resident vacancies at the home and that a Registered Manager had not yet appointed. During the course of the inspection: the home’s records, documents, policies and procedures were viewed. A tour of the building was undertaken. Observations were made. Discussions were held with two residents and two care support workers. The requirements that were made at the last inspection and all key Standards were examined. The Inspector received co-operation and appropriate assistance from a care support worker throughout the inspection. What the service does well: Separate cultural and religious needs are being met at the home. Specifically, people are able to visit Temples with relatives and are being escorted to Church Services. Residents were observed viewing specific cultural television programmes and listening to music of choice in separate lounges. Two care support workers cover duty during waking hours and people are able to participate, with support, during separate activities within the community. Medical records were up-to-date and reflective of people receiving access to healthcare professionals as required and being accompanied by care support staff during medical appointments. People were appropriately assessed prior to admission and appeared settled and comfortable. They moved freely around the home, related in a friendly and spontaneous manner with care support workers and expressed satisfaction with the level of support they received. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 6 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. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal records of two residents were inspected and reflected that people are being satisfactorily assessed prior to admission. EVIDENCE: The records relating to two residents were examined. It was evidenced that they had been referred to the home by social workers based in hospitals or community teams for people with learning difficulties. Family histories and initial needs led assessments were submitted at the point of referral. Assessments of need were also carried out by the home subsequent to referrals being received and were initiated by visits to prospective residents in hospital or at home. It was indicated that prior to new residents being admitted to the home, prospective residents, relatives, social workers and relevant healthcare professionals were involved in the process of assessing and determining the capacity of the home to meet separate identified needs and aspirations. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments were viewed and were satisfactory. However, reviews of care plans and risk assessments not being carried out. It was indicated on care plans and from discussions with care staff that people are able to make decisions regarding their daily living routines. EVIDENCE: The records of two residents were viewed and indicated that care plans had been appropriately drawn up. Individual personal, healthcare, cultural, religious and social needs had been assessed and action plans and goals were put in place. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 10 Risk assessments were also undertaken in relation to specific activities identified within care plans and included inappropriate behaviour, overeating and finances. There were, however, no indicators that care plans and risk assessments were being reviewed on a regular basis or following significant changes. It was reflected on care plans and confirmed by a care support worker that people were able to make decisions regarding day-to-day routines such as what they wore, when they arose each morning and retired at night. Residents received weekly benefit allowances, handled their own personal allowances and made purchases of their choice. All bedrooms were fitted with separate locks and residents were given keys. The Inspector was informed by a care support worker that people received meal choices but the Inspector noted that lunch options were not offered to residents. People were observed moving freely around the home and individual choices and interests were reflected in their personalised bedrooms. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. Activities Programmes that had been drawn up in relation to individual residents were viewed, discussions were held with residents and support staff members and observations were made. It was indicated that people are being supported in participating in indoor and outdoor activities of their choice including those that are culturally appropriate. People are also able to assist with various housekeeping tasks. It was evident that contact with family and/or friends is being encouraged and facilitated. The provision of varied and nutritional meals was not evidenced at the time of the inspection. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 12 EVIDENCE: The records were reflective of individual activities programmes being drawn up. These indicated that residents attended the Temple, Church Services, open door projects and sport centres. They were also supported during activities such as bowling, shopping, meals out and visiting the cinema. An open visiting policy is in place and contact with relatives and friends are encouraged and facilitated. A care support worker reported that residents carried out various housekeeping tasks including clearing the dining table, bringing down laundry and tidying their respective bedrooms. The Inspector was informed by a care support worker that lunch out had been planned but that residents would instead be taken to an outdoor activity following the inspection. People who use the service reported being regularly supported in activities within the community. They were able to make personal telephone calls, receive visits from relatives and friends and were often taken out by them. People were observed viewing television programmes which included cultural preferences and listening to music of their choice in separate lounges. One resident vacuumed his/her bedroom at the time of the inspection. Although a care support worker confirmed that cooked meals were provided in the evenings, menus that were reflective of varied and wholesome meals choices were not available for viewing. Residents were not offered lunch options that were nutritious, substantial or appealing at the time of the inspection. The meal provided was light, basic and came from a tin. The Inspector’s suggestion of an additional wholesome sandwich was initially resisted by care staff but very much appreciated by residents. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans regarding two residents were viewed and indicated that people received personal support as required. However, it was not evidenced that people received required assistance in relation to change of clothing. Records were indicative of the physical and emotional health care needs of residents being appropriately met. The home’s medication policy and procedures are satisfactory. EVIDENCE: It was reflected on care plans that people were independent in relation to their personal care routines but may some require prompting. Nonetheless, a Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 14 resident was seen to be wearing noticeably unclean clothing throughout the inspection. A care support worker confirmed that people’s privacy and dignity were being respected and that they were able to choose what they wore each day. However, a resident’s clothing cupboard was locked as he/she had the tendency of frequently changing outfits throughout the day. It was not apparent that a resident had received access to fresh clothing on the day of the Inspection. Care support staff were observed relating with residents in a respectful manner and knocked on bedroom doors prior to entering. The records were indicative of residents receiving appropriate access to health care professionals including therapists as required and were accompanied during hospital appointments. Prescribed medication was contained in blister packs and securely stored. Medication Administration Sheets were viewed and were accurately documented and signed. The Inspector was advised by a care support worker that residents lacked capacity to self administer their medication. The home’s medication policy was in place and the records reflective of medication training being delivered to one care support worker. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 15 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 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records were indicative of the safety and welfare of people being protected but the complaints procedure was not accessible. EVIDENCE: Although the complaints procedure was satisfactorily detailed and were included within the policies folder, copies were not on display or accessible to residents and/or relatives, friends or advocates. The complaints book was not available for viewing but a care support worker confirmed that no complaints had been received at the home following the last inspection. Policies and procedures on health and safety and the protection of vulnerable adults were in place. The records indicated that one care support worker had received training in Health and Safety and Adult Abuse Awareness. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 16 The residents receive weekly benefit allowances and cash, relating to one person, is being safeguarded at the home. Individual financial records were examined and no discrepancies were identified. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 17 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A tour of the building was undertaken and the overall environment was being unsatisfactorily maintained. EVIDENCE: The communal areas at the home are spacious and suitable for shared and/or individual activity. However, all parts of the home were not being kept clean and/or reasonably decorated. There were significant cracks on walls in the lounge/dining area. Stained patches on carpets and furniture in lounges and bedrooms were damaged and/or outdated. Drawers were missing from a cabinet in the laundry room. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 18 The toilet bowl in the en-suite bathroom on the ground floor was discoloured. Bathroom mats, net curtains and windows were unclean. Soap containers in en-suite bathrooms on ground and first floors were empty or watered down. A mat at the entrance to the garden was dusty and torn. The garden contained discarded items and the grass required cutting. The kitchen was clean and hygienic and contained appropriate equipment. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Only one of two care support workers was appropriately trained for meeting the needs of people who use the service. The home’s recruitment policy and procedures are satisfactory. EVIDENCE: Rotas were not being drawn up on a regular basis and a current rota was not in place. A care support worker confirmed that two staff members were employed at the home and were on duty during waking hours. One of the two Registered Providers covered sleep-in duty at night. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 20 The staffing ratio in relation to residents was very satisfactory. The records indicated that one care support worker had achieved level 2 National Vocational Qualification in Health and Social Care and one care support worker attended a course on Psychology. Staff recruitment files were inspected and contained all required documents such as CRB disclosure certificates, application forms, references, photoidentification and signed contracts/statement of terms and conditions. The Inspector was informed by a care support worker that he/she received induction training but that subsequent mandatory training had not been delivered. The training certificates of one care support worker were viewed and indicated that he/she had received training on Adult Abuse Awareness, Health and Safety, Infection Control, Moving and Handling, First Aid and Effective Communication and Diversity. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 21 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A Registered Manager was not in post at the time of the inspection. Although systems are in place for undertaking quality assurance, the process of reviewing the service has not been initiated. Health and safety records were viewed and indicated that the welfare of residents are being satisfactorily protected. EVIDENCE: The home has been without a Registered Manager for eighteen months. Subsequent to the inspection, the Inspector discussed this matter with the Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 22 Registered Providers on the telephone and was informed that a Registered Manager would be appointed following admission of additional residents. However, the Registered Providers were unable to be specific when this would happen. There are currently three resident vacancies at the home. Systems for carrying out effective quality assurance were in place but it was not evidenced that the process of self-monitoring and reviewing the service had been initiated. Health and safety records were viewed and it was reflected that checks for fire safety, emergency lighting, portable appliances, water temperature and gas maintenance were up to date. Fire drills were being undertaken. Training on health and safety, moving and handling and first aid had been delivered to one care support worker. Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 23 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 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X X 3 X Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 24 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 Requirement The service user plan must be periodically reviewed and updated to reflect any changes. Previous timescales 01/06/06 and 01/04/07. The Registered Person must make sure that residents receive appropriate assistance in relation to change of clothing to ensure that they are clean and well presented at all times. The Registered Person must ensure that that residents are made aware of how to make a complaint and that the complaints procedure is accessible to residents, relatives/friends. The Registered Person must make sure that a programme of redecoration and refurbishment is put in place. Carpets, net curtains, bath mats and windows are cleaned and ensure that all parts of the home are well maintained. The Registered Person must make sure that the garden is tidied and maintained to avoid DS0000051552.V349088.R01.S.doc Timescale for action 31/01/08 2. YA18 12(1)(a) 30/09/07 3. YA22 22(5) 30/09/07 4. YA24 23(2)(d) 31/12/07 5. YA24 23(2)(o) 31/12/07 Athelstan House Version 5.2 Page 25 potential risks to residents. 6. 7. YA24 YA24 16(2)(c) 13(4)(c) The Registered Person must ensure that worn and damaged furniture are replaced. The Registered Person must ensure that that soap for hand washing is at all times available within en-suite bathrooms to avoid risk of infection. The Registered Person must make sure that current duty rotas are in place for reflecting working arrangements at the home. The Registered Person must make sure that appropriate training for meeting the needs of residents is delivered to a care support worker. Appropriate management arrangements must be made for the home. (Previous timescale 01/04/06, 01/08/06 and 01/04/07 not met). The Registered Person must ensure that quality assurance processes for reviewing the service are initiated. 31/12/07 30/09/07 8. YA33 17(2) Schedule 4 (7) 18(1)(c)(I) 30/09/07 9. YA35 30/11/07 10. YA37 8 11/11/07 11. YA39 24(1) 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Athelstan House DS0000051552.V349088.R01.S.doc Version 5.2 Page 27 - 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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