Inspection on 12/04/10 for Care Assist in Harrow

This inspection was carried out on 12th April 2010.

CQC found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 23 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Similar services:

Hornsey Lane (148)

Ashlong House

Norbury Crescent (30)

Queen Ann Lodge

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Queen Ann House

Extracts from inspection reports are licensed from CQC, this page was updated on 18/06/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Care Assist in Harrow 236 Kings Road Harrow Middx HA2 9JR     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Jane Collisson     Date: 1 9 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Care Assist in Harrow 236 Kings Road Harrow Middx HA2 9JR 0208688240 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): c.piper@careassistuk.com Care Assist Limited Name of registered manager (if applicable) Mrs Olga Tsybulska Type of registration: Number of places registered: care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 6 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Learning Disability - Code LD Date of last inspection Brief description of the care home 236 Kings Road, Harrow is a care home for six people with mental health needs and learning disabilities. The Provider is Care Assist in Harrow Ltd. It is located in a residential area of Harrow, close to public transport facilities and within walking distance of the shops. The home has six bedrooms, all with en suite showers. The communal areas consist of a large open plan lounge, dining area and kitchen. There is Care Homes for Adults (18-65 years) Page 4 of 40 Over 65 0 0 6 6 Brief description of the care home a games room located in the garden. There is a laundry room, and sleeping in facilities for the staff. Care Homes for Adults (18-65 years) Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced inspection was carried out at the home on 12th April 2010 from 10.45 to 18.10. This was the first inspection of the home. At this visit, the Registered Manager was not present and we were informed she no longer managed the home and had not done so since its registration in February 2010. We were informed that there was an Acting Manager, who was on leave, so the Registered Manager was called and came to the home later in the day. She is the Registered Manager of another of the Companys homes and has also been managing a second home, both in Harrow. She assisted us with the first visit. There were some records which were not available and others which were locked away and the key was not available. This included the staff, recruitment and the training records. We visited the home on the 19th April to meet with the Area Manager who, we were informed, had been the Acting Manager for some months. Care Homes for Adults (18-65 years) Page 6 of 40 Prior to its registration, on 10th February 2010, we were informed that the home had been operating as a supported living service. It did not require registration with the Care Quality Commission as its residents at that time did not require personal care. Some residents had been living in the some for several months and three had been admitted in 2010. At the first visit, we met with the five residents speaking to two in private. At the second visit one had been admitted to hospital but the other four were in the home. At the time of this inspection a complaint had been made to the London Borough of Harrow and it was being investigated by the Safeguarding Adults department. The investigation was ongoing at the time of the conclusion of this report. We met on the second visit to the Area Manager. He told us that he will not be applying to become the Registered Manager as we had been informed, but told us the Company would be recruiting a new manager and the process had just commenced. We were informed after the inspection that a new Manager had started on 4th May 2010. We discussed the current situation, in regard to the residents and their support needs, the staffing, training, and the records which were required. There were a number of shortfalls in the records and management systems of the home. We made an Immediate Requirement for the health and safety checks to be undertaken as there was no evidence that any checks, including the fire alarms, had been made since the registration of the home. These were all required to be checked within 48 hours. We did not initally receive confirmation on this initially but did receive the information in early May regarding the fire alarm checks, fire and emergency lighting checks, hot water and fridge and freezer checks. We were later informed that emergency plans had been put in place for the residents and that a fire drill was planned for 13th May 2010. The Annual Quality Assurance Assessment was not returned in the timescale required. This has information about how the service is managed and provides its services to its residents. We did not find that the home had sent, or had available, the notices required under the Care Home Regulations or had them available for inspection. A Regulation 26 visit report, for April 2010, was submitted to us after the conclusion of the inspection. The information on staff recruitment was not available at the first visit and was not all available on the second visit. There were shortfalls in the information that was available. We spoke to all of the members of the staff team who were on duty and found that the majority were quite new. Not all were permanent staff and there had been a lack of training since they had been in post. On checking the staff recruitment records we found shortfalls or records not available and took information with a view to taking further statutory action. Overall, we found that the management procedures of the home were not sufficiently robust to promote and develop the home for the benefit of its residents. The service has failed to comply full with the Regulations. The commission is therefore taking enforcement action to secure compliance and improve outcomes for people who Care Homes for Adults (18-65 years) Page 7 of 40 use the service. Care Homes for Adults (18-65 years) Page 8 of 40 What the care home does well: What has improved since the last inspection? What they could do better: There has been a lack of management input to ensure that all of the required records have been monitored, reviewed or kept up-to-date. We have therefore taken enforcement action to secure compliance and improve outcomes for people who use the service. We found that there had been a lack of basic and specialist training to support the staff to assist the people living in the home to develop their skills. In particular, there had been no training in mental health or learning disabilities for which the home is registered. We did not find that the documentation the home has for care planning and risk assessment would be easily accessible to the residents or for staff to be able to demonstrate good outcomes for people. In particular, the opportunities for developing skills. The way in which the meals are organised, while appearing to promote peoples independence, did not demonstrate that enough emphasis was being placed to help people to have a nutritious and varied diet. Participation in the running of the home was not demonstrated and it was not clear if people were aware of the restrictions and the reasons for them. It needs to be evidenced that people are involved in the decision making and that this is relevant to the current residents. All of the Regulations which are require notification to the Care Quality Commission must be completed. Staff must have an awareness of those which they are required to complete. The Annual Quality Assurance Assessment must be completed with the given timescale. The medication systems we found were not sufficiently robust to ensure that there was good administration and that monitoring systems were in place. It was not demonstrated that those people who need support would have sufficient staff on duty to assist them to access to community. Care Homes for Adults (18-65 years) Page 9 of 40 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 40 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with information about the home, but it is not up-to-date. People are not provided with the terms and conditions prior to being admitted. Staff are not all trained to meet the specialist needs of the residents which would support the homes aims and objectives. People have the opportunity to visit the home to help them to decide about admisison. Evidence: We asked for the information which people might wish to have when considering a placement at the home but this was not available on the first inspection. One of the staff provided us with the copy of the information which is made available to the residents and is kept in their rooms. The Statement of Purpose and the Residents Handbook do not have all of the information required by the National Minimum Standards and Care Home Regulations 2001. The information had not been changed to take into account the Care Quality Commissions information. The information needs to be updated and reviewed regularly to ensure people are fully informed. Updated documents were provided to us after the inspection was completed. Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: We looked at a sample of care planning files and found that the files contained assessments from the authorities placing the residents. These had been completed prior to the registration of the home. Preliminary care plans had been drawn up for one of the newer residents, from the assessment, but these were in need of reviewing to reflect his current needs. We asked the staff about their training to meet the needs of the residents. No training records were available on the first visit to the home. Three of the staff on duty said they had medication training and two said they had safeguarding training. One staff member had experience of working with people with dementia and learning disabilities in a previous employment. The needs of the current residents would indicate that a range of training in mental health, general health needs, and health and safety are the training courses which are required as a matter of some urgency. We spoke to the Acting Manager on the second visit who said that a set of DVDs has been acquired which will be used for training in the future. There was no mental health or learning disability training planned at the time of the inspection and the Providers need to address this as these are the areas of specialism the home offers. Staff need to have the experience and training to support the people who use the service and to meet the aims and objectives of the service. One of the staff members informed us that a prospective resident had recently visited the home with view to seeing if the home suited him before moving in. We asked if the residents had been issued with terms and conditions in relation to the home now being a registered care home. When they had been admitted, the home was for people in a supported living setting. We were informed that work on the contracts is being undertaken at the present time. People must have details of the terms and conditions of the home, including their charges and obligations. A sample of the contract was submitted to us after the inspection was completed. Care Homes for Adults (18-65 years) Page 13 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are in place but are repetitive and not in a user-friendly format. People are not always protected by clear and agreed risk assessments. People may be unduly restricted by staff working arrangements. People are not seen to be fully consulted on the way in which the home is run. Evidence: We looked at a sample of care plans, which included a person-centred one written from the residents point of view. While the care plans are comprehensive, we found much of the information to be repetitive. Some of the information appeared to have been copied from other peoples care plans, and needs to be checked to ensure that it is correct and relevant for that person. One of the staff told us that they are to change the style of the plans and we recommend that they are made more user-friendly for the residents and staff, particularly those staff who are new or are working on only an occasional basis. The Area Manager also said that they plan to change the care plans. Residents are able to make decisions about how they spend their time and we saw Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: that they choose to mainly remain in their bedrooms, which the daily notes confirmed. The residents are all involved in doing their food shopping individually, either alone or with staff support. We did not see from the information in the files, how much participation in running the home takes place or is encouraged. Four people are able to go out independently and do so. One person, who needs support when outside of the home, is not able to go out when there is single staff cover unless this is pre-planned. According to the rotas, there is only single staff cover from 6pm in the evening. Where there are restrictions on peoples freedom, this must be clearly explained and agreed with them. We were provided with a copy of house rules dated March 2009. As the current residents were not living in the home at that time, these need to be revised and agreed by the people now resident. One rule, regarding smoking in the house, was not being adhered to during this inspection so would need to be revised or enforced if it is to form part of the house rules. People are currently required to ring the door bell to be let in or ask staff to let them out of the door. If this has been agreed with the residents and those involved in their support, it must be recorded. We saw that the files we examined had risk assessments for a variety of identified risks. While some information was available of the individual risks, we found that information on each of the residents needs and support was repeated for each risk assessment, making the relevant information, which should be readily accessible, quite difficult to access. We recommend that the important information for each risk is clearly identified to make it easier for staff to read and residents to agree. We saw that the files are stored confidentially in the office. Care Homes for Adults (18-65 years) Page 15 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are aware of the needs to support residents to develop their skills but there is a lack of evidence that this is a planned activity or that residents are encouraged to delevop their interests. The service does not present as being one that is focussed on maintaining a healthy lifestyle. Meals may be limited in choice and nutrition by the lack of active involvement of the staff. Evidence: We found that, at present, none of the residents attend day services, college or work placements. One of the staff said that day services have been offered but had been declined. One person told us that they enjoyed sports and had been able to participate in these since living in the home. We were informed that a staff member has tried to interest the residents in indoor activities with some limited success. People have family and friends who visit. There is no separate lounge available for Care Homes for Adults (18-65 years) Page 16 of 40 Evidence: meeting with visitors but staff said that the games room in the garden could be used for this purpose. Four of the five residents are able to access the community by themselves. The residents carry mobile phones should they need to contact staff. For the resident who needs to be escorted when outside the home, the Acting Manager said that additional staff could be put on the rota should a specific outing be required. This would not allow for spontaneous outings and the Providers need to ensure that there is evidence that peoples needs are being met by the staffing levels. At the present time, each of the residents buys and cooks their own meals and staff said that they are supported by staff in accordance with their abilities. Staff said that they encourage healthy eating but it was noted from the records that many meals recorded are quite basic, such as bacon and eggs. We were informed that some of the residents do cook for themselves, but otherwise depend on the food staff cook which, we were informed, may also be basic. As the home is a residential facility, ways need to be found to encourage better nutrition, whilst maintaining and developing the independence of the people living in the home. The staff said that some meals are taken communally when they have takeaway meal, for instance. Residents are given a sum of money each week with which to shop for themselves and staff said that they help people to budget. From speaking with staff, and looking at records, we did not see that any specific cultural needs are being met although some residents are from different ethnic backgrounds. It was noted in two of the care plans the residents have been asked about following religious practices but had declined. Care Homes for Adults (18-65 years) Page 17 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to a range of professional medical help and are supported with appointments. The medication procedures have not been sufficiently robust to ensure that medication is correctly administered. There is insufficient evidence that errors have been followed up. Evidence: We saw from the records we examined that the residents are generally self-caring for personal care but in some cases they require prompting. All of the residents have their own en suite shower rooms and toilets, ensuring their privacy can be met. Each of the residents with a nearby medical centre and on the first visit, one person was accompanied by staff to visit the GP. There is information in the care planning files regarding medical appointments and we saw information on hospital visits. All of the residents are supported by mental health professionals as required. We saw that a record of a recent medical appointment had been recorded and a copy kept in the persons file. We looked at the medication administration procedures. Four of the residents have Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: their medication in their rooms, in a locked cupboard. We found that, in some cases, the Medication Administration Records MAR were obtained from the pharmacy but were being retyped by the staff into a different format. We discussed this with the Registered Manager as we felt that using the original paperwork was safer. The pharmacy records also have space for the information recording the receipt of medication and the date the medication was started. This was not being recorded. The dates of opening were not being recorded and a check on one of the medications could not be agreed with the information on receipt and use of the tablets. It appeared that there were two too many tablets but this could not be confirmed from the information recorded. No audits had taken place which might have shown if there was an error. By the second visit, staff had started a system to audit the medication. The Area Manager said, however, that he would be looking at the medication procedures to ensure that it is being correctly administered and checked. It has been practice in the home to ask the residents to also sign the MAR sheets. We asked the staff if this was to do with supporting residents with possible self-medication in the future, but they confirmed that this was not the case. From the samples we saw, residents did not consistently sign if they did not wish to do so and, in some cases, had signed where the staff were recording their initials, making it difficult to decipher who had signed. We advised that the MAR sheets need to be sufficiently clear so as to ensure it is clear which staff signed them. Should the home wish residents to continue to sign, this could be done on a separate sheet. We saw that there were omissions in the signatures of staff without explanations. We asked the staff if these had been reported and one of the staff said that they are passed to the Area Manager. As we saw no recording of one-to-one supervision, we did not see if these errors had been formally discussed. We found that one medication, Temazepam, was not being stored as a controlled drug and was being signed by the staff member and the resident in a book. The total was correct but one of the additions was wrongly recorded. The staff must ensure that errors are checked and details recorded if changes are made. There was an out-ofdate list of signatures of those staff who had been trained to administer medication. Staff said that only those staff who have been trained by the pharmacist are allowed to administer medication but the list of those able to do so had not been kept up-todate. We found that one staff was unsure of the difference between PRN medication and a medication given on a daily basis. The Registered Manager was unsure as to whether staff competency has been tested. Care Homes for Adults (18-65 years) Page 19 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is limited evidence that people are encouraged to voice their concerns. People are not protected by staff being trained in safeguarding procedures. The procedures for managing peoples money are not sufficiently robust to ensure good management of finances. Evidence: We asked to see a summary of the complaints raised in the home. The staff member on duty said that none had been made. There was no complaints log or books in which staff could have recorded complaints available although we did see some blank forms in peoples files. The information in the Residents Handbook did not include any information on who to contact in the event of a complaint, such as the Care Quality Commission (CQC) or Social Services. The information also mentioned the Commission for Social Care Inspection (CSCI). After the first visit, the Registered Manager said that she had changed the polices and procedures to reflect the change to the CQC. We saw that the home has the London Borough of Harrow Safeguarding information available. A chart displayed in the office had the relevant phone numbers. However, we were informed by the staff on duty that only two had attended safeguarding training since commencing in the home and some have no previous training. A staff member confirmed he had training in a previous employment but had not been asked for details. Care Homes for Adults (18-65 years) Page 20 of 40 Evidence: We looked at the finances the home keeps for the residents. Each resident has a sum kept for food each week which is provided by the home. Four people manage their own personal money. One person has their personal money kept on their behalf and we examined the book. Although receipts are kept and numbered, the money going into the account was not checked against the receipts from the Post Office and this should be done. The money is periodically checked against the amount in the tin but there was no check on the amounts of money in and out. There was some weeks between the checks. Care Homes for Adults (18-65 years) Page 21 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a pleasant environment for its residents with facilities for leisure activities. People have their own bathing facilities which promote privacy and independence. Evidence: The home has been recently refurbished to a good standard and each person has their own single room with en suite shower and toilet. The rooms we saw had been furnished in the same style, which includes the paintings. The Acting Manager said residents were welcome to change the furnishings and pictures if they wished to do. There is a lounge, dining room and kitchen for the six to share, furnished with comfortable furniture for the six people. There is also a television and a computer for their use. The games room is accessed across the paved garden, where there is seating and a pergola. There is also seating on the terrace outside the lounge. The sleeping in room is located in the loft, where there is a staff bathroom and toilet. The ladder to the space is very steep and we were informed that this was to be changed. There was some concern amongst the staff about this.We did not see any information in the home from the London Fire and Emergency Planning Authority (LFEPA) about the stairs but had information from them after inspection that it is Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: acceptable as the home has a fire alarm system. The home should ensure that there are risk assessments in place for the staff to ensure that people who use the ladder are safe to do so, particularly if they are woken during the night. The home does not have a lift and there are stairs to the garden, so residents require good mobility to assess all areas of the home. Staff said that no equipment is used at present by any of the residents and, as they all have an en suite shower, no bath equipment is required. Care Homes for Adults (18-65 years) Page 23 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The lack of regular management staff does not support the staff or the residents to provide a good standard of care and support. The lack of induction procedures, basic and ongoing training do not support staff to develop in their roles. Recruitment procedures are unsatisfactory and the home cannot demonstrate robust processes. Staff are not supported through regular supervision. Evidence: We found on the first visit to the home that the Registered Manager was not working at this home and was the employed at two of the companys other homes. The Area Manager was on the homes displayed rotas every weekday from 9am to 5pm, including the day of the inspection. However, it was confirmed he was on leave for the week we commenced the inspection and he did not regularly work the hours shown on the rota in Kings Road. The Registered Manager was contacted and came to the home in the middle of the day. As she had not actually worked in the home since its registration, or since December 2009, she was not able to assist us with all aspects of the inspection. However, she had been responsible for setting up the files and so was able to identify those which we required. Not all of these were available. The rota showed that there are care staff working from 8am until 3pm, from 3pm until 10pm, with a mid shift of 11am to 6pm. There is member of staff sleeping in at night Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: from 10pm to 7am. We were concerned that the records indicated, and staff confirmed, that they are sometimes woken during the night. There are no emergency alarms in the bedrooms but a baby alarm is in use between the kitchen and the sleeping-in room so that staff are aware if a resident is in the kitchen at night. There have also been incidents of loud televisions and music which disturbs other residents. The staff said that any incidents during the night are recorded. It was recommended that they keep a log of disturbed nights as staff work before and after sleeping-in shifts and should not be regularly disturbed. We discussed this with the Acting Manager at the second visit. If the sleeping-in staff are regularly disturbed, then consideration will need to be given to different staffing arrangements, particularly if staff are undertaking shifts before and after their sleeping in duty. There have been a number of changes in the staff team since the registration in February 2010. Some staff had worked in the home when it was a supported living facility, the longest serving since August 2009. A Deputy Team leader had been appointed but left after a short period of work. Some of the staff team are working as casual workers and have not been included in a training programme. The Acting Manager said that he intended that they would participate in the future. A new senior staff member was undertaking an induction during the inspection and was shadowing other staff until his Criminal Bureau Records disclosure had been obtained. The Registered Manager said that staff worked under supervision if only the POVA 1st Check has been obtained. We were not able to examine any staff or training records on the first day of the inspection as they were locked and the Acting Manager, who was on leave, had the key. We informed the Registered Individual of the date of our second visit, but only found that half of the staff records were in the home. Four of those staff shown on the rota did not have any information available. The Acting Manager obtained the Criminal Bureau Records number for some of the staff by email but these could not be checked as the other records were missing. There were also some shortfalls on the records which were in place, including references not being sufficiently detailed to check against the employment history and, in one case, previous work in care not being detailed on a work history or a reference obtained. No explanations were in place to explain if there were reasons for these ommission or if they had been followed up. We asked staff about their training and found that it was limited to medication training for three of the staff we met, and two said they had been on safeguarding training with the Local Authority. They said that it was intended that there would be training, using DVDs, when the Acting Manager returned from leave. He confirmed that this would be commencing and that the Care Assist homes in the area and that they would be using the games room for training purposes. Care Homes for Adults (18-65 years) Page 25 of 40 Evidence: We did not have the information to show how many staff have a National Vocational Qualification. We did not see any supervision records on our first visit as we were informed these were locked away. We did see the Minutes of the one staff meeting held since its Registration. Some issues had been raised at that meeting regarding the staff in the home which needed to be addressed. However, we found that there has been no formal, one-to-one supervision sessions undertaken which could be used to address the issues. Care Homes for Adults (18-65 years) Page 26 of 40 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A lack of consistent management and leadership has not supported the staff to develop the home and it service to its residents. Insufficient attention has been paid to complying with the Care Homes Regulations. People have not been protected by the robust monitoring of records to ensure that people are safe and the aims and objectives of the home are being carried out. The service has failed to comply with regulations. The commission is therefore taking enforcement action to secure compliance and improve outcomes for people who use the service. Evidence: When the home was registered in February 2010, the CQC had been informed that the Registered Manager would be working in two of the Companys homes in Harrow, one of which was Kings Road. We were informed in March that this would be changing and that a new Manager was to be recruited. We were not aware that the Registered Manager was no longer working in the home until the inspection. We were informed Care Homes for Adults (18-65 years) Page 27 of 40 Evidence: that the Area Manager was to become the Registered Manager However, he confirmed that this was not the case and recruitment would underway to find a new manager. From the information given to us and the records we examined, the lack of management staff in the home has not supported the new staff team, and the new residents, to have a clear direction and work to develop good services. We found that the staff were trying hard to provide services but had a lack of knowledge of running a registered home and what that entails. We did not find evidence that staff had been supported through a difficult period, either with sufficient input or training. No surveys or other quality assurance has yet taken place with the residents but the Registered Manager said that this would be done in due course. We asked to see any Regulation 26 visits that had been made to the home by the Registered Providers but none were in evidence. Although the Responsible Individual visited the home between our two visits, no Regulation 26 report was made although there was a list of identified shortfalls. The Registered Providers need to ensure that the home is visited on a monthly visits unannounced, and the reports are compiled for the manager and for the CQC if requested. The April report was submitted to us in May but did not show an action plan for staff to address the shortfalls. We did not examine all of the Policies and Procedures on this occasion, but the Registered Manager said that she changed the information, where required, to show the Care Quality Commission, in place of the Commission for Social Care Inspection. We found shortfalls in the record keeping on the first visit. Staff were asked about record keeping in respect of Regulation 37 notices, to inform the CQC of incidents and accidents, but did not have any awareness of these. There was no file to evidence to evidence that any had been sent. A number of incident forms completed for the Registered Providers indicated that there have been times when a Regulation 37 notice should have been sent to the CQC. We found a number of shortfalls in the health and safety records. No rooms checks or water temperature checks has been carried out since October 2009. The London Fire and Emergency Planning Authority visited in November 2009 and made requirements in respect of a Fire Risk Assessment. The copy we saw was dated prior to the visit and did not take into account the new residents assessments. As several of the residents smoke in their rooms, the fire risk assessment must take into account any risks posed by this and their ability to respond the the fire alarms. No fire drill records and fire alarm test records were found. Staff were not able to assist with this. Fridge and freezer recorded as being too high for several days but no record of action. We made Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: an Immediate Requirement at the second visit to the home to have all of the health and safety checks, including the fire alarms, to be carried out within 48 hours. We were not informed within the timescale of the test being undertaken. Care Homes for Adults (18-65 years) Page 29 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 30 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 42 13 That all of the health and 21/04/2010 safety checks including water temperatures, fire alarms, emergency lighting and any equipment are checked and recorded. Action must be taken if any prove deficient. To ensure all health and safety checks are carried out to confirm the safe operation of equipment. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 5 The Registered Providers 30/06/2010 must ensure that there is a system place to ensure that the Statement of Purpose and Service Users Guide are current and contain the information required. To provide information to people living in the home and prospective residents. 2 3 18 The Registered Providers must ensure that staff have the training which helps them to support the needs of the people living in the 07/07/2010 Care Homes for Adults (18-65 years) Page 31 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action home and meeting the needs of the residents. In particular training in mental health and learning disabilities must be offered. To ensure that staff have the knowledge and skills to provide a good quality of support. 3 5 5 The Registered Providers must ensure that the residents have information regarding the terms and conditions for living in the home. To ensure that people who live in the home and those who are prospective resdidents are fully informed of their rights and responsibilities. 4 6 15 The Registered Providers must ensure that care plans are correctly prepared and in a format to suit the people using the service. To ensure that the care plans reflect the support the residents need and agree. 5 7 12 The Registered Providers must ensure that there is evidence that people are involved in the decision31/07/2010 31/07/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 32 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action making processes in the home and there is evidence of this. Where there are any restrictions, these must be seen to be recorded and agreed. To show that people are involved in the decisions which affect their daily lives. 6 9 13 The Registered Providers 31/07/2010 must ensure that there are clear risk assessments which are seen to be discussed with, and agreed with, the residents and their representatives. To demonstrate that people are supported to take responsible risks, within the homes risk management strategies. 7 12 16 The Registered Providers must demonstate that people are supported to make choice regarding education, work and training. To ensure that people are aware of the options available to them for development and education. 8 17 16 The Registered Provider must ensure that the people living in the home are 31/07/2010 31/07/2010 Care Homes for Adults (18-65 years) Page 33 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action encouraged towards healthy eating with choices of meals made available. To ensure that peope have the opportunity to have a healthy diet. 9 20 13 The Registered Providers must ensure that staff are competent to administer medication and that appropriate action is taken when errors are made. To ensure that residents have their medication correctly administered. 10 20 13 The Registered Providers must ensure that the medication administration is correctly recorded, and that there is an audit trail to ensure it has been administered correctly. To ensure that residents have their medication correctly administered. 11 23 13 The Registered Providers must ensure that there are systems in place to check regularly on finances and there is monitoring of the records. 30/06/2010 31/05/2010 31/05/2010 Care Homes for Adults (18-65 years) Page 34 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that peoples finances are maintained in good order. 12 23 13 The Registered Providers must ensure that staff are trained in safeguarding as part of their induction and ongoing training. To ensure that staff are fully aware of the procedures for reported safeguarding issues. 13 31 33 The Registered Providers must ensure that staff are familiar of their roles and responsibilities within a registered home environment through training and information. To ensure that the people in the home are protected by good staff management and compliance with the Care Homes Regulations. 14 32 18 The Registered Providers 31/07/2010 must ensure that staff have the induction and training, which include all of the basic training courses required, to carry out the work they perform. To ensure that staff are trained and their training 31/07/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 35 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action needs are indentified. To ensure that the people who live in the home are supported by people with the knowledge and skills to do so. 15 33 18 The Registered Providers 30/06/2010 must ensure that is evidence that there are sufficient staff to meet the needs of the residents. To ensure that people have sufficient choice of activities. 16 34 19 The Registered Person must ensure that all of the information in respect of staff recruitment is obtained as required and is available for inspection. To ensure that people are protected by robust recruitment practices. 17 35 18 The Registered Providers must demonstrate that staff have the opportunity for staff to undertake National Vocational Qualification. To ensure that staff are able to develop their skills. 18 36 18 The Registered Providers must provide evidence that staff are supported through regular one-to-one supervision. 31/07/2010 30/06/2010 09/06/2010 Care Homes for Adults (18-65 years) Page 36 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that staff have regular support from the management staff. 19 37 18 The Registered Providers must ensure that there are sufficient management staff available in the home to ensure that the home can meet its stated purpose, aims and objectives. To ensure that the home is being managed and residents and staff are supported through a wellmanaged service. 20 39 26 The Registered Providers must ensure that regular, unannounced visits to the home are made under Regulation 26, and that evidence of these visits are recorded and available for inspection. To ensure that the Providers monitor the running of the home and are able to identify that the home is being managed satisfactorily. 21 39 24 The Registered Providers must demonstrate that the home has good quality monitoring processes in place. 30/06/2010 30/06/2010 30/06/2010 Care Homes for Adults (18-65 years) Page 37 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure that the services the home provides are monitored and reviewed as part of a quality assurance process. 22 41 17 You are required by 9th June 09/06/2010 2010 to ensure that all records specified in Schedule 4 of the Care Homes Regulations 2001 are maintained in the care home, and that they are kept up-to-date and are at all times available for inspection in the care home. THIS IS A STATUTORY REQUIREMENT NOTICE. To ensure that there is evidence of the homes good management. 23 42 13 The Registered Providers 30/06/2010 must ensure that there are systems in place to carry out the required health and safety checks and that the completion of these is monitored. To safeguard the people living in the home, staff and visitors by ensuring that Care Homes for Adults (18-65 years) Page 38 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 7 9 That care plans are in a format which is easy to follow. That the important information on risk assessments is clearly identified so that it can be easy accessed by the staff team and agreed with the residents. Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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