CARE HOME ADULTS 18-65
Chapel Lane, 74 Hillingdon Middlesex UB8 3DS Lead Inspector
Ms Pauline Griffin Unannounced Inspection 12 3 November 2005
rd Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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 Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Chapel Lane, 74 Address Hillingdon Middlesex UB8 3DS 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) 01895 446958 01895 440826 London Borough of Hillingdon Mrs Margaret Anne Howell Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The radiators must have low temperature surfaces by 31 January 2004. Care Homes Regulations 2001. Reg 13(2)(c). Ramps must be fitted to the front door and from the patio door into the garden by 31 March 2004. Care Homes Regulations 2001. Reg 23(2)(d). 5th November 2004 Date of last inspection Brief Description of the Service: The home provides a service for six people with learning disabilities. The property is owned by Shepherds Bush Housing Association and the care is supplied by London Borough of Hillingdon. The house is a large detached family residence which has been extended. The house is situated in a quiet residential avenue in Hillingdon that is within easy reach of public transport links to central Uxbridge and other shopping centres in the area. There are a few local shops within walking distance. All of the six bedrooms are single occupancy and have wash hand basins. There is no lift in the home. The ground floor accommodation comprises two bedrooms and all the shared communal facilities. There is a very large lounge with dining area and access to the garden via French doors. The garden is wheelchair accessible and there is a wheelchair accessible shower/toilet on the ground floor as well as a large domestic kitchen, laundry and office. The first floor has four bedrooms, a shower/bathroom and a toilet. The stairs are fitted with support rails. The Registered Manager is supported by three Care Staff and are currently 68.50 permanent hours short per week. These hours are made up by the Local Authority ‘Reserve Team’ and a local employment agency. The home is accessed at the front by ramp and new ramps now give wheelchair access to the rear garden. The home has a minibus used for outings with Service Users contributing to the cost. The home continues to give care to three men and three woman. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over 5.30 hours. A Senior Careworker assisted the Inspector in the absence of the Registered Manager who was on annual leave. Three Service Users and two Staff members were interviewed and one Service User’s file chosen at random. Policies, guidance, records and logs were examined but no Staff file was available for inspection due to the absence of the Registered Manager. The home has a stable team of experienced Careworkers and although the number of permanent hours has been reducing over the past two inspections, Staff said that they did not feel this had any impact on the Service Users or the service provided because the deficit was made up by temporary Staff who were familiar with the home. Service Users were given a hot snack meal of quiche and baked beans on the day of the inspection when they returned from their respective Day Centres. This was prior to attending an evening social event with a supper included. The Staff demonstrated their knowledge of Service Users needs and wishes by the way that they interpreted them. There were only three Service Users in the home at the time of the inspection because the other three were away on a holiday together. The house was in good decorative order and repair throughout and the Service Users’ bedrooms and communal rooms were comfortably furnished and clean. What the service does well:
The service provides personalised care from a team of experienced Careworkers who are familiar with their needs and preferences. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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 Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home is able to demonstrate it’s ability to meet Service User’s needs. EVIDENCE: The home provides a service for people with learning disabilities and the Staff team have worked in the home long term and are experienced. The Service Users have also all been in the home for many years. A Senior Careworker said that training and specialist training had been improved in recent years and she felt they were provided with the information they needed. There has recently been a change around for each Service User’s keyworker in order that a fresh approach can be taken to their needs. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Staff support Service Users to make choices and take risks within an assessed framework to ensure that they optimise an independent lifestyle. EVIDENCE: The Senior Careworker said that Staff encouraged Service Users to carry out and enjoy activities within a risk assessed framework. One Service User wishes to walk to a local shop and cross the road by himself/herself. Staff have devised a way to follow him/her at a safe distance to ensure his/her safety. Risk assessments are made for all activities that Service Users are involved in. Service Users who work in the kitchen help with small tasks but do no actual cooking and they also perform light cleaning. Risk assessments are carried out for all of these activities. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 17 The Service Users enjoy a lifestyle that includes appropriate activities designed to provide them with stimulation and enjoyment. EVIDENCE: Each of the Service Users attends a Day Centre four days a week. None of the Service Users are in paid employment. One Service User has training in information technology at his/her Day Centre and a local college. The Service Users enjoy a range of activities outside the home at weekends and evenings. These include several different clubs, swimming and excursions to the local theatre, cinema, places interest, restaurants and pubs. The home has a minibus to use for outings with the Service Users. None of the Service Users attend church but two attend a local Sunday club each week. The menus of food served in the home includes favourite meals that have fresh vegetables and fruit. Service User meetings held each month, include discussion about food. However, the home has adopted the practice of only
Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 11 providing a dessert on Sundays. Desserts on other 6 days is restricted to fruit and yoghurt although not all of the Service Users need a restricted diet and might enjoy more choice. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 21 Service Users receive personal care support provided in a sensitive manner that takes into account their preferences and needs. EVIDENCE: The Service User group have low levels of need for assistance with personal care. The Staff group now includes two males and three females. The Senior Careworker said that Service Users have the choice as to the gender of the Careworker who provides their care. Each Service User has a designated keyworker. Lone male Careworkers are providing sleep in duties on a rota. Health checks are arranged with the Service User’s general practitioner and other specialist services are accessed through the Primary Health Care Services or the CTPLD (Central Team for People with Learning Disabilities) at the Local Authority. The home operates a system of health action planning to monitor the health care needs of the Service Users and to which they contribute where possible. The home has advised on previous inspections that it does not offer places to Service Users after they reach their 65th year. This important issue has not been included in the home’s Statement of Purpose.
Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 13 The issue of death and dying is usually approached with the Service User’s family or representative and most of the Service Users have notes on record of their wishes. For the Service Users for whom this has not been undertaken, the home should attempt to obtain guidance regarding treatments, religious observance and wills. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Service Users and their representatives are confident that their views are heard and acted upon. Service Users are protected by the home’s policies that ensure their safety and wellbeing. EVIDENCE: There have been no complaints received regarding the service since the previous inspection and there was, therefore, no documentation to examine. There is a pictorial complaints leaflet designed for Service Users and a leaflet produced by the Local Authority. These are on display in the hall of the home together with a complaints policy. Service Users all have a one-to-one meeting with a member of Staff or an advocate and these are used to obtain their views. The home follows the London Borough of Hillingdon’s Protection of Vulnerable Adults Policy and Staff have received training in Adult Protection provided by the Local Authority. There have been no adult protection issues in the home and restraint is not used. One Service User’s money float was chosen at random and the float tallied exactly with the written record. The financial recording log of incoming and outgoing amounts was satisfactory. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 The home is able to provide suitable facilities for the Service Users to ensure their needs are met. EVIDENCE: The home has three toilets, two showers and one assisted bath across the two floors. The toilets and bathrooms have locks but most of the Service Users require some form of assistance when using them. The toilet and shower on the ground floor is wheelchair accessible. There are ramps leading to the front entrance of the home and the garden is also wheelchair accessible. One Service User on the ground floor has an alarm so that she/he can call the sleep-in Careworker if necessary during the night. Two Service Users have wheelchairs and walking aids. The home is clean and hygienic throughout and there were no odours. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 & 35 Service Users benefit from a committed Staff team who understand their individual responsibilities and work well together. EVIDENCE: Staff records were not available for inspection due to the absence of the Registered Manager. The two Staff spoken to were able to demonstrate a good understanding of their role and responsibilities and their detailed knowledge of the Service Users. The present Staff group consists of three females (including the Registered Manager), one male and one male from the staff agency. The one Service User who requires the most personal care support is female and so she can receive personal care from a person of the same gender at all times apart from some occasions during the night when a lone male Careworker is on duty. Staffing levels of permanent hours have been dropping steadily over the past two years. Vacant hours for the home currently stands at 68.50 hours per week. These hours are filled by the Local Authority Reserve Team or a Staff Agency. Training records examined showed that Staff have received mandatory training in the basic subjects as well as specialist training.
Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,39,41 & 42 Service Users benefit from an environment where their rights and views are respected. The Registered Manager must continue to develop a quality monitoring system that is designed to obtain feedback that assists in developing the service. EVIDENCE: The home is well run and the Staff said that they felt supported by the Registered Manager. The quality monitoring system developed by the Registered Manager has included questionnaires for Service Users and their representatives and this is an area that can be further developed to include feedback from the Day Care services and Clubs and any other area where feedback can be sought. A summary of the outcomes of the quality monitoring system must be sent to the CSCI each year. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 18 Record keeping in the home is satisfactory and the Service User’s file chosen at random included all the information required which was up to date and comprehensive. The accident book was examined and it was noted that this was kept in accordance with the Health & Safety Executive under the Data Protection Act 1998 and all details of accidents were filed individually and not kept in the book. The home has numbered the accident sheets to provide a form of reference. The new Accident Reporting format that requires the separation of individual reports, leaves the home with no way to monitor trends in accidents and hazards that might have provided preventative information. Records in the home were kept in locked cabinets. Logs of the checks made on water, gas, electrical equipment, fire safety equipment by accredited organisations were up to date and had all been completed within the previous 12 month period. Staff said that they kept a maintenance book and reported things that needed repair or re-decoration to the Housing Association who responded well to any requests. The most recent fire drill was held on 23/10/05 and alarms and lighting is checked each week. A representative from the London Fire Department visited the home in April 2005 and made no recommendations. Logs of the fridge/freezer temperature checks were maintained up to date. The first aid box was examined and found satisfactory. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X 3 X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X 3 x Standard No 24 25 26 27 28 29 30
STAFFING Score X X X 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 2 X 3 x CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Chapel Lane, 74 Score 3 3 X 2 Standard No 37 38 39 40 41 42 43 Score X 3 3 X 3 3 x DS0000032581.V254658.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? No Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 21 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 17 Regulation 16(2)(i) Requirement Timescale for action 06/01/06 2 21 3 21 4 33 The Registered Manager must provide evidence that Service Users are given the opportunity to choose from a selection of foods designed to appeal to them and that are within their dietary and cultural needs. 4(1)(2)5,6 Sch 1 The home has a policy that Service Users over the age of 65 years cannot remain there. This must be included in the Service User Guide and Statement of Purpose. 12(1)(b)(2) The home must obtain (3) information regarding the Service Users wishes in connection with medical treatments, arrangements at the time of death, religious observance and wills for those Service Users for whom no information has already been sought. 18(1)(a)(b)12(3) The Registered Manager must provide evidence that the home has sufficient numbers of skilled Staff on duty to provide an effective service to a Service User group whose needs are increasing through the aging process and/or general health issues. 06/01/06 06/01/06 09/12/05 Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 22 Evidence must include confirmation that the choices of the Service Users are not compromised by Staffing issues. 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 18 Good Practice Recommendations Evidence should be available that all Service Users have been given the choice as to the gender of the person providing their personal care. This should cover any time including assistance they might need overnight when only one member of Staff is sleeping in. Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection West London Area Office 58 Uxbridge Road Ealing London W5 2ST National Enquiry Line: 0845 015 0120 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 Chapel Lane, 74 DS0000032581.V254658.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!