CARE HOMES FOR OLDER PEOPLE
Edwina House 64-66 Grovelands Road Palmers Green London N13 4RJ Lead Inspector
Tony Brennan Unannounced Inspection 3rd April 2006 10:00 X10015.doc Version 1.40 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 Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Edwina House Address 64-66 Grovelands Road Palmers Green London N13 4RJ 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) 020 8886 6658 020 8882 6265 Mr Sooreeadeo Hurree Mrs Elizabeth Ann Hurree Mr Sooreeadeo Hurree Care Home 22 Category(ies) of Past or present alcohol dependence (0), registration, with number Dementia (0), Old age, not falling within any of places other category (0), Physical disability (0) Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Where service users are admitted only for intermediate care, dedicated accommodation is provided. 3rd October 2005 Date of last inspection Brief Description of the Service: Edwina House is owned and managed by Mr Sooreeadeo Hurree and Mrs Elizabeth Hurree. The home is registered to care for twenty-two service users. The home is comprised of two semi-detached two-storey houses, which are joined and extended. There are fourteen single and four double bedrooms. There are two communal areas for sitting and dining. The home has a passenger lift. There is a garden to the rear of the property. The home is within walking distance of shops and public transport links. The home aims to provide a supportive and caring environment for those who use the service. Currently the homes fees range between £450 and £570 per week. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection process. The inspector also sought to confirm that the six areas for improvement identified at the last inspection were addressed. The inspection took place over one day. The registered person, Mr Sooreeadeo Hurree, assisted the inspector. The inspector spoke with seven people who live at Edwina House, two relatives and three staff. The inspector observed care practice and interaction between service users and staff. A tour of the building took place. A number of records relating to the care, health and safety and management in the home were examined. The inspectors would like to thank the registered manager and staff who assisted them by answering questions about the running of the home. The inspector would also like to thank those people who live at the home who discussed their views of the service they receive. What the service does well: What has improved since the last inspection?
Six areas for improvement had been identified at the last inspection and four had been met. The inspector was able to see that falls risk assessments and prevention plan had been put in place to ensure the safety of those living at Edwina House. Measures have been put in place to ensure that the tissue viability needs are met. This includes regular assessments and prevention plans where a person might be at greater risk of developing pressure sores. The safety of those living at the home has been maintained by providing a comprehensive fire risk assessment for the home. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 6 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. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Service users needs are assessed prior to admission to the home. EVIDENCE: The inspector observed the care provided for a service user recently admitted to the home and found that this corresponded with the initial assessment and care plan. Staff spoken to could explain the needs of this service user. The registered person explained that he always carries out an assessment of the service users prior to their admission to the home. Copies of these assessments were available and identified the needs of service users. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Service users health, personal and social cares needs are planned for and met. Service users are protected by safe procedures for handling medication. Service users right to privacy is respected. EVIDENCE: One service user explained how staff understood the support she required to promote her mobility. Care plans reflected this support. Staff spoken to understood the needs of service users. Another service user said that staff ‘understand what I want and how I like things.’ Since the last inspection falls risk assessments and tissue viability assessments are now in place. There were also plans detailing how these needs should be met. Medication procedures were in place. Records for the receipt, administration and return of medicines were all complete. Staff had received training in the safe administration of medication. Staff were observed administering medication and this was seen to be carried out safely. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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 15 Service users are provided with sufficient and varied activities to meet their needs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are able to make choices about how they live in the home, and are provided with varied and balanced meals. However, pureed meals are not presented in a pleasing way. EVIDENCE: Service users said they had been provided with activities and entertainment. Service users gave examples of sing-a-long, gentle exercise and listening to music. The hairdresser was at the home on the day of the inspection. A service user commented that she enjoyed this. Service users interests and involvement in activities was recorded in their care plans. The registered person explained that a volunteer visits the home and understands the cultural needs of the two Greek service users who live at the home. Service users spoken to confirmed they had a choice as to whom they wished to see. Relatives spoken to told the inspector that they could visit whenever they wished and that they were always made welcome. Service users said that they felt that they could make choices about how they lived in the home. Service users and relatives commented that the food was good and choices were provided. The menu showed that balanced meals were offered. A service user commented that he ‘likes what is on the menu’. Service users said they were consulted about the choices being offered. One service user
Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 11 who is Greek said that she is offered Greek food. The inspector observed that pureed food was being given to service users all mixed together. Staff spoken to by the inspector said this was a regular practice. This was discussed with the registered person who agreed to ensure that pureed food is presented separately. Service users were supported in a relaxed manner. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Service users are confident that their complaints will be listened to, taken seriously and acted upon. Staff do not have the necessary knowledge to ensure that service users are protected from abuse. EVIDENCE: Service users said that they felt confident in making their concerns known to staff. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. Since the last inspection there has been one complaint concerning the care of one service user. This complaint was investigated by the Commission and found to be unsubstantiated. Service users said that they felt safe and could approach staff if they had any concerns regarding how they are treated. There were policies on handling abuse and protection. Staff spoken to were unclear about the signs of and how to respond abuse. Training records also indicates a gap in the provision of training on adult protection. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 The home provides a safe and well-maintained environment for service users. Service users live in a clean and hygienic home. EVIDENCE: Service users spoken to said that they were happy with the decor and layout of the home. A redecoration programme was in place and on going redecoration of the home is taking place. The inspector found that the home was adapted to meet the needs of service users. There were assisted baths and toilets provided. Service users were able to access all parts of the building by the lift. The inspector found that the home was clean and hygienic. Guidance and procedures were in place to prevent cross infection. Protective clothing and hand washing facilities are available to staff throughout the home. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Sufficient staff are available at all times to meet service users needs. Staff do have the skills to meet all the assessed needs of service users. Service users are protected by the home’s recruitment practices. EVIDENCE: Service users said that they felt that staff were always available to meet their needs. The rota showed that a consistent staffing level was maintained. Discussion with staff and training records showed that there was a need for training to be provided on adult protection, infection control and food hygiene. Training had been provided on manual handling. The home still needs to ensure that 50 of staff have the National Vocational Qualification at level 2 in care. The inspector examined staff records, these contained all the required information. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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 38 The registered person has the necessary qualifications to manage the home effectively and ensure that the needs of service users are met. Service users are consulted about the quality of the service provided and encouraged to make suggestions for improvement. Service users financial interests are protected by the home’s procedures. The homes health and safety procedures and policies maintain the safety of service users. EVIDENCE: The registered manager has a nursing qualification. The registered person was able to show that his MNMC registration was up to date. Service users and staff said that the registered manager was supportive and understanding of their needs. The inspector found that there were systems in place to ensure that service users and relatives are consulted about the quality of the service provided. Actions to improve the service are identified. A service user said that he had ‘told them what he thinks of the home’. The registered person explained that the survey was being repeated. A copy of the results of the previous quality survey has been sent to the Commission. The registered
Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 16 person explained that money is only held for one service user. Either relatives or social service departments manage all other service users’ money. The inspector found that the money of the service user held by the home was accounted for and a record of expenditure and receipts was maintained. Records showed that fire equipment was tested regularly and maintained. Drills were taking place. The fire risk assessment had been updated and provides more details of potential risks of fire. The registered person was able to confirm that the fire service had examined the fire risk assessment and had confirmed it was in line with their guidance. All health and safety policies were available. Certificates for gas and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 18 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 2 Standard OP15 OP28 Regulation 16(2)(g) 18(1) Requirement The registered persons must ensure that any pureed food is presented as individual items. The registered persons must ensure that 50 of staff achieve National Vocational Qualification in care at level. 2. The registered persons must ensure that training is provided on adult protection and infection control. The registered persons must ensure that training is provided on the following topics; Food hygiene (The timescale of 01/01/06 was not met). Timescale for action 01/06/06 01/11/06 3 OP30 18(1) 01/06/06 4 OP30 18(1) 01/06/06 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 Edwina House DS0000027807.V287859.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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