Inspection on 29/01/08 for Elmfield Way, 1-2

This inspection was carried out on 29th January 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmfield Way, 1-2 21/08/07

Elmfield Way, 1-2 18/12/06

Elmfield Way, 1-2 01/02/06

Elmfield Way, 1-2 03/03/05

Elmfield Way, 1-2 13/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Elmfield Way, 1-2 1-2 Elmfield Way London W9 3TU Lead Inspector Tony Lawrence Key Unannounced Inspection 29th January 2008 09:30 Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmfield Way, 1-2 Address 1-2 Elmfield Way London W9 3TU 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 7266 1200 020 7266 3412 info@yarrowhousing.org.uk Yarrow Housing Limited Caryl Anderson Care Home 6 Category(ies) of Learning disability (18) registration, with number of places Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2007 Brief Description of the Service: 1-2 Elmfield Way is a registered care home providing accommodation and personal care for six people with autism and/or challenging behaviours. At the time of this visit there were 3 men and 2 women living in the home and one vacancy. Kensington Housing Trust owns the property and the care is provided by Yarrow Housing Limited, a voluntary organisation. The home is located off Harrow Road, a busy main road. It is close to local shops and transport links. Originally built as two separate units, the home has been converted to provide spacious accommodation that is fully accessible to people using wheelchairs. The home is well staffed to provide intensive support to people with high care needs. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on Tuesday 29th January 2008 from 09:30 – 15:00. Tony Lawrence, Regulation Inspector, carried out the inspection. He spent time talking with residents and staff on duty, one of the home’s deputy managers and Yarrow’s Care Services Manager. He also checked care records and saw all communal parts of the home and three residents’ bedrooms. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 6 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 Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Significant time and effort is spent planning to make admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life-changing decisions they need to make. There is a high value on responding to individual needs for information, reassurance and support. EVIDENCE: Following a requirement made at the last inspection, Yarrow’s Care Services Manager told us that the home’s Service User Guide had been updated. The home currently has one vacancy and staff from the home have been working with the local Learning Disability Services to find a person whose needs can be met in the home. During this visit we saw that managers and staff have developed an excellent transition plan to make sure that the person is supported to make a positive choice to move into the home. The plan has included 5 afternoon visits, 2 overnight stays and 2 weekend stays. Some of these visits had already happened before this inspection and staff from the home had kept a good record of the care and support provided during each visit. Staff on duty were able to tell us about the visits and the person’s responses on each occasion and this information was also well recorded in an individual Log Book. We saw that a behaviour assessment and positive support plans had been written by a Senior Challenging Behaviour nurse in October 2005 and a Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 8 positive behaviour support plan had been produced in January 2007. Staff were able to tell us that the person’s needs had changed since these assessments were completed. The Care Services Manager confirmed that a more recent needs assessment had been partially completed, but a copy was not available for staff in the home. Managers must make sure that a current care needs assessment and Health Action Plan are completed before the person moves into the home. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff understand the importance of residents being supported to take control of their own lives. Individuals are encouraged to make their own decisions and choices. The service will know and record the preferred communication style of the individual, and will use proven methods that enable the person to lead a full life that promotes independence and choice. EVIDENCE: Two of the three key Standards were met at the last key inspection in August 2007. During this visit, staff told us that they have involved residents more in spending their own money in local shops to buy food, clothes and other items. Staff did tell that this is not always possible, as some residents sometimes need significant levels of support to make sure that they are safe when out of the home. We saw that assessments and support plans completed for a potential new resident identified the need for all staff working with the person to be familiar with and use signs from the Makaton Vocabulary to facilitate communication. The Care Services Manager confirmed that all staff working in the home had completed a two-day certificated Makaton training course in December 2007. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 10 We saw that staff from Elmfield Way had some completed risk assessments for the person who was visiting the home as a potential new resident. These assessments covered arrangements for visits to the home use of public transport. Other risk assessments had been provided by the person’s current care home, but there is a need to make sure that assessments are completed for other areas identified in needs assessments, including road safety, epilepsy and behavioural issues. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to enabling residents to develop or maintain their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. EVIDENCE: Following a requirement made at the last inspection, we checked the individual Log Books for two people living in the home and one person who may move in. Staff on each shift are now recording important information about each resident’s activities, diet and other issues, including contact with relatives, friends and other significant people. All other key Standards were met at the last inspection in August 2007. During this visit we saw evidence that managers and staff from the home have worked well with the family of a potential new resident to make sure that they are involved in and happy with the person’s planned move. This has involved arranging for the person’s parents and others to visit the home while the person has been visiting for trials and involving them in discussions about the care and support the person needs. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 12 During the day, we saw that staff supported all 5 people to spend time out of the home. Two people had already left for their day services when we arrived. The other three residents each went out with staff support for a walk or drive. We discussed with the Care Services Manager a proposal from the local authority Social Services Department to alter the arrangements for providing day time support to three people living in the home and the potential new resident. Day services are currently provided by staff from Yarrow who are based in the home. Under the new proposals, support will be provided by the local authority’s Flexible Support Service and each person will receive 9 hours 2:1 support each week. We are concerned that this will restrict residents’ access to activities in the home and the local community at times that suit each individual. Yarrow must make sure that the local authority’s proposals are agreed with the Commission before they are implemented. If the new arrangements are agreed, Yarrow must monitor the effects of staff changes on residents’ access to activities at times that they choose. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is responsive to the varied and individual needs and preferences. The delivery of personal care is individual and is flexible, consistent, reliable, and person centred. EVIDENCE: All three key Standards were met at the last inspection in August 2007. During this visit we looked at medication records and the healthcare records of two people living in the home. We saw evidence that people’s healthcare needs were well recorded and the home keeps a good record of each person’s contact with health and social care professionals. We checked the risk and care needs assessments completed for one person who may move into the home. These identified the need for staff to be trained in administering specialist medication and this training must be arranged by the home before the person moves in. We also checked the Medication Administration Record (MAR) sheets for all five people living in the home. These were well completed and we saw no errors or omissions. We did talk to the home’s deputy manager and Yarrow’s Care Services Manager about two issues. We found the home’s systems for recording the administration of PRN (‘as required’) medication confusing. The home currently uses two systems and one of these does not include the reason Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 14 why medication has been given. To make sure that residents are cared for safely, staff must make sure that they include the time, amount and a reason for the administration of any PRN medication. Staff must also make sure that they record details of a resident’s behaviour if a decision is taken to administer PRN medication. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for safely but there is a need to make sure that staff have access to safeguarding adults procedures. EVIDENCE: Following a requirement made after the last key inspection in August 2007, the Care Services Manager told us that the home’s complaints procedure had been discussed in a team meeting to make sure that all staff were aware of the importance of supporting residents to raise concerns. The procedure will also be sent out again to residents’ relatives and other significant people to remind them of the home’s policy. During this visit we checked the finance records for two people living in the home. We saw that records were generally well kept, receipts were always obtained when residents spent their personal money and balances of individual accounts were checked and signed off by managers. We also saw that Yarrow had developed a safeguarding adults policy and procedures. There is a need to make sure that copies of the local authority’s policy and procedures are available in the home for staff reference. Managers should also consider using the local authority’s safeguarding adults induction workbook with all new staff. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is a very pleasant, safe place to live the bedrooms and communal rooms meet these Standards or are larger. EVIDENCE: 1-2 Elmfield Way is a registered care home providing accommodation and personal care for six people with autism and/or challenging behaviours. Kensington Housing Trust owns the property. The home is located off Harrow Road, a busy main road, close to local shops and transport links. Originally built as two separate units, the home has been converted to provide spacious accommodation that is fully accessible to people using wheelchairs. The home has a large, enclosed garden and an excellent summer house that provides additional space for residents to spend time alone or with staff. During this visit we looked at all communal parts of the home, toilets and bathrooms and some of the residents’ bedrooms. The last inspection report included a requirement that essential repairs and refurbishment works must be completed by 30/09/07. While we saw that repairs to the bath / shower rooms and toilets have now been completed, other works are still outstanding and Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 17 these must now be completed without further delay. Staff told us new carpets are being provided in the main lounge / dining room and two residents’ bedrooms. The standard of accommodation in residents’ bedrooms is very good and each room is very individual but other parts of the home now need to be brought up to the same standard. During this visit, all parts of the home that we saw were clean and hygienic. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are consistently enough staff available to meet the needs of the people using the service, with more staff being available at peak times of activity. The staffing structure is based around delivering outcomes for residents and is not led by staff requirements. EVIDENCE: Following a requirement made after the last key inspection in August 2007, managers now keep copies of Criminal Records Bureau checks carried out on all agency staff working in the home. During this visit we saw that the home was well staffed to meet the needs of residents. Nine residential and day services staff were on duty in the morning and 7 staff were working in the afternoon / early evening. We saw that staff worked well together throughout the day to offer residents choices and support them with their personal care, meals and social activities. There are still a number of permanent staff vacancies in the home and the Care Services Manager told us that recent targeted advertising had resulted in 22 applicants for seven vacancies. We saw evidence that staff will have access to relevant training during the period January – March 2007, including communication, medication and autism training. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 41 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home, but needs to register with the Commission. EVIDENCE: Following a significant period without a registered Manager, the Care Services Manager told us that a new, permanent Manager had been appointed in January 2008. He told us that the new Manager had completed his National Vocational Qualification Level 4 management training and had previously been the registered care manager of another residential service. There is a need to make sure that the new Manager applies for a Criminal Records Bureau check through the Commission without delay and then applies for registration with the Commission as a ‘fit person’ to manage the home. During this visit we checked a selection of care records kept by staff in the home. We saw that standards of recording in the home have improved since the last key inspection in August 2007. We saw that individual resident’s daily Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 20 Log Books were well completed and residents’ finance and medical records were up to date. We saw that staff were keeping accurate fire safety records and daily records of food storage temperatures in the home. Staff must also make sure that they keep accurate records of hot water temperatures in the home. We saw that monthly monitoring visits by senior managers from Yarrow were carried out in October, November and December 2007 and January 2008. Reports had been written following each visit and copies were available in the home. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 3 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X 3 2 X Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 Requirement Timescale for action 31/03/08 2. YA9 13 (4) 3. YA12 16 (2) m 4. YA20 13 (2) To make sure that the care needs of a potential new resident can be met in the home, Managers must make sure that a current care needs assessment and Health Action Plan are completed before the person moves in. To make sure that a potential 31/03/08 new resident is cared for safely, there is a need to make sure that assessments are completed for the management of potential risks identified in care needs assessments. 31/03/08 To make sure that residents continue to have access to meaningful activities, Yarrow must make sure that the local authority’s proposals to change day staffing arrangements are agreed with the Commission before they are implemented. If the new arrangements are agreed, Yarrow must monitor the effects of staff changes on residents’ access to activities at times that they choose. Specialist medication training 31/03/08 must be arranged by the home DS0000010873.V358654.R01.S.doc Version 5.2 Elmfield Way, 1-2 Page 23 5. YA20 13 (2) 6. YA20 13 (2) 7. YA22 13 (6) 8. YA42 23 before a potential new resident moves into the home. To make sure that residents are cared for safely, staff must make sure that they include the time, amount and a reason for the administration of any PRN medication. Staff must also make sure that they record details of a resident’s behaviour if a decision is taken to administer PRN medication. To make sure staff care for residents safely, there is a need to make sure that copies of the local authority’s safeguarding adults policy and procedures are available in the home for reference. Staff must make sure that they keep accurate records of hot water temperatures in the home. 31/03/08 31/03/08 31/03/08 31/03/08 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 YA22 Good Practice Recommendations To make sure that staff are aware of local procedures, Managers should consider using the local authority’s safeguarding adults induction workbook with all new staff. Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elmfield Way, 1-2 DS0000010873.V358654.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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