Inspection on 11/04/05 for Foxlands House

This inspection was carried out on 11th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Foxlands House 19/06/06

Foxlands House 06/09/05

Foxlands House 25/10/04

Foxlands House 14/07/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 FOXLANDS HOUSE 1 & 2 Cranesbill Close Annesley Avenue Colindale, London NW9 5RQ Lead Inspector Daniel Lim Unannounced 11 April 2005 @10.00 am 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 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 Stationary 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. FOXLANDS HOUSE Version 1.10 Page 3 SERVICE INFORMATION Name of service Foxlands House Address 1 & 2 Cranesbill Close, Annesley Avenue, Colindale, London NW9 5RQ Telephone number Fax number Email 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 8200 1796 020 8200 9610 Nigel Pink for The Richmond Fellowship Gloria Achiekwelu PC Care Home Only 6 Category(ies) of MD Mental Disorder registration, with number of places FOXLANDS HOUSE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 The homes will have one registered manager and a designated deputy manager in each home. 2 There is one male service user at Foxland House over the age of 65 years (dob 24/4/1934). The CSCI must be informed when this service user no longer receives care at the home. 3 The homes Meridan House and Foxlands House will function separately with their own registration and independent staff group to provide personal care only. Date of last inspection 25 October 2004 Brief Description of the Service: Foxlands House is a small purpose built care home which was opened in 1998. It forms part of a complex of six buildings developed on this site to accommodate people who were previously patients at Napsbury Hospital in Hertfordshire. The home is run by a charity called The Richmond Fellowship. It is registered for a maximum of six service users with mental disorders. Three of the service users may be over the age of 65 years. The stated aim of the home is to provide a home where service users can be cared for with dignity and where they can lead as independent a life as possible. The home is a detached, two storey modern house. It has six single bedrooms located on the ground and first floors. All bedrooms have ensuite facilities.The staff office, lounge, kitchen and laundry are located on the ground floor. The manager’s office and a smaller lounge is on the first floor. There is a communal bathroom and toilet on the ground floor and a second communal bathroom and toilet on the first floor. There is a small car park at the front and a garden at the back. The home is within walking distance of Colindale Hospital and about a mile away from Edgware Hospital. It is also close to shops and public transport facilities along the Edgware Road. FOXLANDS HOUSE Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on the 11 April 2005 and took three and a half hours to complete. The inspector found that almost all of the National Minimum Standards assessed had been met and the overall quality of care provided was of a high standard. During this inspection, the inspector was accompanied by the home manager (Gloria Achiekwelu). The inspector was able to interview four residents independently of staff. They spoke highly of staff and indicated that they were satisfied with the quality of care provided. There were no visitors at the home during the inspection. What the service does well: Residents’ case records were well maintained and their plans of care which were examined were of a high standard and had been signed by residents. The healthcare needs of residents had been assessed and residents interviewed were able to confirm that their healthcare needs had been met. The home had a varied programme of social and therapeutic activities which residents said was appropriate. Residents stated that they liked the meals provided and they were involved in planning the menu. The home was kept clean and well furnished. It felt cosy and homely. The manager and her staff were well trained and competent. Residents spoke highly of staff. Regular residents’ meetings and staff meetings had been held and there was evidence that suggestions and concerns expressed had been responded to. The arrangements for fire safety and other health and safety arrangements were found to be satisfactory and staff and the manager had acted promptly to health and safety requirements made by the inspector. FOXLANDS HOUSE Version 1.10 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 full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. FOXLANDS HOUSE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection FOXLANDS HOUSE Version 1.10 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 standard(s) 1 ,2 & 3 The manager and her staff had a good understanding of the needs of residents and were able to ensure that their needs are met. Residents interviewed spoke highly of staff and indicated that their care needs had been met. EVIDENCE: Four residents who were interviewed stated that their needs had been met at the home and they were well treated. A sample of four case records contained plans of care and details of how residents needs had been met. Reviews of care examined indicated that the professionals involved (CPNs and care managers) were satisfied with the care provided at the home. The inspector observed that residents in the home were clean, appropriately dressed and appeared well cared for. FOXLANDS HOUSE Version 1.10 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 standard(s) 6-9 Residents said that they had been treated with respect and dignity were able to make choices regarding the care and service provided. There was evidence that staff had enabled residents to remain as independent as possible and minimise potential risks. EVIDENCE: Residents who were interviewed were able to confirm that staff listened to them and suggestions made by them had been acted upon. This included holidays, outings and meals served. The minutes of residents meetings were examined. These contained evidence that residents’ wishes had been responded to. Staff on duty were interviewed and found to be knowledgeable regarding the preferences of residents. The sample of four residents’ case records contained comprehensive plans of care and up to date risks assessments. FOXLANDS HOUSE Version 1.10 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 standard(s) 12-17 Residents informed the inspector that they were able to engage in various activities which they found to be appropriate. The kitchen and arrangements for the provision of meals was found to be satisfactory. EVIDENCE: Residents interviewed were able to confirm that they had been in contact with their family and friends. FOXLANDS HOUSE Version 1.10 Page 11 The sample of case records contained documented evidence of activities that residents had engaged in. These included attendance at the local MIND day centre, a work scheme, shopping, holidays and outings to the museum. Service users were able to confirm that they participated in these activities. Residents interviewed confirmed that they had been encouraged to remain as independent as possible and were involved in household chores such as doing their own laundry, preparation of meals, shopping, cleaning and tidying of their bedrooms. The kitchen was inspected and found to be clean. Daily recorded temperatures of the fridge and freezer were satisfactory. The menu was examined and found to be varied and balanced. Residents interviewed about the meals served stated that they were satisfactory and menu planning meetings had been held in the home. FOXLANDS HOUSE Version 1.10 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 standard(s) 18 -20 Residents interviewed informed tha inspector that their healthcare needs had been attended to. The case records of residents contained detailed plans of care and staff were knowledgeable regarding the care needs of residents. Residents stated that they had been given their medication. The arrangements for the administration of medicines was satisfactory. EVIDENCE: Residents who were interviewed stated that staff took good care of them and they had been seen by their doctor and their community psychiatric nurse. The case records of four residents were examined. These contained details of how the needs of residents had been met and included appointments with doctors, dentists, opticians and community nurses. The medication charts were examined. These indicated that medication had been administered as prescribed. In addition, the temperature records of the room where medication was stored was examined. This was satisfactory. FOXLANDS HOUSE Version 1.10 Page 13 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 standard(s) 22.23 There was evidence that the rights of residents are protected and complaints are taken seriously. Residents are protected from abuse and ill treatment Staff had been provided with training on adult protection and knew how to respond to allegations made. EVIDENCE: The staff records were examined. These contained evidence that staff had been provided with adult protection training. The complaints book was examined and it was noted that complaints made had been promptly responded to The four residents interviewed stated that they were well treated by staff. FOXLANDS HOUSE Version 1.10 Page 14 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 standard(s) 24, 25, 26,27,28, 30 Residents stated that they were happy with the accommodation provided and the premises had been kept clean. The home was well maintained . EVIDENCE: An inspection of the premises, including the kitchen, bedrooms, toilets and bathrooms, laundry room and garden was carried out. The premises were found to be clean and well maintained. The home’s maintenance book was examined. Safety inspection certificates for portable appliances, gas and electrical installation were examined and found to be satisfactory. The records examined also indicated that the emergency lighting had been checked weekly. FOXLANDS HOUSE Version 1.10 Page 15 The fire records were examined and found to be satisfactory. Weekly fire alarm tests, fire drills and fire training had been provided. The hot water in bedrooms was tested and found to be within the required safety temperature range of no higher than 43C FOXLANDS HOUSE Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31-36 Residents who were interviewed expressed confidence in staff and stated that they were well treated by staff. The staff team were competent and well trained. The inspector was uncertain if the night staffing arrangements were adequate and a requirement is made for this to be reviewed. EVIDENCE: The staff rota was examined. This indicated that there were three staff on duty during the morning shift, two staff during the afternoon and evening shifts and one staff on sleeping night duty. On weekends, only two staff are on duty during the day shift. There had been no regression in the staffing level. The inspector was concerned that there was only one staff on duty during the night shift and one of the residents had at times exhibited challenging behaviour. This was discussed with the manager who reassured the inspector that there was an on call system in place and staff (in a nearby home) were able to provide support within minutes if assistance is required. FOXLANDS HOUSE Version 1.10 Page 17 The inspector nevertheless, made a requirement for the registered person to review staffing arrangements during the night. This is to ensure that the needs of residents are met and residents and staff are not exposed to unnecessary risks. Two staff records were examined. These contained the required documentation such as references, passport photos, CRB disclosures and contracts. There was also documented evidence of regular staff supervision. Staff training records were examined. These contained evidence that staff had been provided with essential training (such as food hygiene, health and safety and adult protection) and new staff had been provided with a period of induction. FOXLANDS HOUSE Version 1.10 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,41,42 Staff and all four residents interviewed were of the opinion that the home was well managed. The manager was competent and knowledgeable. EVIDENCE: Residents and staff were interviewed. They were able to confirm that the manager was competent, the home was well run and care provided was of a high standard. System were in place to ensure the health and safety of residents and staff. These included risk assessments, fire procedures, training and staff supervision. FOXLANDS HOUSE Version 1.10 Page 19 The fire records were examined.These were satisfactory and contained details of weekly fire alarm tests, drills and fire training. Minutes of staff and residents’ meetings were examined. These contained evidence that suggestions made had been followed up. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 4 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 3 3 3 3 x 3 Standard No FOXLANDS HOUSE Standard No 31 32 Version 1.10 Score 3 3 Page 20 11 12 13 14 15 16 17 x 3 3 3 3 3 3 33 34 35 36 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 3 x FOXLANDS HOUSE Version 1.10 Page 21 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 33 Regulation 15, 18 Requirement The registered person must review the night staffing arrangements to ensure that the needs of residents are met and staff and residents are not exposed to unnecesary risks. Timescale for action 17/6/05 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 Good Practice Recommendations FOXLANDS HOUSE Version 1.10 Page 22 Commission for Social Care Inspection 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 © 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 FOXLANDS HOUSE Version 1.10 Page 23 - 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. 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