Inspection on 14/11/06 for Garthowen

This inspection was carried out on 14th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Garthowen 01/10/07

Garthowen 09/05/07

Garthowen 16/05/06

Garthowen 06/01/06

Garthowen 14/06/05

Garthowen 28/01/05

Garthowen 06/08/04

Garthowen 12/02/04

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

CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Sarah Middleton 14 & 15 th th Unannounced Inspection November 2006 09:50 Garthowen DS0000022889.V315255.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 Garthowen DS0000022889.V315255.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. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road Chiswick London W4 4QP 0208 995 9702 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) www.together-uk.org Together Working for Wellbeing Oluminde Ojudun Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2006 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is registered for twelve service users with mental health problems. The London Borough of Hounslow is the main purchaser and has blocked purchase seven of the bed places. The home is owned and managed by Together Working For Wellbeing. The accommodation has nine single bedrooms on the first floor. There is a selfcontained flat on the ground floor and two flats on the second floor. Service users who are ready to move on to more independent living use the latter. The lounge is a designated smoking room. The dining room can be used as a quiet area in between meals. There are no lifts in the building so it is only suitable for service users with good mobility. Service users are expected to participate in cooking, looking after their own laundry and helping with some domestic tasks around the home. After a settling in period, service users are expected to become more involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support service users to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Fees range from £511.32 for those service users placed by Hounslow Local Authority and £560.00 for those service users placed by other Local Authorities. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process and was carried out over two days. The Inspector was accompanied and assisted by a Regulation Manager, Sue Mitchell, for the first day of the inspection. Service users individual files, staffing files, maintenance records and a tour of the home formed the inspection process. Three members of staff and three service users were spoken with during the inspection. The Area Manager and the three senior members of staff, two of whom are currently working on a temporary basis and have transferred from another service, assisted with the inspection process and the Inspector would like to thank them for their help during the two days. Equality and diversity issues and how the home meets this area has been looked at during this inspection and commented on where appropriate. The Registered Manager is currently absent from the service. This situation is due to be resolved in the very near future. There had been an agency Manager in post for a short while, but they had left, leaving the Area Manager and another Manager visiting the home on a regular basis. The Inspector was informed, subsequent to this inspection, that another agency Manager had been identified and would begin working at the home on the 27th November 2006. The Deputy Manager had recently left the home and this post is due to be filled in the near future, along with the senior social care worker post, that is also vacant. The staffing changes and uncertainties have left the home vulnerable, however the Inspectors were satisfied this had been acknowledged by senior Management and that arrangements were now in place to have an effective and competent staff team who could fully support the service users. The service users vacancies are also due to be filled. All of the Key Standards were inspected and several previous requirements had been met. Fourteen new requirements were made and three were restated requirements. What the service does well: The staff working in the home respect the service users rights to make decisions and choices about their lives. The staff members spoken with were experienced and aware of the service users needs. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 6 The aim is to offer rehabilitation to the service users living in the home and overall the home strives to offer the majority of the service users the opportunity to develop skills and independence. What has improved since the last inspection? What they could do better: All service users accepted to live in the home must have a detailed preadmission assessment carried out on them prior to a decision being made for them to move in on a trial basis. This was not available for inspection on a recently admitted service user. Although members of staff make attempts to engage service users in meaningful activities, this is still not evident for all service users. Where service users are unwilling or unable to take part in activities offered and provided for them, the home must consider whether the placement is suitable for the service users. The home aims to offer rehabilitation and thus must ensure there is clear evidence and objectives for each individual service user to gain skills, confidence and eventually the ability to move on to more independent living. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 7 There continues to be outstanding maintenance and environmental shortfalls, these are clearly separately identified in the report. There must be a maintenance and action plan developed to identify areas needing attention, along with timescales, to ensure the home improves to a good quality standard. The training needs of the staff team need to be identified and recorded to ensure staff receive information and training on the areas they require. Each individual member of staff must have a training programme so that management can monitor the staff team and recognise where there might be any shortfalls and training needs. Staff need to receive formal one to one supervision meetings with their line manager in order for staff to feel supported, listened to and to maintain their professional development. Annual appraisals also need to take place to ensure the home has a skilled and professional staff team working to support the service users. Whilst it is acknowledged that the Area Manager has been present for the majority of the week, along with another Manager visiting the home once a week, as the Registered Manager is absent, there must be a designated person in day-to-day charge of the home. The person appointed must be registered The systems in place for reviewing the quality of care in the home need to be more detailed with a clear overall report, preferably an annual report, that can evidence areas that have been reviewed and are working well and areas where there is room for improvement. Service users and their representatives views must be included into any report, thus showing how the home has consulted with service users and how their comments will be addressed for the forthcoming year. The recommendations made by the Fire Brigade must be considered and addressed to protect the health and safety of the service users and those visiting and working in the home. 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. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 8 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 Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 9 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): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Service User Guide has been updated and includes the necessary information for service users. The shortfall in evidencing pre-admission assessments on prospective service users needs to be addressed in order for the home to demonstrate how they make decisions regarding accepting new service users into the home. EVIDENCE: The Inspector viewed the updated Service User Guide and this was detailed and up to date, with information about the home for service users to read and be aware of what to expect from the home. The Inspector viewed a recently admitted service user’s file. There was no preadmission assessment available regarding this service user. The Inspector was informed that the Deputy Manager had carried out the assessment and they were no longer working in the home. A requirement was made for any prospective service user referred to the home must have an up to date assessment carried out on them to ensure the home can identify the service users needs and consider whether the home can meet those needs. Only then Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 10 should the prospective service user be considered for a trial period in the home. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 11 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): Standards 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual service user care plans were detailed and showed how the identified needs would be met. Service users had been included in the development of the care plan. Service users are supported to make decisions on a daily basis. Risks are identified and recorded and reviewed on a regular basis. EVIDENCE: The Inspector viewed a sample of service users care plans. These had recently been updated and improvements were noted by the Inspector. The care plans detailed the health, personal and social care needs of the service users and how these needs were to be met. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 12 There was clear evidence of service users input in the development of the care plan and those service users asked confirmed they met on a regular basis with their keyworker and that they had contributed to the care plan. It was commendable to view clearly stated aims and objectives on each section of the care plan. Staff members just need to ensure these aims are the focus when working with the service users. Samples of daily records were seen and overall these outlined the mood, behaviour and activities relating to the service user. Staff spoken with stated that service users are encouraged to make decisions about their lives and these decisions are acknowledged and respected. Service users attend a community meeting every morning where discussions take place regarding what the service users are doing for the day ahead. In addition monthly meetings also take place where both staff and service users can put forward items for the agenda and discuss any concerns or comments they wish to make regarding the home. Where possible service users manage their own finances. The Inspector viewed a sample of risk assessments. These were up to date and detailed the history of risks along with any current identified risks. Service users had also been involved in the completion of these risk assessments. One service user had potential weapons recently found in their bedroom. Room checks are now carried out on a regular basis and are recorded when they have been completed. A risk assessment was seen relating to this potential risk to both the service user and towards others. The home obtains a history of the service users prior to their admission into the home and this is taken into account when developing the risk assessments. A senior member of staff informed the Inspector that both care plans and risk assessments are reviewed every three months or more frequently when there has been a change in needs. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 13 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 & 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There continues to be some service users unwilling or unable to engage in activities or rehabilitation. Staff need to consider how to motivate and encourage these service users. Overall most of the service users go out into the community and access local resources. Family contact is encouraged by the home thus supporting service users to maintain social relationships. Service users rights are acknowledged and recognised by the members of staff. The home strives to offer a well balanced diet for all the service users. Records of the meals eaten have improved. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 14 EVIDENCE: The home continues to struggle with some service users who feel unable or are not interested in taking part in daily activities whether this be in the home or out in the community. Those service users asked stated they keep busy through various ways, from cooking, maintaining their personal laundry and by going out to take part in voluntary work. However the Inspector was aware that for a few service users they are reluctant or unable to undertake activities asked of them. Those members of staff asked stated wherever possible they make attempts to motivate service users, but that for some service users this is an ongoing difficulty. The Inspector discussed this issue with all the senior members of staff and the Area Manager and acknowledged that for some service users activities might be very small and last for short periods of time. However for those service users not gaining skills or independence then their placements should be reviewed. The Inspector re-stated the previous requirement relating to providing evidence of the activities offered to all service users. Where possible service users are encouraged to go out into the community and where necessary are supported to do so by members of staff. Various places are accessed such as the local supermarket, church and drop-in centre. Some service users are keen to attend College or look for voluntary work and this is encouraged by the members of staff. The Area Manager informed the Inspector that in the near future once staff vacancies have been filled, the aim is for the home to have a member of staff working on a day/mid-shift in order to offer activities and one to one time with those service users in particular who find it difficult to do much with their time. This was seen as a positive step taken by the home in order to meet the diverse needs of the service users. The Inspector was informed that family and friends contact is encouraged. Visiting times are flexible, within reason. Service users can choose where they meet with visitors, either in their rooms or in the communal areas. As outlined earlier in the report, service users are included in some of the decisions made in the house and they are kept informed regarding changes or information they would need to know through the daily meetings. Service users confirmed that they have a key to their bedrooms and can lock their rooms if they so wish. A member of staff told the Inspector that service users receive their personal mail. Service users can and do spend time alone in their bedrooms, but members of staff monitor those service users spending too much time in their bedrooms. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 15 Staff were seen to interact with service users throughout the inspection and the Area Manager stated that the issue with staff spending too much time in the office is no longer a problem, as they are now engaging with the service users on a more regular basis. Rules on drugs, alcohol and smoking are made clear to service users. The Inspector viewed the kitchen and noted that the colour coded chopping boards were very worn and scratched. The home were seen to address this shortfall by ordering new chopping boards whilst the Inspector was there and these would be delivered the following week. The Inspector was satisfied that this had been addressed and a requirement was not issued on this occasion. Overall the kitchen was clean and tidy, fresh produce was seen and used in meals wherever possible. Each week there is a meeting held for service users to decide on what day they will cook a meal or wash dishes. Menus viewed reflected choices whilst balancing this with a varied diet. Service users told the Inspector that they manage cooking for the whole home and only ask staff for support where needed. The recording of meals is difficult for breakfast and lunch as the service users get up at different times of the day and eat at different times of the day. There had been an improvement in the recording of the main evening meals and any alternatives prepared. The Inspector also viewed a form used to monitor all meals and activities relating to a service user who has health/physical problems. The members of staff aim to record all meals but informed the Inspector this can be difficult as the family often visit and bring food or the service user hoards food in their bedroom. The Inspector was informed that this service user refuses to see a Dietician. The Inspector discussed with staff the various ways for them to consider addressing this ongoing issue, such as room checks for food. The members of staff are aware of this needing continuous monitoring in order to minimise the risk to the service user. Fridge and freezer temperatures had been taken on a daily basis and were within an appropriate range. Food that had been opened was dated. Service users can choose where to eat, although for the main evening meal it is preferred for service users to sit and eat together in the dining room. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 16 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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive prompts and reminders regarding their personal care as and when necessary. The health and emotional needs of the service users are clearly recorded and are met. Robust medication systems were in place to safeguard the service users. EVIDENCE: Service users can carry out personal care tasks independent of staff. However in some cases, members of staff need to prompt or remind service users to wash or change their clothes. Times for getting up and going to bed are flexible and service users choose their own clothes to wear. Keyworkers are assigned to service users and the aim once the new senior member of staff is in post, that only seniors will be the main key worker to each service user, with social care workers being the co-keyworker to assist the seniors and service users where necessary. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 17 Health needs are clearly identified on individual care plans. Service users have access to all the regular health professionals, such as GP’s, Dentists and Psychiatrists. Some service users choose to attend appointments alone, whilst others need support from a member of staff. The Inspector viewed a form used to record when medical appointments have taken place along with any outcome from the appointment. Members of staff record when service users have refused to attend an appointment and seek to follow up appointments to ensure health needs are met. The home has a designated senior carer who is responsible for overseeing the medication records, ordering and disposal of medication. Since the last inspection a new staff reminder checklist has been put in place to ensure that there have been no errors in the administration of medication and that the records have been signed. This was seen as good practice and there was evidence of staff completing these forms on a daily basis. The Medication Administration Records were checked by the Inspector and found to be completed for that day’s medication. Three service users self medicate fully and one person has just completed stage 2 of the self-medication process. There was a record of the stages that he had gone through and his care plan reflected his wish to self medicate. There was a record of the medication that the self-medicating service users were on and a record of their receipt of their medication. The Inspector was informed that staff assist the service users to fill their dosset boxes as part of the preparation to fully self medicate. The staff informed the Inspector that the service users keep their medication in a locked cabinet in their rooms, which are spot-checked by staff every two months. The home uses the Boots monitored dosage system for those service users who are on regular medication. For those whose medication is under regular review the home administers from the original packaging. The medication cabinet was seen to be well organised. There was record of the Boots pharmacist’s quarterly visits. There was evidence that the home had complied with the last recommendation made by the pharmacist – to record the date of opening of liquid medication on the bottles. There were detailed records of receipt and disposal of medication. Boots collect repeat prescriptions and deliver the medication to the home. Four people have regular depot injections, which are recorded and carried out by the community psychiatric nurse. There was a record of all staff signatures for those who are authorised to administer medication. Currently five staff are authorised. The Inspector was informed that four staff had recently attended medication training with the Brentford, Isleworth and Chiswick Community Mental Health Team. The organisation also includes medication training within its induction training. One new member of staff was due to have her induction shortly. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 18 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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users views are listened to and acknowledged. Procedures are in place to record complaints. Systems are in place to protect the service users. EVIDENCE: The Inspector viewed the complaints book that is freely available in the main entrance hall. No complaints had been recorded. In addition there is a separate file to record complaints and outcomes of complaints, in particular when they are confidential. The CSCI had not directly received any complaints. Those service users asked stated they would speak to a member of staff, or usually the Area Manager if they had a comment or complaint. One service user gave an example of a maintenance problem that had taken a week to be fixed. This was brought to the attention of the seniors who explained that the problem had been fixed the following day. Another service user told the Inspector that they did not receive enough money when going out for lunch. Staff explained to the Inspector that an allowance is given to those service users choosing to go out during the week, usually to College, the drop in centre or voluntary job. Service users can make lunch to take with them, but they usually prefer to purchase something out in the community. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 19 Finally one service users informed the Inspector that they like a shower in the evening and that the water is not hot enough, even though a new boiler has been fitted. This was fedback to the seniors who confirmed they would check the water temperature when the service user is due to have a shower and will resolve the issue if a problem is identified. There had been one Protection of Vulnerable Adults (POVA) incident a few months ago, where the home was concerned about a service user who was possibly being financially abused by their family. This was reported to the Local Authority’s Safeguarding Adults co-ordinator and the service user’s money is now held in Court of Protection. There was no written evidence of the POVA concern and who was contacted along with any outcomes/conclusions and therefore the Inspector made a strong recommendation for the home to devise a system to clearly record any POVA allegation/concern. The Inspector acknowledged that it was clearly recorded in the service users care plan regarding their financial arrangements. The home has copies of the Local Authority’s POVA policies and procedures and a copy of the Department of Health No Secrets document and the Inspector viewed these. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 20 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, 25 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home continues to have maintenance areas requiring attention. These areas need to be addressed in order to provide a safe, homely and welcoming place for the service users to live in. Overall the home was free from offensive odours and the general standard of cleanliness was satisfactory. EVIDENCE: The Inspector toured the premises and was able to see a couple of service users rooms and a vacant room. There were a number of requirements relating to the premises from the last inspection in May and additional visit in July 2006.These were reviewed during this inspection. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 21 Carpets were being laid in the home during the inspection in the hall and up in the semi independent flat. The Inspector was informed that a number of service users rooms would be having new carpets and furniture and be redecorated. The home had been required to provide an action plan detailing when work would be carried out on the areas identified at the last inspections. The Inspectors had been informed verbally of the plans to replace/ refurbish but no plan had been provided. This is outstanding and is a repeat requirement from this inspection. The new senior carer informed the Inspector that he was recording all the identified repairs, replacement furniture needed etc in a maintenance book. It was recommended that the book should include information on when the fault/ repair was reported and to whom, in order for him to ensure that the work had been carried out in a timely fashion. It should also be used when the staff carry out their regular health and safety checks of the home and inspection of residents rooms. Residents should be encouraged to report any repairs or replacements needed in their rooms in their community meetings. The tour of the premises identified a number of areas that must be refurbished to provide a quality environment for the service users: Ground floor flat: presently unoccupied but the window frames need to be repaired and cleaned/ repainted, net curtains and curtains replaced, the bedroom needs to be redecorated, a light shade provided and the light fitting in the vestibule between the kitchen and hallway must be replaced. The kitchen items in the hallway must be disposed of or returned to the service user. The kitchen cupboard doors in the second floor flat must be repaired: the wall and under sink doors are not closing properly. The windows in the second floor flat lounge did not have restrictors on them. A decision was taken the next day to lock this room, as suitable restrictors were not available easily. The service users do not use this room at present, preferring to use the lounge downstairs. There were unwanted items of furniture, old suitcases, curtains etc behind the fire door leading to the attic area. This presents as a potential fire hazard and must be removed. Room 9: At the time of the inspection the service user stated that he wanted a new bed as his was in very poor condition. This was carried out during the inspection. It is strongly recommended that all the beds be inspected to ensure they are to a good standard. The bedroom is in need of redecoration and the carpet must be replaced. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 22 The recently vacated room on the first floor must be redecorated and refurbished to a good standard prior to a new service user moving in. It was noted that a number of window frames within the house were in need repair and repainting i.e. first floor toilet had flaking paint and holes in the wood. These must be repaired and repainted to prevent further deterioration. The ground floor bathroom has now had the flooring replaced and the windows repaired. The staff toilet on the ground floor did not have a working light in the vestibule, instead a light shone permanently from the open ceiling from the floor above. The vestibule toilet light must be put into working order. Previous inspections had highlighted the need for there to be temperature controls on service users sinks and baths. A new boiler has been installed and the Inspectors were informed that this now controls the water temperatures to these areas. There is evidence from this inspection that efforts are being made to improve the standard of accommodation provided to the service users, which is positive. This must continue to ensure that they live in a quality environment. The Inspectors were informed that the cleaner’s hours had been increased to three hours a day. The cleaner works Monday to Friday. The staff informed the inspector that the service users and staff clean the house at weekends. The house was odour free during the inspection however some of the unused rooms did have an odour, and would benefit from a deep clean prior to any one moving in. There is small laundry room, which is used by the service users. The Inspector was informed that the service users decide who is doing their washing at the morning community meetings, staff check to ensure that each person has the opportunity to do their washing each week. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 23 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, 33, 34, 35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by a competent and diverse staff team that aim to meet the needs of the service users. Recruitment procedures are robust and protect the welfare and safety of the service users. The shortfalls in the identification of the training needs within the staff team need to be addressed to ensure service users are supported by staff who have the knowledge and skills to care for them. Staff need to receive one to one time and support with their line managers, along with annual appraisals, to ensure staff receive the advice and guidance they might require to enable them to carry out their roles and responsibilities effectively. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 24 EVIDENCE: The Inspector was informed that the staff team comprises of a mixture of gender, cultural background and experience. Discussions took place with the Area Manager regarding ensuring that members of staff are enrolled to study for an NVQ or equivalent. One of the senior’s has completed NVQ3 and one is in the process of completion. The Area Manager had been informed that the company used by the Registered Provider to provide NVQ training only enrols members of staff onto it once a year. The Area Manager acknowledged that this was not acceptable and whilst the inspection took place it was confirmed that in early 2007 the two newest members of staff, along with another support care worker would begin to study for this relevant qualification. The Inspector viewed the rota. Where possible the home is avoiding using agency members of staff. A stated earlier, it has been recognised that the service users would benefit from additional members of staff to offer them one to one and to encourage those who do not engage in activities. Therefore once there is a full and permanent staff team, then there will be a mid-shift worker to ensure service users diverse needs are addressed. It is acknowledged that the home has had an increase in the turnover of staff. This has been for various reasons that the Area Manager is seeking to address. Once the staff team is established and posts are filled there will be team-building days to ensure all members of staff are working towards the same aims and objectives. The Inspector discussed with the seniors the benefits of having a seniors meeting so that they are clear about who is responsible for the different areas in the home that need attention. This will be considered and implemented if deemed beneficial to the home. The file for the newest staff member was viewed. All the appropriate checks were in place. The inspector was informed that the newest member of staff did not have a “Together” CRB check as her previous one was less than 3 months old. They had been advised by the CRB that a further check wasn’t necessary at the time. The provider is strongly recommended to apply for a new CRB for this member of staff under the organisation’s umbrella. An in house induction checklist was in place. The staff member informed the Inspector that she was due to attend the organisation’s corporate induction in January 2007. There was a record of one supervision session for this person (July 2006). The CSCI recruitment checklist was in the file but had not been completed. It is recommended that this or some other form of recording that CRB checks/ certificates/ references had been received, be used. The Inspectors were informed that following recent recruitment one permanent and two relief staff had been appointed, two of who were male. The deputy’s post has also been advertised. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 25 Copies of training / qualification certificates for all staff were in the training folder. The senior member of staff stated that she was in the process of meeting with staff to discuss their training needs, she has met with two staff so far and hopes to complete a training profile for the home which can then be linked with the organisation’s training plan for the next year. The Inspector was informed about recent medication training, and that risk assessment training was planned for the end of November for all staff. It had been identified that the newest staff member needed updated POVA training. The Inspector advised the senior to contact Hounslow Social Services Adult Protection coordinators for information on training available for staff. “Together” has a learning and development programme for 2006-07 based on Skills for Care modules. The Registered Provider must ensure that the training needs assessments are completed and that a clear training programme for each staff member is in place for 2007-08 The Inspectors were aware that, due to recent events within the home, staff had not been regularly supervised nor had they had annual appraisals. The process of identifying individual training needs will contribute to appraising staff. The management team must ensure that staff receive regular supervision and to carry out annual appraisals. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 26 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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The absence of a full-time Manager needs to be addressed to ensure the home is well managed and that service users and staff are supported appropriately. A quality assurance summary needs to be developed for service users, thus informing them of the work the home has been doing to improve the standards of the home. The shortfalls in the health and safety records need to be worked on to maintain a safe place for those living, working and visiting the home. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager has been on special leave for the past three months. Management arrangements have been that for the majority of the time, the Area Manager had been spending time in the home. In addition every Friday a Manager from another service has been visiting the home to offer extra support. There had been, for a short while, a Manager Designate, via an external agency, however this person had to leave the home and therefore the above arrangements have been the main source of support to both service users and members of staff. The Area Manager and Director, whilst the Registered Manager is absent from the home, are keen to have a Manager Designate in place and it was acknowledged by the Inspector that attempts have been made to identify a suitable candidate for the position, however so far this has proved to be difficult. A requirement was made for the home to have a full-time Manager Designate to ensure the home is being managed on a day-to-day basis by someone who can give their full attention to the needs of the home. The person appointed must be registered. Discussions took place with the Area Manager regarding providing a summary of all the reviews that have taken place over the year along with results of the questionnaires completed by service users, their representatives etc. A summary can then ensure service users have access to information about where the home has made improvements and what the future objectives are to continue to improve the standard of care offered to them. So far, although quality assurance systems are in place, such as monthly Regulation 26 visits, where reports are now forwarded on to the CSCI, and quarterly Health and Safety reports are completed, a summary has not yet been devised. Prior to the inspection the Inspector had liaised with the Director with regards to the need to provide this information in a service user-friendly format and it had been acknowledged that this could be implemented, however so far this requirement has not been met and is consequently re-stated in this inspection. The Area Manager and the Inspector also discussed the summary and it is hoped that a format will be developed and will be available for inspection and for service users at the next inspection. All certificates relating to the service for all equipment and appliances used in the home were made available for inspection. These were noted to be up to date and with no outstanding work required. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 28 There were weekly call bell tests recorded. These were being carried out with service users each week. The Fire Brigade last visited the home in May 2006. There had been a number of recommendations from their visit, which the Area Manager acknowledged had not been addressed. The Area Manager must ensure that all the Fire Brigades recommendations from the May 2006 visit are met. A fire drill had last been carried out on 9/11/06. There was a record of attendance as well as comments regarding those service users who did not respond. Drills are being carried out two monthly, as the service users are heavy smokers. It was recommended that the home start to have a drill at night at least once a year to ensure that both staff and service users respond during the hours of darkness. An updated fire risk assessment was provided subsequent to the inspection. The COSHH cupboard was securely locked. The Inspector was informed that the service users use cleaning materials under supervision. The COSHH data folder was viewed. The senior stated that they were to have a new supplier of cleaning materials and would be getting rid of the old stock and starting afresh. The Inspector recommended that a list of the first aid remedies when using cleaning materials be placed where service users and staff could see them i.e. kitchens and bathrooms. Training records indicated that staff have had health and safety, fire safety, infection control and food hygiene training. The corporate staff induction includes the Skills for Care health and safety training. As outlined earlier in the report, the senior is in the process of updating staff training needs and arranging for refresher courses as necessary. Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 29 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 3 2 2 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 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 3 x 2 x 2 x x 2 x Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 30 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. Standard YA2 Regulation 14 Requirement Pre-admission assessments on prospective service users must be completed and available for inspection. Evidence must be available regarding the activities and rehabilitation offered for the service users. There must be an increase in activities for those service users currently with no daily structured programme. (Previous timescale 31/08/06 not met). Timescale for action 14/11/06 2. YA12 16(m)(n) 31/12/06 Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 31 3. YA24 23(2)(b)(d) The Registered Provider 31/12/06 must provide an action plan detailing the work required from this and previous inspections and when this is proposed to be completed. (See requirements below for details) A copy of this plan must accompany the response to the draft report. (Previous timescales of 31/03/06 and 31/7/06 not met). The kitchen cupboard doors in the second floor flat must be repaired: the wall under the sink doors are not closing properly. The unwanted items of furniture, old suitcases, curtains etc behind the fire door leading to the attic area must be removed The window frames within the house must be repaired and repainted i.e. first floor toilet had flaking paint and holes in the wood. The staff toilet light in the vestibule must be put into working order. The Registered Provider must ensure that it continues to make improvements to the environment through regular checks and a planned rolling programme of redecoration and refurbishment 31/12/06 4. YA24 23(2)(b) 5. YA24 23(4)(a) 31/12/06 6. YA24 23(2)(b) 31/12/06 7. YA24 23(2)(b) 31/12/06 8. YA24 23(2) 31/12/06 Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 32 9. YA25 23(2)(b)(d) Ground floor flat: the 31/12/06 window frames must be repaired and cleaned/ repainted, net curtains and curtains replaced, the bedroom to be redecorated, a light shade provided and the light fitting in the vestibule between the kitchen and hallway must be replaced. The kitchen items in the hallway must be disposed of or returned to the service user. Bedroom 9:The bedroom is must be redecorated and the carpet must be replaced. The recently vacated room on the first floor must be redecorated and refurbished to a good standard prior to a new service user moving in. The Registered Provider must ensure that the training needs assessments are completed and that a clear training programme for each staff member is in place for 2007-08 The management team must ensure that staff receive regular supervision and carry out annual appraisals The Registered Provider must ensure there is a designate person/Manager appointed to manage the day-to-day running of the home. The person appointed must be DS0000022889.V315255.R01.S.doc 10. YA25 23(2)(b)(d) 31/12/06 11. YA25 23(2)(b)(d) 31/12/06 12. YA35 18(1)(c) 31/01/07 13. YA36 18(2) 31/12/06 14. YA37 8 08/01/07 Garthowen Version 5.2 Page 33 registered 15. YA39 24(2) An overall summary/report regarding the quality assurance and monitoring systems that are in place must be devised and implemented and be available for inspection and for service users and/or their representatives. (Previous timescale of 02/10/06 not met). 30/03/07 16. YA42 23(4)(a-c) The Area Manager must ensure that all the Fire Brigades recommendations from the May 2006 visit are met. 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations Residents should be encouraged to report any repairs or replacements needed in their rooms in their community meetings. It is strongly recommended for the home to implement a system for recording and storing information regarding any Adult Protection issues, allegations and/or investigations. It is strongly recommended that all the beds be inspected on a regular basis to ensure they are to a good standard. It is strongly recommended that vacant bedrooms have a deep clean prior to new service users moving in. It is recommended that a format for recording that CRB checks/ certificates/ references had been received, be used. DS0000022889.V315255.R01.S.doc Version 5.2 Page 34 2. 2. 3. YA23 YA25 YA30 5. YA34 Garthowen 6. YA34 The provider is strongly recommended to apply for a new CRB for the newest member of staff under the organisation’s umbrella. It was recommended that the home start to have a drill at night at least once a year to ensure that both staff and service users respond during the hours of darkness. It is recommended that a list of the first aid remedies when using cleaning materials be placed where service users and staff could see them i.e. kitchens and bathrooms. 7. 8. YA42 YA42 Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection West London Area 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 Garthowen DS0000022889.V315255.R01.S.doc Version 5.2 Page 36 - 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. 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