Inspection on 30/01/06 for Glasson House

This inspection was carried out on 30th January 2006.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Glasson House 05/09/06

Glasson House 16/05/05

Glasson House 08/12/04

Glasson House 13/05/04

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

CARE HOME ADULTS 18-65 Glasson House 93 Belmont Avenue Cockfosters Barnet Hertfordshire EN4 9JS Lead Inspector Rebecca Bauers Unannounced Inspection 30th January 2006 12:00 Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Glasson House Address 93 Belmont Avenue Cockfosters Barnet Hertfordshire EN4 9JS 020 8449 7808 020 8364 9257 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) De Bohun Care Limited Patricia Shanahan Care Home 5 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (5) of places Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th May 2005 Brief Description of the Service: Glasson House is a care home providing personal care and accommodation for five adults with mental disorders, excluding learning disabilities or dementia. De Bohun Care Ltd, which has another service nearby for people with mental health problems, runs the home. The home is set in a quiet residential road and benefits from good shopping and transport facilities, which are only about seven to ten minutes, walk away. Each service user has a single bedroom, which meets the required minimum standard of bedroom size. The home provides three bathrooms with toilets and a separate toilet on the first floor. The kitchen and the dining room are on the ground floor. The staff support the service users with their medication, personal care, social and recreational activities, and with cooking. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on the 30th of January 2006 and took lasted six hours to complete. The inspector able to speak to three service users and four staff both independently and as a group. The registered manager was present for most of the inspection and was open and helpful throughout the inspection. The feedback from service users was positive regarding the management and staff at the home. A full tour of the premises took place. Care records, personnel records and health and safety records were examined. Further information was obtained through observations of staff and service users interaction. What the service does well: Service users benefit from knowing that their needs assessment is detailed to ensure that staff understand their needs and are able to support them in the way they prefer. Comprehensive individual plans ensure that individual aspirations are acknowledged and that consistent support is provided by staff to achieve these goals. Service users benefit from knowing that they are supported to take risks as part of promoting and developing an independent lifestyle. A range of activities are accessed to promote personal development and service users are actively involved in the running of the home. Staff are well trained and service users can and do feel confident that they have a stable competent staff team to support them. Service users benefit from living in a very comfortable spacious living environment. Service users and staff benefit from having a competent, well organised manager who understands their needs and provides an empowering environment that facilitates development personally and within the service provided. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Excellent detailed assessments are undertaken prior to placement in the home. Service users are given ample time to test drive the home prior to deciding if they wish to move in. Service users can feel confident that their needs are understood and can be met by well informed staff that know how to support them. The home is not currently operating within its conditions of registration in the case of one service user who is over 65 years of age. EVIDENCE: There has been one new admission since the last inspection. The assessment process was detailed and took almost five months to complete incorporating two visits at the service users previous address and six full day visits to the home including overnight stays. The service user can feel confident that the staff understand and are able to meet his needs. Staff have detailed information about the individuals past history and current needs to ensure a holistic approach to the support provided. One service user has now reached the age of 65 . This means that the current registration category does not reflect the age of the service user and it also means that the home is operating outside of its category of registration. A minor variation to the conditions of registration must be applied for via the Commission. This application must include a report from the placing authority stating if the home is still appropriate and able to meet the needs of the service user. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8,9,10 Good individual plans are in place for each service user that reflect their changing needs and goals. Service users are supported to take appropriate risks. Service users confidences are kept and information about them is stored appropriately. Service users are regularly consulted with regard to the running of the home and participate in all activities within the home. EVIDENCE: Four individual plans were seen. All were comprehensive and had been developed from the initial assessments of need. The individual’s mental health diagnosis and support needs were excellent giving detailed information to staff with regard to early signs of relapse and actions to be taken in the event of the service user being unwell. The individual care plans set out clear goals for each individual how to staff need to support them to achieve these and whether or not they were achieved. Four out of five individual plans included a recent photograph of the service user. All must have photographs on their files. Service users spoken to were aware of their individual plans and had been involved in the development of them; those that were able had signed and agreed the plans. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 10 During the observed staff handover staff discussed each individuals progress with goals for that day as per their individual plan. Appropriate risk assessments were in place for service user as part of supporting an independent lifestyle. There was evidence that all service users had enhanced CPA reviews within the last year and individual plans are reviewed at least on a six monthly basis. Service users confidential information is stored appropriately and staff have a good awareness of the issues of confidentiality. Service users have monthly minuted meetings to discuss issues/practice within the home and more recently, the support that they could offer to the new person that has just moved into the home. Service users spoken to discussed their participation in the daily running of the home such as shopping and cooking for each other. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,15,16,17 Service users continue to be actively encouraged and supported to take part in appropriate activities within and outside the home to promote personal development. Contact with family is promoted and service users who wish to have regular independent contact with family and friends are supported to do this. Service users rights are recognised and respected although in one case the documentation to suggest this is not in place. Service users feel that they are supported to cook healthy balanced meals. EVIDENCE: A requirement made at the last inspection for the food actually eaten by service users to be recorded had been fully progressed. Individual meals eaten are now being recorded fully and provide adequate information to indicate that service users are receiving balanced healthy meals. Service users spoken to state that they enjoy cooking for each other during the week and that they all help on a rota basis with the clearing up. Service users spoken to confirmed that they continue to access the community both independently, in small groups and through attendance at a daycentre. Records of activities within the home had been recorded to demonstrate that service users are encouraged to interact with others and to improve their social Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 12 skills, for example art, bingo and music sessions. Each service user has a freedom pass to use public transport and some use dial-a-ride. Service users confirmed that they see family and friends when they wish. Issues with regard to sexuality and culture are addressed in detail during the initial assessments. Appropriate risk assessments were in place for independent travel within the local community and each service user had a good clear missing persons procedure specific to them on their own files to ensure that all staff are familiar with the timescales for action in the event that someone goes missing. It was noted that restrictive practices were being carried out with regard to locking the kitchen and fridge/freezer at night. This is practiced for the wellbeing of service users and to prevent the risk of fire at night. However there was not a risk assessment in place to address these risks specifically with regard to the restrictions. This must be developed to demonstrate the risks and need for the restrictions. Service users do have access to drinks throughout the night however. Staff spoken to expressed the importance of having fun and laughter to create a relaxed atmosphere for service users. Good communication was also sighted as an essential part of support provided to service users, to ensure open, consistent working. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 Service users do receive good personal support in a way that promotes dignity. Service users receive good health care support to ensure that all health and emotional needs are met. EVIDENCE: Staff spoken to had a good understanding of the individual needs of service users and were knowledgeable with regard to promoting dignity and respecting service users wishes when providing support with personal care whether verbal prompts or actual physical support in one case. Any support required had been documented in the support plans. Service users spoken to stated ‘ the staff are very caring, they are like our friends’. There was evidence that service users receive regular input from health professionals including CPN’s, dentists, GP’s, psychiatrists, chiropodists and their own social workers. All service users have a key worker. The CPN makes monthly visits to the home. The individual health records were good with detailed information about the outcomes of appointments and any follow up action to support the service user. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Service users do feel that their views are listened to and acted upon. Service users are protected by well trained staff that are confident in the identification and reporting of potential adult protection issues. EVIDENCE: No complaints have been made or recorded since the last inspection. Service users that the inspector spoke with said they had no complaints about the home and knew what to do if they had any. ‘ I like living here, it’s like one big family’. Evidence was seen in the minutes of the service users meetings that any minor issues are listened to, discussed and acted upon. A requirement made at the last inspection for staff to undertake adult protection awareness training to develop their confidence in the reporting of any allegations of abuse had been fully progressed. Staff spoken to were confident with regard to the reporting protocols in the event of an allegation being made. In addition, staff had also through their NVQ level 2 in care training gained an understanding and awareness of the different types of abuse that vulnerable adults could be potentially at risk from. Staff were familiar with the homes whistle blowing policy. The home carry out a quality assurance audit every year to obtain information about the service being provided in the home and received by service users Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,28,30 The home is comfortable, clean and a safe environment for service users to live in. There is adequate communal space and one of the bathrooms has been adapted to suit the needs of the service users. Adequate risk assessments are in place where risks have been identified. EVIDENCE: The home is comfortable and safe. All the rooms are large and spacious and meet the required minimum standards. The home has a smoking policy, and bedrooms, the kitchen and the dining room are currently non-smoking areas. In reality some service users do smoke in their rooms and appropriate risk assessments were seen. The premises were bright, airy, clean and free from offensive odours on the day of the inspection. The downstairs shower room has recently been refurbished into a walk in shower room to benefit service users and to reduce potential risks, particularly for one service user whose sight is poor. New sofas have been purchased for the lounge. Service users bedrooms were spacious and personalised. Service users stated that they were responsible for ensuring their room were kept clean with staff support. Staff spoken to stated that maintenance issues are addressed quickly. Records are maintained of all repairs at the home. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35,36 Service users are supported by a well trained competent staff team although some refresher training is needed. Service users are protected by the homes recruitment procedures. Staff are very well supported although this is not always demonstrated in the records of supervision. Staff morale is good and creates a warm friendly environment for service users. EVIDENCE: The service users are protected by the homes recruitment policies and procedures all relevant documentation was in place, which included up-to-date CRB certificates and two references. However two of the three staff files examined had expired working visa information on file. The registered provider must obtain up-to-date information from the staff members to demonstrate that the staff have leave to remain in the UK and continue to work. This information must be held on file. The staff training records contained certificates of training attended by staff, which includes all statutory training although some refresher training was needed in some areas. A requirement is made in the relevant section of the report. Most staff have now either completed NVQ level 2 in care or are currently doing the course. Some staff are undertaking NVQ level 3. Several of the staff had also completed three day course in relapse prevention and other mental health related training to ensure that the needs of service users can be understood and met. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 17 Supervision records seen were excellent in respect of the detail, follow up and monitoring of the individual member of staff. However the records did not indicate that this occurred every two months. However, through discussion with staff and the registered manager it was evident that staff do meet almost weekly with the registered manager both as a group and on an individual basis. These sessions must be recorded to demonstrate the actual time and energy that is spent supporting staff to improve practices in the home and to develop them individually to meet the needs of service users in a consistent manner. Staff spoken to explained that staff morale was good and that issues are discussed openly and freely. The term ‘ learn form experience’ was used. It would appear that the culture of the home is about promoting and supporting good practice through ownership for both staff and service users alike. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Service users benefit from living in a well run home and an open management style. The health, safety and welfare of service users and staff are protected. EVIDENCE: A requirement made at the last inspection for the acting manager to become registered with the Commission had been fully progressed. The registration certificate provided evidence of this. The newly registered manager has worked with the organisation for twenty years. The management approach is open and organised. Emphasis is placed upon ownership and empowerment of service users. Staff were very positive with regard to the support and guidance they receive from the registered manager. It was evident through observation that service users have a good relationship with the manager and staff which is conducive to a relaxed living environment. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 19 A requirement made at the last inspection for the actions agreed in service users meeting to be clearly identified had been fully progressed and had been noted in the subsequent meeting minutes seen. A requirement made for smoke detectors to be checked on a more regular basis as service users are known to smoke in their rooms had been fully progressed and records had been kept. All relevant health and safety checks are being carried out to protect the health safety and welfare of service users and staff. Two requirements made at the last inspection relating to health and safety concerning the water temperatures in wash hand basins are thermostatically controlled and that radiator in the kitchen area must be fitted with guards had been fully progressed. Records of water temperatures were seen and were satisfactory. The radiator is now thermostatically controlled to ensure a low surface temperature to ensure the safety of service users. Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 4 3 4 x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X X 3 X 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 X 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 2 2 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Glasson House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 3 X X X 3 x DS0000010444.V270009.R01.S.doc Version 5.0 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 YA1 Regulation 4(3)(b) Requirement The registered person must apply to the Commission for a minor variation to enable a service user who is over 65yrs of age to remain living in the home if it is still appropriate. The registered person must ensure that every service user has a recent photo on their individual plan. The registered person must ensure that risk assessments are in place for the restrictions in place for all service users with regard to access to the fridge and access to the kitchen at night. The reasons for the restriction must be clearly stipulated in the risk assessment. The registered person must ensure that those staff who have a working visa have up-to date information on file stating that they are able to continue to work in the UK or that they have leave to remain in the UK. The registered person must ensure that all staff have refresher training in health and DS0000010444.V270009.R01.S.doc Timescale for action 31/03/06 2 YA6 17(1)(a) Sch 3 (2) 12(3) 13(4)(c) 01/04/06 3 YA16 01/04/06 4 YA34 19(1) 01/04/06 5 YA35 18(1)(c) (i) 01/05/06 Glasson House Version 5.0 Page 22 6 YA36 18(2) safety, food hygiene and manual handling and lifting. The registered person must ensure that all staff receive documented supervision at least six times a year. 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Glasson House DS0000010444.V270009.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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