Inspection on 22/03/07 for Greenford House

This inspection was carried out on 22nd March 2007.

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

Other inspections for this house

Greenford House 07/02/06

Greenford House 04/07/05

Greenford House 05/01/05

Greenford House 22/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Greenford House Monpekson Care Limited 38 Greenford Road Harrow Middlesex HA1 3QH Lead Inspector Clive Heidrich Unannounced Inspection 22nd March 2007 15:10 Greenford House DS0000017572.V327079.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 Greenford House DS0000017572.V327079.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. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenford House Address Monpekson Care Limited 38 Greenford Road Harrow Middlesex HA1 3QH 0208 864 0626 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) Ms Monica Pryme Mrs Pek Kio Entwistle Mrs Pek Kio Entwistle Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 LD Date of last inspection Brief Description of the Service: 38 Greenford Road is a private care home owned by Monpekson Care Ltd, a small, local care organization. The service at the home provides care and accommodation for up to three adults with learning disabilities. There was one vacancy at the time of the inspection. The home has been open since 1997. The house is semi-detached on two floors. It is situated on a busy main road close to local shops and transport. There are three single bedrooms and a bathroom on the first floor. There is a large lounge and dining room on the ground floor. There is a small rear garden with a lawn and patio. There is parking for two cars to the front of the building. The service user guide, and the range of fees charged by the service, are available from management on request. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place across two weekdays in late March. It lasted just under six hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspector spoke privately with both service users living at the home during the visit. Their feedback is included within the evidence of this report. The inspection process also involved observations of how staff provide support to service users, discussions with staff, checks of the environment, and the viewing of a number of records. The manager was present for most of the visit. She was provided with overall feedback at the end of the visit. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: Both service users were very positive in their overall feedback about the home. One service user noted in particular that the service at the home is friendly. Both service users pointed out individual ways in which the service at the home has helped with their particular needs, such as with providing grab-rails in the bathroom. Recorded evidence in the home, about independent views of the service, were also found to be positive. The service focuses well on developing service users’ skills, enabling independence, and encouraging service users to make responsible decisions about their lives. The service provides service users with support, where needed, to undertake appropriate community activities and uphold personal relationships. The service provides a good standard of enabling service users’ individual health needs to be addressed. Excellent support is provided to service users to enable them to personalise and own their bedrooms. The home itself is kept clean and suitably furnished. The service provides an experienced and consistent staff and management team in a manner that supports service users’ staffing needs. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 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 Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): None of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The judgement is made based on the evidence of the previous inspection, as there has been no-one moving into the home since then. EVIDENCE: The manager stated that there has been no-one assessed for placement at the home since the last inspection. As the procedures for moving into the home were assessed as suitable at the previous inspection, none of these standards were inspected on this occasion. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have adequate individual plans that are very focussed on their specific needs and goals. Improvements are needed with clearly involving the service users in their plans. The service appropriately enables service users to take risks as part of an independent lifestyle. Improvements are needed with documenting assessments for some specific hazards that service users present. The service provides good day-to-day standards of enabling service users to make decisions about their lives. EVIDENCE: Checks were made of the care plan files for both service users. Care plans were in place and up-to-date. These plans specifically explained what the current individual goals for each service user are, and how staff would provide support for this. There was evidence of the plans being reviewed regularly, Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 10 including with updates. There were additionally health action plans in place, to explain about the health support needs of the service user. This all shows that plans are suitably individual to each service user’s needs. Some shortfalls are identified with the care plans. There was no clear evidence of how the service user is involved in the plan, nor that the plan is made available in a format that assists the service user to understand it so that they can keep a copy. Doing this would enable the service users to be more aware of, and to negotiate, the support that they can expect from the service at the home, which in turn enables them greater empowerment. The manager must ensure that this is addressed, and is recommended to look into the PersonCentred Planning (PCP) approaches that are being encouraged by the Government White Paper ‘Valuing People’. There were a number of written risk assessments in place within each service user’s file. They were about relevant individual issues such as community safety. They were sufficiently up-to-date. The inspector pointed out to the manager that the assessments did not cover some other relevant areas, where individual risk factors were evident from the inspection evidence, such as for the falls that both service users have recently had. This could allow for further accidents or injuries to occur unnecessarily. The manager must ensure that this is addressed. There was however evidence that the service encourages service users to take reasonable risks in support of their independence. For instance, service users are assessed as capable of going out by themselves, with one service user now being encouraged to use nearby buses to get to college alone. One service user noted that they couldn’t manage to make tea for themselves without risk of scalding, but that equipment has since been acquired to enable their full independence. The risk management approach of the service is therefore seen as suitably enabling for service users. Minutes of recent individual service user’s review meetings were available. They involved the service user, their family members, management and keyworkers at the home, and day service representatives. The minutes showed that service users’ needs are met and that placements are agreed as suitable. Service users reported that they make decisions about their lives in this home. One service user noted that they choose to have a beard, another that they can have a cigarette when they want. Service users had the freedom of the home during the inspection. Records such as resident meeting minutes showed that residents are consulted for such things as holiday choices and community activities. The overall evidence shows that the service supports service users to make decisions about their lives. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have individual weekly community activities to attend, and use the local community with support where needed. The service provides them with support where needed to undertake leisure activities of their choice, including contacting and visiting family and friends. The service enables service users to develop skills and abilities. Their rights and choices are respected, including with meals and snacks in the home. Diets are suitably healthy. EVIDENCE: Care plan goals, for such things as independent bus use and leaving answerphone messages successfully, show that good individual support is provided to service users in respect of skills developments. Review meeting minutes included independent confirmation of progression with some skills. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 12 Feedback and records showed that service users have individually-planned weekly occupations that include day centre presence, college attendance, and time at home. Both service users expressed satisfaction with this set-up. One service user noted that they take the bus independently to college. Both noted that they go out to local shops alone. One service user discussed with the manager about ensuring a smooth trip to a weekend recreational club. Both service users confirmed that attendance at such clubs is fully supported by the services at the home. Service users confirmed that they are content with their lifestyles in the home. The home has cable-TV which one service user was using during the inspection. Both service users use local shops to buy reading materials such as newspapers and crossword books. Both service users said that they had been on holiday last year, one going twice. These were to Butlins holiday camps, which service users confirmed enjoyment of. Records showed that holidays for this year are being considered. Service users both spoke positively about family and friend involvement, including that they can have visitors into the home. One service user noted that they can make and receive phone calls. Feedback and records showed that one service user is taken out for meals and shopping with family members and with a friend, and that one service user visits their boyfriend regularly. Service users spoke positively about their rights and responsibilities around the home. Neither get much involved in cooking, for instance, but one service user takes responsibility for washing up after dinner. One service user explained about the times they like to get up and go to bed, including that staff respect this, and noted that they do their own ironing and room tidying. Observations of both bedrooms show that the service users take great pride in their rooms. Service users also confirmed that they have keys to their rooms and to the house. Both service users were complimentary about the food, saying that it is, for instance, ‘very nice.’ They confirmed that they get choices, snacks, and that there is enough to eat. One service user was clear as to what the meal for the day was, what they had yesterday, and that they have ‘fish and chips on Fridays.’ Checks of the kitchen found there to be a good supply of food available, including fresh fruit and vegetables, dairy products, bread and meat. Chicken was being marinated for the evening meal. Records are kept, as required, for the meals provided. These showed that a sufficiently varied range of food is supplied based around traditional meals. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18-20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides service users with a good standard of individualised personal support that enables independence. The service provides a good standard of enabling service users’ individual health needs to be addressed. There are good standards of medication procedures in the home, to support service users with any medications. However, improvements are needed with training and auditing. EVIDENCE: Observations, and discussions with service users and staff, indicated that staff are committed to a service that promotes privacy, respect and dignity to service users’ preferences in relation to their personal care. Daily living routines were flexible in the home. The service supports and encourages service users to carry out personal care tasks independently. Staff provide support as and when necessary. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 14 Bedrooms are all single rooms with suitable locks fitted to doors to help ensure privacy. One service user said that they lock their door when they leave the home and are able to keep their key. Service users confirmed that staff knock on doors before asking if they can come in. Both service users were well-presented in casual clothing from the start of the inspection. One service user noted that they had recently gone to have their beard trimmed. One service user showed the inspector that they have a good supply of clothes, and that they are happy with arrangements for their clothes to be washed. One service user kindly showed the inspector the variety of grab-rails set up in the home, especially the bathroom, to assist with them moving around independently. They can consequently manage the bath themselves. Health records within service users’ files showed that they attend routine health checks such as with the chiropodist and the dentist frequently. The records also showed that any health concerns are addressed, at the GP or at a hospital, and that any consequent appointments with specialists are followed up. Discussions with service users confirmed this. There was also evidence of medication reviews with GPs, and of preventative health screening, which is good practice. Each service user has a Health Action Plan in place. These provide broad information on the health needs of the service user, and the support needed including through health professionals, which is good practice. However, the plans dated from April 2005, and had generally not been signed as agreed by anyone, hence suggesting that their use has been minimal more recently. Management should ensure that the plans are brought up-to-date and are agreed by involved people. No service users look after their medications. One service user confirmed that support with medications is suitably provided. The service at the home provides for secure storage. A local pharmacist supplies pre-packed weekly dosette boxes on a monthly basis. Checks of the administration records found that these were up-to-date, and that this tallied with the boxes. The medication file also had records of the use of each medication that each service user takes, and of possible side-effects, which is good practice. There was similarly a detailed homely-remedies procedure that appropriately included for GP consultations within 24 hours. There was no concerns about excess stock, with records of medicines returned to the pharmacist being kept. There were no records of medicines coming into the home. The manager noted that she does a quick check at the pharmacists. The lack of records about quantities coming in however prevents there being any auditing of medicines, which can be very useful if any mistakes arise or Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 15 allegations of medication mismanagement occur. The manager must address this. Records showed that some staff received medication training from a pharmacist in 2005. Others had no recent evidence of such training. The manager noted that she would not allow anyone unsuitable to support service users with medication. Whilst the medication procedures are robust, the lack of recent training may disempower some staff from following appropriate and current practices, which could result in poor practices being followed in supporting service users with their medications. The manager must ensure that this is addressed for all staff who are involved in administering medication. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 16 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): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides procedures and a culture in which service users can raise complaints and have them looked into. The service has reasonable procedures in place to help minimise and address abuse scenarios. However, minor improvements are needed to ensure that new staff receive training in this area promptly. EVIDENCE: One service user stated that they would speak with the manager if they had a complaint, and that this would help resolve the issue. Both noted that they have no complaints. The complaints book had details of one complaint since the last inspection, from a service user about going out too much. Records showed that this was addressed. There have been no complaints to the CSCI since the last inspection. The home’s complaints procedure is judged as suitable. The service has an abuse-prevention policy in place that includes about informing management as soon as a concern comes to light, and that management will inform appropriate agencies such as the CSCI. The policy considers the safety of the service user, and includes consideration of staff suspension if staff are accused of abuse. The service does not have the updated guidance from Harrow council in respect of abuse prevention, which the manager was strongly recommended to acquire to ensure that the service’s policies work in line with. It was noted that there are also staff Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 17 guidelines, dated from 2006 and in booklet form for ease of use, about abuse prevention and whistleblowing. This is good practice. The majority of staff were found, from records, to have undertaken training in abuse-prevention in 2005. The induction process for new staff however fails to incorporate abuse-prevention as a learning area. To highlight the importance of recognising abusive behaviours, and to better ensure appropriate responses to possible abuse scenarios, it is required that training in this area included in the induction process. The finance records, of money held on behalf of each service user, were checked. These raised no concerns. Records are suitably detailed, and are backed by receipts. Service users generally sign for any money that they take, and one service user confirmed that they can take money when they want. Purchases match the profiles of the service users, and include for such larger expenditures as hairdressing and buying clothes. The home also looks after the bank-book for one service user. The manager explained that the service user has to go the bank to withdraw from their account. Bank withdrawals were suitably recorded about within the home’s finance books, showing that the money is used entirely by the service user. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 18 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): All of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The facilities and services at the home provide service users with good standards of homely accommodation. The home is kept clean, and adaptations are provided where identified as needed. Excellent support is provided to service users to enable them to personalise and own their bedrooms. EVIDENCE: The home was found to be clean, warm, comfortable and homely from the start of the inspection. It is pleasantly furnished and suitably decorated. It is reasonably spacious. Each service user has their own bedroom. There is a through lounge that includes a dining area. Part of it doubles as the staff sleep-over area during the night, which service users confirmed no difficulty with. There is a separate kitchen that service users were seen to use as they wished. There is a bathroom with both overhead shower and toilet upstairs, and a WC downstairs. There is also an enclosed garden area with patio and a Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 19 small amount of garden furniture. The garden was well-kept, with grass having been recently cut. The home also has an office and attached laundry area. It has a domestic washing machine and tumble drier, and has reasonable facilities to uphold infection control standards. Both service users kindly showed the inspector their rooms. Rooms are spacious, with suitable furnishings, and are colour-coordinated. The tidiness and use of the rooms suggest that service users take pride in the rooms. Both rooms have washbasins, and suitable storage facilities. One service user has a television fixed to the wall so that they can view it easily when in bed. One service user showed the inspector a handles-free chest of drawers that they had recently acquired, which they confirmed as easy to use and better for them. It is consequently judged that the service provides excellent support for service users to individualise their rooms to their choosing. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 20 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): 32-35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides an experienced and consistent staff team in a manner that supports service users’ staffing needs. The staff team have attended a variety of relevant training courses. However, updates are needed for emergency first aid training, and there is a lack of evidence in support of the team having any relevant NVQ training. The service has a reasonable recruitment policy that could be improved on in light of recent legislative changes. EVIDENCE: Service users fedback positively about the staff, one noting that it is a ‘nice, friendly home’. One service user noted that they do not see new faces amongst the staff, which is positive. Both confirmed that there are enough staff. The manager confirmed that the majority of staff have been working at the home for many years, and that there have been no new staff since the last inspection except for one emergency when cover was provided by a staff member employed at another of the company’s homes. The inspector also Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 21 observed an easy ambience between staff and service users, which was encouraging. Checks of the rosters found that there is currently one staff member present when either of the two service users are in the home. The manager is generally around during the day, including for support of any service users who do not go out. Staff provide sleep-in support. The manager confirmed that two staff are present if there is ever the need for service users to be supported to different appointment in the community. Service users reported no difficulties with getting staff support where needed, when going out. These staffing levels are therefore considered to be suitable. A check of the training log, and some staff members’ training certificates, established that staff are generally up-to-date in manual handling, fire safety, food hygiene, and infection control. Other courses are provided where needed, such as for some staff who undertook dementia training so as to better meet the needs of a previous service user. It was found however that most staff had had training in emergency first aid a number of years ago, and hence were in need of refresher training, to better ensure that they could respond appropriately to first aid scenarios, particularly as staff are currently usually working alone. The manager agreed to address this. The manager noted that some staff have NVQ qualifications in care. There was feedback to suggest that the company enables staff to pursue NVQs. There were however no records or certificates to evidence the NVQ qualifications of the staff team. The expectation within the National Minimum Standards is for a minimum of 50 of staff to have the qualification, to help ensure that the staff team are suitably knowledgeable in care practices. The manager must ensure that this minimum expectation is addressed, with copies of qualification certificates available as evidence. The service’s induction policy was viewed. It states that new staff work for a week as supernumerary, and includes much detail about the topics to be covered with management as induction training. It does not however refer to the National Training Organisation (‘Skills for Care’) and omits some key areas such as abuse awareness, which could leave new staff with knowledge gaps to service users’ detriment. The manager noted that she has recently attended update training on induction processes, and so will review and update the policy accordingly. As there have been no new staff members since the last inspection, individual recruitment records were not checked. Previous inspections found standards to be suitable in this respect. A viewing of the recruitment policy noted that Criminal Record Bureau (CRB) disclosures and written references are acquired before employment, and that an application form and interview process is followed. It is recommended, to evidence that updated processes will be followed, that the policy be updated to include reference to the Amendment Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 22 Regulations. For instance, that references include the last care employment of the prospective employee that lasted at least three months, and to establish the procedures that the service will follow in respect of the PoVA-First components of the CRB check. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 23 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 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service provides service users with a suitably-run home, and systems to help ensure quality, based on service users’ opinions and needs. There are suitable standards of health & safety in the home, to minimise risks of accidents to anyone using the home. EVIDENCE: The manager has been a co-director of the business since the service at this home first opened ten years ago. She noted that she remains a registered nurse and is a member of the Royal College of Nursing. She has had much experience of working with people who have learning disabilities including at long-stay hospitals. She has recently completed the NVQ level 4 award in care management. There was also positive feedback about management in the home. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 24 The home has a quality monitoring policy. It refers to, for instance, the use of the care-planning processes, service-user review meetings, staff training, residents’ meetings, and annual formal consultations with service users and their representatives about the running of the home. There were records of the last such audit, from March 2006, through completed questionnaires filled in by service users and their representatives, all of which were generally very positive. There are also records of monthly proprietor visits, which included evidence of maintenance issues being addressed. As the home is small, and hence communication can and does flow easily between service users, staff, and management, this is considered as suitable quality auditing. Accident records, including body charts, are kept. There were a few entries, mainly to do with service user falls in the home and the community. In some cases, further health professional advice was sought. Suitable professional health & safety checks were in place for the gas systems, the electrical wiring (including actions to address faults), portable electrical appliances, and the fire equipment. It is noted that the gas check passed the equipment as safe but noted a shortfall with the flue in respect of current standards, which is recommended for addressing. Internal monthly health and safety checks also generally take place using a standard form. This includes for hot water temperatures, for which thermostats were seen to be fitted and effective. There are additionally reasonable risk assessments in place about the systems in the home, to help minimise the chances of accident and injury. The local council environmental health department visited the home in January 2007. The manager stated that this had raised no concerns, but that new kitchen hygiene practices had since been adopted in line with updated legislation. The home has a fire-safety risk assessment in place dating from August 2006. There were fire drill records that happen every couple of months, in support of ensuring that the fire equipment works and that service users leave the premises safely. It is recommended that equipment checks take place at least monthly, to more quickly identify any faults. The fire authority last visited the home in 2004, documenting standards to be satisfactory to them. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 Requirement Timescale for action 01/07/07 2 YA9 13(4) 3 YA20 13(2) 4 YA20 13(2) The manager must ensure that: • There is clear evidence of service users being involved in their care plans; and • Care plans are made available in a format that assists the service user to understand it so that they can keep a copy. The manager must ensure that 15/05/07 risk assessments about individual service users cover all areas of clear hazard, such as for the recent falls that both service users have had. This is to evidence that appropriate consideration and actions have been taken. The manager must ensure that 01/05/07 clear records are kept of all medications received into the home on behalf of service users. This is for stock-control and auditing purposes. The manager must ensure that 01/07/07 all staff who are involved in administering medication, have received appropriate, formal training. This is to help ensure that service users receive appropriate support with their DS0000017572.V327079.R01.S.doc Version 5.2 Greenford House Page 27 medications. 5 YA23 13(6) To highlight the importance of recognising abusive behaviours, and to better ensure appropriate responses to possible abuse scenarios, it is required that training in this area be included in the induction process. The manager must ensure that the minimum expectation, of 50 of staff to have achieved the NVQ level 2 in care qualification or equivalent, is being addressed, with copies of qualification certificates available as evidence. This is to help ensure that service users are supported by a staff team that is suitably qualified and up-to-date in respect of care practices. The manager must ensure that all care staff have up-to-date training in emergency first aid, to better ensure that they can all respond appropriately to first aid scenarios, particularly as staff are currently usually working alone. 01/06/07 6 YA32 18(1)(c) 01/09/07 7 YA35 13(4) 01/07/07 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 YA6 Good Practice Recommendations The manager is recommended to look into the PersonCentred Planning (PCP) approaches that are being encouraged by the Government White Paper ‘Valuing People’. Management should ensure that the service users’ individual Health Action Plans are brought up-to-date and are agreed by involved people. The updated Harrow Council Safeguarding Adults (abuseprevention) procedure should be acquired, to ensure that DS0000017572.V327079.R01.S.doc Version 5.2 Page 28 2 3 YA19 YA23 Greenford House 4 YA34 5 6 7 YA35 YA42 YA42 the service’s policies work in line with it. It is recommended, to evidence that updated processes will be followed, that the recruitment policy be updated to include appropriate reference to the Care Homes Amendment Regulations. It is recommended that the service’s induction policy be matched to the guidance of the National Training Organisation (‘Skills for Care’). It is recommended that fire equipment checks take place at least monthly, to more quickly identify any faults. The professional gas check passed the equipment as safe but noted a shortfall with the flue in respect of current standards. This is recommended for addressing. Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Greenford House DS0000017572.V327079.R01.S.doc Version 5.2 Page 30 - 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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