Inspection on 15/11/07 for Hanwell House

This inspection was carried out on 15th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Hanwell House 191 Boston Road Hanwell London W7 2HW Lead Inspector Robert Bond Unannounced Inspection 15th November 2007 10:00 X10015.doc Version 1.40 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 Hanwell House DS0000069523.V350063.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 Older People. 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. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hanwell House Address 191 Boston Road Hanwell London W7 2HW Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8579 4798 020 8579 5019 Manager.hanwellhouse@virgin.net Homestead Residential Care Ltd Alan Christopher Kelly Care Home 52 Category(ies) of Dementia (52) registration, with number of places Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Dementia - Code DE The maximum number of service users who can be accommodated is: 52 15th January 2007 Date of last inspection Brief Description of the Service: Hanwell House is a well-established residential care home with 52 places for older people with a primary diagnosis of dementia. The home is set in a residential part of Hanwell, within walking distance of local shops and on a bus route. There is a mainline railway station and an underground station a short distance away. The home was built about 40 years ago but has recently undergone a major refurbishment. There is parking at the front of the building and a secure garden to one side. The downstairs has a large dining room and lounge combined, and a second lounge diner upstairs. Facilities include an activity room, hairdressing room, first aid room, and a training room. Bedrooms are spread over three floors, and there is a lift. Two of the bedrooms are double, the rest are single, none have en-suite facilities. The home is operated by Homestead Residential Care Ltd., whose General Manager is the Registered Manager. He is assisted by a Care Manager, and a large team of care workers and domestic staff, that includes a cook and a handyman. The fees range from £512 to £550 per week. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was a ‘key’ inspection that considered mainly the key National Minimum Standards (NMS) for care homes for older people as published by the Department of Health. The Inspector spent four hours at the home, interviewed the Registered Manager and the Care Manager, met other staff members, talked to residents, toured the premises, and examined a range of policies and files. An Annual Quality Assurance Assessment (AQAA) was completed in advance by the Registered Manager for the CSCI, and surveys were sent out to relatives and health professionals who visit the home to gain their views. A total of 12 completed surveys were returned. The level of satisfaction was very high. For example a daughter of a current resident wrote, “The constant care from all staff is quite extraordinary, nothing ever seems too much trouble or effort.” Likewise a doctor who knows the home wrote, “It is an excellent home. I have unanimously high reports from my patients’ families who are delighted at the high standard of care provided.” On the day of the CSCI inspection, the home was fully staffed, with the exception of one catering assistant vacancy. All of the residents’ places were taken, with the two double rooms being occupied by married couples. No issues of equality and diversity came to light during the inspection except in a positive way such as cultural and spiritual needs of Polish residents being met. All the requirements and recommendations of the previous CSCI inspection report have been met. Following the inspection and analysis of survey responses, the Inspector found that the anticipated outcomes of 15 NMS were fully met, and 4 outcomes were exceeded but 3 outcomes were only partially met. As a result of the latter, the Inspector made 3 requirements and 5 recommendations. What the service does well: Good quality information is provided by the home to prospective and actual residents, their relatives and representatives, and good quality assessments are obtained prior to anyone moving in. Detailed and comprehensive care plans are prepared on each resident with their involvement and these are kept regularly updated. Personal care needs and health needs are given particular attention. Residents are very well protected by the home’s policies and procedures for dealing with medicines. A good range of activities is offered, and fresh food is prepared with plenty of variety. The premises are attractively and fully decorated, furnished and equipped, and the premises are kept very clean and odour free. The home is very well managed, and staffed to a good level with well trained and qualified permanent staff, who are a stable work group. Health and safety measures are in place and quality assurance surveys are undertaken independently. Hanwell House DS0000069523.V350063.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. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective and actual residents, their relatives and representatives are provided with good quality information about the care home. Good quality assessments of prospective residents are undertaken and provided to the home by care managers employed by the local authorities who refer most of the residents. Intermediate care is not a service that is offered by the care home. EVIDENCE: The Inspector examined the CSCI registration certificate and found that only page 1 was displayed. As certain registration information appears on page 2, the Registered Manager agreed to make sure this information was displayed also. The Inspector noted that the home has recently produced a revised Service Users’ Guide that describes the new management and ownership arrangements for the care home. The Inspector examined in detail two care files (case-tracking exercise) and found that both contained good quality comprehensive assessments undertaken by the referring care manager. The home only undertakes its own assessment if the prospective resident is self-funding. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are well recorded in individual plans of care and residents are very well protected by the home’s policies and procedures for dealing with medicines. Residents’ dignity and privacy however are not being maximised as bedroom doors are sometimes left open, and not all residents have a lockable space in their bedroom to keep their valuables safe. EVIDENCE: The Inspector examined in detail two of the residents’ care files, chosen at random. Both contained a recent photograph of the resident and a detailed individual care plan dated September 2007. Evidence was seen of frequent reviews taking place on a six weekly basis. Residents are involved in drawing up the care plans, and sign them where possible. The care plans contain details about how the resident wishes to have their personal care needs met. Residents’ health care needs and medication needs are also fully documented. Religion, ethnicity and country of origin are recorded, together with the residents’ social interests. Risk assessments are undertaken for moving and handling purposes, and Waterlow assessments are done concerning skin care. Records of weight are kept, and where required, blood pressure records are maintained on file by visiting community nursing staff. One such visitor told Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 10 the Inspector, “Residents are always taken to their room when we provide care.” The Inspector checked a sample of medication record keeping and the storage arrangements, including the medication refrigerator. Controlled medication, returned medication, administered medication, and loose medication records were all checked and found to be precisely kept with no errors. The list of sample staff initials was up to date, and it was particularly easy to see which member of staff had administered which drug, which is commended. It was noted that the pharmacist does six monthly audits and issues his own report, which is also commended. Each bedroom door has a photograph of the occupant framed upon it, which is commended, but the Inspector noted that on one corridor of the care home, all the bedroom doors had been left open. This presumably was done to air the bedrooms and to make their cleaning easier to undertake as the rooms generally did not have a resident or a member of staff in them. However, leaving bedroom doors open is not conducive to maintaining the privacy and dignity of residents as their personal possessions are open to view by visitors and other residents alike. Hence a requirement is made about this aspect. Indeed, as not all residents have a lockable storage space in their bedroom for medication, money or valuables, a further requirement is made to this effect under the Environment set of Standards. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ social, cultural, religious and recreational needs are being well met. Links with family, friends and community are sufficiently encouraged. Residents are adequately consulted. A varied, appealing and wholesome diet is provided, with a vegetarian main course option being the only advertised choice. EVIDENCE: Residents social interests are assessed and recorded in their individual care plans. A note of activities each resident engages in is also recorded in the care plan file. An activity programme is clearly displayed within the home and it covers all seven days of the week. Two activity co-ordinators are employed and they also cover the whole week, however neither was in the home on the day of this inspection. Nevertheless activities were being organised by the care staff in both lounges. Board games, music and dancing were all observed. One relative who completed a survey said that more entertainment was necessary. The Inspector noted relatives visiting the home, and that relatives are also invited to review meetings. Several relatives reported how welcome they were made to feel when they visited the home. The Care Manager reported that no formal residents’ meetings are held, but that individual resident’s views are sought not only during reviews, but also by surveys that their key workers assist them to complete. The AQAA completed by the home states that the Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 12 home is visited by two local churches and a Polish priest. Daily newspapers are delivered to the home including Polish papers. The Inspector examined the home’s food menu and talked to the cook about aspects of it. The only choice that appears on the menu is a vegetarian option. The AQAA states that home-made vegetable soup has recently been introduced as a starter for the main meal and also the evening meal. One relative praised the food served, but another suggested that fresh fruit should also be available. Meals are served in pleasant surroundings, but a recommendation is made under the Environment Standards that the main dining room floor is resealed as it shows sign of wear. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an adequate one-stage complaints procedure and a satisfactory Adult Protection procedure in place. EVIDENCE: The Inspector examined the home’s complaints procedure, which has only one stage, but has timescales attached. The contact details of the CSCI are included. No complaints at all had been recorded by the home using the format that had been designed for the purpose. The Inspector examined the home’s policy and procedure for the Protection of Vulnerable Adults and found that it lacked a sentence about referring any allegations of abuse to the London Borough of Ealing’s Safeguarding Adults section, which would convene a strategy meeting to decide how the allegation would be investigated. The omission was agreed and corrected by the Registered Manager. The Inspector noted records that indicated that all the home’s staff had received POVA training. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The premises are not currently considered to be wholly safe for residents and staff pending further expert advice and some remedial action. Five bedrooms are not quite furnished to the required minimum standard. The home is however very clean, pleasant and hygienic throughout. EVIDENCE: The Inspector toured the premises and found them to be very clean throughout and without any malodours. A relative wrote, “The home is well kept and always clean.” The premises have been recently refurbished to a high standard. Decoration, furniture and equipment were all new and generally in excellent condition. The exceptions included the main dining room floor that needs to be resealed, a broken washing machine, a damaged fly screen in the food store, and wood being stored in a stair well. The latter has been reported to the Fire Service for expert advice. The Inspector asked the Registered Manager whether he had a Food Safety report on the refurbished home but he did not. A requirement and a recommendation are made concerning the potential environmental health hazard in the food store. In the ‘what we could do better’ section of the AQAA document completed by the Registered Manager Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 15 it says, “To ensure that the staff team are more vigilant with health and safety and infection control with regards to all communal areas.” The Inspector observed a bedroom that did not contain the required lockable space for resident’s valuables to be kept safely and privately. The Registered Manager confirmed that five bedroom cabinets without locks had been erroneously purchased. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are being well met by the numbers of care staff on duty. All the permanent staff are well trained and sufficiently qualified but one third of staff are not permanent employees. Residents are well protected by the home’s thorough recruitment policies and procedures. EVIDENCE: The Registered Manager reported that the home was fully staffed, with the exception of a kitchen assistant. He added that the staff group was very stable, but some long-term temporary agency employees are used, and at the present time 10 carers per shift instead of the usual 8 are being deployed. This was because three new carers have not yet been CRB cleared hence are working as supernumaries under close supervision. The additional staffing is commended. The Inspector confirmed by observation that sufficient staff, and more, were on duty on the day of the inspection. A typical comment about the staff in the relative surveys received was, “Care staff are helpful and considerate at all times.” Another relative suggestion, which the Inspector has made a recommendation, is that the staff should wear name tags to identify them to residents and visitors. The home’s AQAA document reports that there are 22 permanent care staff and 11 temporary care staff, and the Registered Manager identifies the need “to attract more high calibre permanent staff.” A recommendation is made also by the Inspector about reducing the proportion of temporary staff. Of the permanent staff, 9 have obtained NVQ level 2 or above awards, and a further 13 are working towards the awards. The home is therefore on target to Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 17 achieve the required more than 50 qualified care staff. The Care Manager of the home has obtained the Registered Managers Award (level 4 NVQ). The Inspector checked the recruitment records of the three most recently recruited care workers. He found that all the required procedures and checks had been undertaken except that there was no evidence of POVA First checks having been obtained. The Registered Manager investigated and produced evidence that the CRB disclosure request forms had been sent off but had not yet been received by the CRB office in Liverpool due to the effects of the Postal Service dispute. In the meantime, the new workers are being closely supervised. The Inspector examined staff training records and noted that thorough induction training is provided, individual training profiles are produced, and staff supervision takes place on a six weekly basis. First aid training was taking place on the day of the inspection. The Registered Manager reported that all the home’s staff, including the domestic staff, are trained in dementia care, which is updated annually. These aspects are commended. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is managed by two people who are well qualified and highly competent. The home is mostly operated in the best interests of residents, but the privacy issue of bedroom doors being left open detracts. Quality assurance satisfaction rates are quite high, and have been independently assessed. Residents’ financial records were not examined at this inspection. Health and safety aspects are generally well met but two concerns are reported in the Environment section of this report. EVIDENCE: The Registered Manager is now also the Registered Provider via the limited company that he has established to operate the care home. The home’s registration with the CSCI has been amended accordingly. The Registered Manager has obtained the Registered Manager’s Award, and he is ably assisted by the home’s Care Manager who also has this qualification, which is commended. The home continues to be very well managed, and all of the requirements from the previous CSCI inspection have been fully met. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 19 Quality Assurance surveys have been undertaken and analysed by an independent company, which is commended. The results show an overall satisfaction level of 89.1 for residents, and 96.5 for relatives. The surveys received back by the Inspector from various stakeholders also demonstrate a very high level of satisfaction. In terms of health and safety, the Inspector checked the home’s lift, hot water supply, fridge and freezer, and call bell system, all of which were working correctly. He also checked maintenance records for servicing the lift, the boilers, the hoists, and water supply (Legionella). The Registered Manager reported that new health and safety manuals have just been received and that all staff undertake annual refresher training in manual handling, fire and food safety. Two potential health and safety concerns that involve other agencies are reported in the Environment section of this report. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x x x x 3 Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 21 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 OP10 Regulation 12(4)(a) Requirement Timescale for action 01/01/08 2 OP19 23(5) 3 OP24 16(2)(l) In order to enhance the privacy and dignity of residents, their bedroom doors must not be left open unless the resident is in the room and wishes the door to be open. The kitchen and food storage 01/01/08 areas must meet Environmental Health standards in relation to prevention of insect infestation. The damaged fly screen must be repaired. Every bedroom must be provided 01/02/08 with a lockable storage space for money or valuables. 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 2 Refer to Standard OP15 OP19 Good Practice Recommendations Fresh fruit should always be available to residents. The main dining room floor should be resealed in order to make it more attractive for residents. DS0000069523.V350063.R01.S.doc Version 5.2 Page 22 Hanwell House 3 4 5 OP19 OP24 OP27 A current Food Safety report should be obtained on the home’s food preparation and food storage areas in order to fully safeguard the health of residents and staff. All staff should be issued with name tags so that residents and visitors can identify them more easily. Continued efforts should be made to reduce the home’s dependence upon temporary care staff. Hanwell House DS0000069523.V350063.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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