Inspection on 02/06/05 for Harefield Road, 156

This inspection was carried out on 2nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

Harefield Road, 156 21/09/09

Harefield Road, 156 08/11/07

Harefield Road, 156 21/09/06

Harefield Road, 156 22/12/05

Harefield Road, 156 09/02/05

Harefield Road, 156 24/06/04

Harefield Road, 156 12/02/04

Harefield Road, 156 09/10/03

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

CARE HOME ADULTS 18-65 Harefield Road, 156 Uxbridge Middlesex UB8 1PP Lead Inspector Pauline Griffin Unannounced 2nd June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 156 Harefield Road Address 156 Harefield Road, Uxbridge, Middlesex, UB8 1PP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01895 254803 Ealing Consortium Miss Kirsten Hadleigh Care Home 4 Category(ies) of Learning Disability and Mental Disorder registration, with number of places Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: One service user over the age of 65 years as approved by the N.C.S.C.ON 08/04/03. Date of last inspection Brief Description of the Service: 156 Harefield Road is a Care Home for four Adult service users with Learning Disabilities who are under the age of 65 years and may also have mental health diagnosis. A variation is in place for one Service User who is outside of the category of the home with respect to age. All four service users are male. The home is an attractive detached property converted from a family home and is in a residential area which is situated on a busy road leading into Uxbridge. The shopping centre and public transport are within easy walking distance and the home is on a bus route. Each service user has their own separate bedroom on the first floor and these are furnished and personalised. None of the bedrooms have en suite facilities but each room has a wash hand basin. The bathroom and toilet is on the first floor and is within easy reach of all bedrooms. The staff office and sleepover room is on the second floor. The staff toilet/shower room is located on the ground floor. The communal space includes a large lounge and an open plan dining room, both of which exceed the space requirements as outlined in the National Minimum Standards. The garden is very large and offers space for gatherings such as summer barbecues and quiet seating areas for service users. All the service users have a schedule of activities outside the home. Weekends are usually unstructured and individuals can choose an excursion when there is enough staff to escort them. A team of one Senior and five Careworkers support the Registered Manager. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over one day of a duration of 6 1/2 hours. The Inspector made a tour of the premises and garden and spoke to two service users and three members of staff. One staff file was examined and one service user’s personal and day file. Recording systems and logs were checked including maintenance records for the home. The home has rectified most of the shortfalls identified in the previous inspection and recruitment and medication issues have been resolved. The building, however is suffering from lack of maintenance both internally and externally and this must be addressed. What the service does well: What has improved since the last inspection? The system of administration of medication has been reviewed and staff have received training. A recruitment drive has resulted in the home securing two permanent staff to join their core staff team reducing the need to use temporary staff. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 6 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. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 & 4 The home has a satisfactory Statement of Purpose and Service User’s Guide and all service users have a contract /agreement. The home offers prospective service users trial visits to the home and assessments are made to ensure that needs and preferences can be met. EVIDENCE: Service users and their representatives are provided with information regarding the home in the form of a Service Users Guide and Statement of Purpose. A copy of these are kept in the reception area of the home so that they are freely available to refer to. The Service Users Guide has been produced in an easy to read, pictorial format. The tenancy agreements include details of the individual rooms to be occupied. Staff receive specialist training to ensure that identified needs are met. The home does not accept emergency or respite placements. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 & 10 The home has comprehensive care plans that give clear details of the daily living needs of the service users in terms of health, welfare, background information and includes their educational/social aspirations and preferences. Service users are assisted to make decisions about their lives such as visiting their favourite local restaurants, cinemas and theatres. EVIDENCE: A service user’s care plan was examined and found comprehensive and up to date. Each service user also has a personal file that includes a ‘pen picture’ of their needs with general information for easy reference. The files also contain daily logs with entries for morning and evening, recording information for staff handover purposes. The home has a weekly record of the daily routine for each of the service users and this demonstrated that individual choices have been included. Individual records describe how service users are supported by staff to enjoy outside activities. Staff and service users hold regular meetings when opinions and suggestions are discussed and acted upon. Satisfactory risk assessments demonstrate that choice is only affected by the assessment process and employing strategies to reduce and/or eliminate risks. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 10 The home makes a monthly reconciliation of each of the service users financial records and draw a cheque for the contribution to Ealing Consortium. Ealing Consortium check the records and the home maintains records of the remaining funds for each service users which they use for personal expenditure on outings, holidays, clothes and entertainments. Service users’ confidentiality is respected and records are stored in a secure manner in accordance with the Data Protection Act 1998. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 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 standard(s) 11,12, 14 and 17. The home supports the service users to achieve their potential in leisure, educational, spiritual and in employment to a high degree. Service users spoken to confirmed that they enjoyed the lifestyle they led in the home. EVIDENCE: Service users are supported to enjoy appropriate day care, educational classes, part time employment, social/emotional sessions and assistance with practical life skills. One service user confirmed he enjoyed embroidery classes at a local college. One service user has two part time paid jobs including one working in a local supermarket. Service users also confirmed that they looked forward to day trips and annual holidays that were chosen individually or taken in small groups linking with another home of those who ‘got along’ well together. Service users were enthusiastic about the food served them in the home and confirmed that the menu included their favourite meals. The evening meal was sampled and was tasty and well cooked. Service users often cook simple food in the kitchen under supervision and have prepared a fruit jelly for sweet on the day of the inspection. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 & 21 Service users each have a keyworker selected by preference and suitability. Personal care and support is performed by a carer of the same gender where preferred. The home accesses additional specialist support from health care professionals and service users also receive routine health checks at the local health clinic. The home administers medication under it’s own training, policies and procedures. Service users health care needs are monitored and their individual preferences are respected. EVIDENCE: The home has recruited a staff ratio that reflects the gender of the service user group and has, therefore, a majority of male careworkers. The service user care plan files has a section for health care and includes detailed information on medical appointments, consultations and medication. None of the service users administer their own medication. All staff administering medication has received recent training from Ealing Consortium and the Boots Pharmacy provide regular checks at the home to monitor the monitored dosage system that they provide. There is an updated medication policy dated January 2005. The home has a policy on death and dying with information on how different cultures approach the subject. The Registered Manager addresses this with Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 13 service users as individuals and uses a written policy called ‘when I die’ that is in a less formal format. None of the service users have made a will. As on the previous inspection, one service user was, again, wearing crumpled, grubby looking clothes, with trousers which had not been pressed or ironed. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 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 standard(s) 22 & 23 The home has a clear and up to date complaints procedure that is included in the Statement of Purpose. The complaints procedure is also in the Service Users Guide and written in a pictorial format that is easy to understand. Staff have received training in the forms abuse can take and the home has policies on adult protection produced both by London Borough of Hillingdon and Ealing Consortium. The home ensures that service user’s views are listened to and staff are trained to be sensitive to adult protection issues. EVIDENCE: The home has good systems for ensuring service user’s views are heard and acted upon. There are monthly meetings and the minutes examined confirmed that service user’s express opinions freely. The Registered Manager has not been able to access any independent advocates for the service users to date. The home has policies and procedures produced by Ealing Consortium that have just been reviewed. The policies include Adult Protection and Whistleblowing. Staff sign to confirm they have read and understood the various policies and they are used in supervision sessions to ensure staff are familiar with them. Staff have received training in ‘de-escalation of aggression’ to enable them to better deal with unpredictable and aggressive behaviour by service users. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 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 standard(s) 24,26,27 &30 The decorative order of the interior of the home is in need of attention. The standard and wear and tear of the wallpapering and paintwork is not conducive with a homely environment. The home is maintained to a good standard in terms of being clean and tidy. Service users benefit from the general relaxed and homely ambience created in the home. EVIDENCE: The communal rooms and bedrooms are large and comfortable and the service users’ bedrooms are personalised. The decorative order, furnishings and curtaining in the home are in need of attention. Areas of the grouting in the bathroom has become discoloured with black mould and there is evidence of dampness on the ceiling and wall in the adjoining bedroom. The secondary double glazing has been removed from the front windows and the Registered Manager said that the noise of the passing traffic disturbs the sleep of staff and service users who occupy the front bedrooms. Cupboard doors in the kitchen are missing. The porch has a large patch of plaster by the front door that has fallen away, leaving bare brickwork Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 16 exposed. Several of the curtains at the windows had fallen off the tracks in places. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34 & 36 The Registered Manager is aware that she must achieve the NVQ level 4 in Care Management (or equivalent) by 2005 and that 50 of the staff team must achieve NVQ level 2 by 2005. A recent recruitment drive has resulted in two permanent staff members joining the team and this will result in a reduced need to use agency and temporary staff. Staff receive regular formal, one to one supervision with the Registered Manager and Senior Careworker. Staff spoken to confirmed that they felt supported to ensure the needs of the service users are met. EVIDENCE: Some staff have already completed NVQ training and other have commenced studies. The Registered Manager is aware that an effort must be made to ensure that the required numbers of trained staff (50 ) must be achieved by 2005. The induction programme provided by Ealing Consortium provides new recruits with training that covers all areas necessary for support workers in care provision specific to the role and the needs of the service user group. Training has also been provided in mandatory subjects as well as administration of medication and ‘de-escalation of aggression’ for core staff. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 18 The home has had a successful recruitment drive and the reliance on agency staff should not now be necessary on a regular basis. The staff team now consists of a majority of male staff to reflect the gender composition of the ‘all male’ service user group. The staff file examined, contained all the necessary checks and declarations including the Criminal Records Bureau clearance. Staff receive regular formal supervision and annual appraisals to identify training needs. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 40, 41 & 42 The home is well managed and the Registered Manager has a positive and open style of management. Meeting service user’s needs is a priority and staff spoken to were familiar with the service user’s needs and committed to their care. The service user group is articulate and expressed their views openly. Records of the service user’s meetings confirmed that their views are recorded and acted upon. EVIDENCE: Staff and service users interacted well and the atmosphere in the home is one of professionalism with a sensitive rapport. Instances of aggressive behaviour have occurred during the past two months that have been well managed and risk assessed although it was noted from records that staff had suffered some injuries. The home must monitor this to ensure the safety of all concerned. The home has a structured quality monitoring system that includes the views of service users and their representatives and records the outcomes to ensure Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 20 that shortfalls are addressed. The monitoring system includes staffing levels, training, accidents/incidents, complaints and maintenance checks of the building and equipment. The monitoring does not include input for quality assessment by professionals/stakeholders connected with the home. The home has a full range of policies and procedures produced by Ealing Consortium and staff sign to confirm they have read and understood them. Ealing Consortium have reviewed all the policies and these are ready to be recirculated in June 2005. Records are kept securely in locked cabinets in the home in accordance with the Data Protection Act 1998. Records of regular fire drills and testing of fire safety equipment are up to date and the home has two designated staff with first aid training. All staff have received health and safety training including moving and handling and cross infection. The Registered Manager is aware that she must ensure that health and safety training for staff is kept up to date. Records showed that there were up to date logs and checks on the water system, gas boiler, electrical appliances, emergency lighting, fire safety equipment and fridge/freezer temperature checks. Up to date risk assessments were in place. Accident and incident recording are completed satisfactorily and are up to date. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 21 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 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 3 x x 3 Standard No 11 12 13 14 15 16 17 3 3 x 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harefield Road 156 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score x 3 3 3 3 3 x G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 22 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. 2. 3. Standard 24 26.4 26 Regulation 23(2)(b)( d) Requirement Timescale for action 1/11/05 20/06/05 1/09/05 Maintenance and re-decoration of the home both externally and internally must be carried out. 13(4)(a)(c Trailing flexes in one of the ) bedrooms must be made safe. 16 (c) Service users bedrooms should contain the furnishing and fittings described in Standard 26.2 and that these be of a suitable quality and in good repair. 4. 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. 3. Refer to Standard 18 33 39 Good Practice Recommendations Service users should be provided with personal support to enable them to appear well groomed and clean. The Registered Manager and 50 of the staff team should achieve NVQ level 4 and 2 respectively by 2005. Quality monitoring should include input from all available sources including from people in a professional capacity connected with the service. Harefield Road 156 G61-G10 S27063 Harefield Road V214325 02.06.05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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. 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