Inspection on 22/12/05 for Harefield Road, 156

This inspection was carried out on 22nd December 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

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 02/06/05

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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Chatsworth Care - Tudor Lodge

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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 Ms Pauline Griffin Unannounced Inspection 22nd December 2005 11:30 Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Harefield Road, 156 Address Uxbridge Middlesex UB8 1PP 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) 01895 254803 Ealing Consortium Limited Miss Kirsten Hadleigh Care Home 4 Category(ies) of Learning disability (0), Mental disorder, registration, with number excluding learning disability or dementia (0) of places Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Condition of registration for one Service User, who is over 65, as approved by the NCSC on 08/04/03 2nd June 2005 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 and a half Careworkers support the Registered Manager. The home is currently carrying two full time Careworker vacancies and using agency workers to make up the deficit. The home is managed by Ealing Consortium and the buildings are owned by Notting Hill Housing Association. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 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 for the duration of 4hrs 30 minutes. The home was busy with Christmas Holiday arrangements and one of the Service Users was in bed suffering with a gastric condition. The inspection, therefore, put pressure on the Staff who demonstrated their ability to deal extremely well with the demands of having an inspection together with the general responsibilities of the day. A tour was made of the premises and two Service Users were spoken to. The Registered Manager and a Senior Careworker were interviewed. One Service User’s file and a Staff file were chosen at random and examined; recording systems and logs were also checked. A builder commissioned by Notting Hill Housing Association was repairing broken glass in the porch door at the time of the inspection. The builder, however, had not been commissioned to repair the front kitchen window which he temporarily boarded up. The exterior of the building is still in need of urgent attention and the interior decorative order of the home is in a shabby condition with chipped paintwork and very worn wallpaper. Many of the windows throughout the home have had the secondary double glazing removed at some time in the past and this means that traffic noise disturbs those who sleep in the front of the house and there is also heat loss. The central heating had broken down and small electric heaters were placed around the home to ensure the rooms were warm enough. Use of the emersion heater for hot water whilst the gas boiler awaited repair, meant that the water coming from the taps was very hot indeed. There continue to be difficulties in obtaining maintenance for the home from Notting Hill Housing Association although a programme has been agreed to commence from January 2006. What the service does well: The home provides a personalised service to the Service Users through a core of permanent staff who have knowledge and experience of them and are committed to meeting their care needs. The Registered Manager said that the Staff team manage regular outbursts of challenging behaviour and occasional clashes between two of the Service Users extremely well. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 6 The home’s recording systems are very well maintained including all assessments, logs, reports and policies. Staff keep the home clean and tidy and Service Users help with some of the tasks within their capabilities. There is no designated cook or domestic support in the home. Food in the home is focussed on what the Service User’s like to eat and the menus show that their preferences have been included on a daily basis. Service Users spoken to confirmed this. The menus include fresh vegetables and fruit. The Service Users receive excellent support from staff to pursue their individual interests and choice of entertainment in the community. 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. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 5 Service Users each have an individual contract and statements of terms and conditions of the home to ensure that they are and set out formally and understood by them and their representatives. EVIDENCE: One Service User’s file was chosen at random and examined and found to be in satisfactory order. It included a contract and terms and conditions. There was also a signed document detailing the room and furnishings of the room to be occupied. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Service Users are assisted to make decisions about their day to day lives within the context of the individual Care Plan and the home’s agreed risk management strategies. EVIDENCE: The Registered Manager said that each Service User had a monthly assessment to monitor their abilities and health related issues. One Service User’s monthly assessments charted his progress and his ability to travel alone on public transport, something that he been too nervous to do when he first came to the home several years ago. Work experience has also been arranged through Ealing Consortium in the form of gardening work and this continues to be a satisfactory arrangement. The Service User has also been given a set amount of money per week which he budgets and usually spends on public transport fares, sweets, toiletries and magazines. Another Service User visits the local pub for meals and drinks and also travels to another public house where he is known to the licensee. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 10 The Registered Manager said that all these type of unescorted trips were risk assessed, monitored and discussed with the individual Service User. Each Service User has a weekly record of their daily routine and this clearly demonstrated that individual choice is included. One Service User has not wished to attend the Day Centre for a few weeks and this choice has been respected. Risk assessments examined indicate that choice is only affected by the assessment process and by employing strategies to reduce or eliminate risks. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15 & 16 The home supports Service Users in their choices of leisure, relationships and freedom of movement within their assessed Care Plan. Staff were observed to relate well to Service Users and Service Users spoken to were enthusiastic about the home’s arrangements for the Christmas Holiday. EVIDENCE: The Registered Manager said that one Service User chooses to attend a local church where he was well known. Other Service Users enjoy shopping in Uxbridge and going for meals in local restaurants and cafes. Service Users also enjoy visits to the local cinema and theatres. Each Service User has their own preferences and don’t often go out in a group but prefer to go alone or with a Staff member. The group meet occasionally with the two other homes run locally by Ealing Consortium and this offers a chance for Service Users to mix and ‘link up’ with other individuals with whom they ‘get along well’ for arranging holidays and trips. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 12 Three of the four Service Users have regular contact with their families and the Registered Manager is seeking an independent advocate for the fourth Service User but has been unsuccessful to date. Staff were observed to relate with Service Users in a positive and sensitive manner. Staff were observed to be constantly alert to ‘trigger’ behaviour to avoid confrontational situations. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 None of the four Service Users administer their own medication. The home administers medication through Staff trained by Ealing Consortium’s own training, policies and procedures. Using only Staff trained in this way has eliminated medication errors in the home that occurred in the past. EVIDENCE: The Registered Manager said that only Staff who have received Ealing Consortium’s medication training administer medication in the home. Staff also receive regular visits from Boots Pharmacy, who provide advice and checks for their own monitored dosage systems. Ealing Consortium’s Medication Policy was updated in January 2005. Medication recording systems in the home were maintained in a satisfactory manner. Stocks of medication were appropriately stored in locked wall cabinets and there was no overstocking of things like shampoo and mouthwash as there had been in the past. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 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 have been monthly meetings and the minutes examined confirmed that service user’s express opinions freely. The Registered Manager said that meetings had not been so frequent of late as the group did not want them. The home has policies and procedures produced by Ealing Consortium that have recently been reviewed. The policies include Adult Protection and ‘Whistleblowing’. Staff sign to confirm they have read and understood the 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 DS0000027063.V260557.R01.S.doc Version 5.0 Page 15 The home has not received any complaints in the previous 12 month period. The Registered Manager agreed that the Service User Guide with the complaints procedure should be sent out to the Service Users’ representatives. A copy of the Service User Guide is placed in the hall of the home and this includes the home’s complaints procedure and gives details of the CSCI for those who wish to contact them direct with any complaint or concern. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,28 & 29 Both the interior and the exterior of the home are in need of urgent attention. The wear and tear of the paintwork and wallpaper inside the home is not conducive with a homely environment and the exterior of the home needs attention for a broken window, missing rendering on the porch wall and the general appearance of the building. EVIDENCE: The communal rooms and bedrooms are large and comfortable and the Service Users’ bedrooms are personalised. The decorative order inside the home is in need of attention to a professional standard. One rear bedroom has a large area where wallpaper has been taken off to attend to a damp patch on the wall (ref. previous inspection June 2005). The secondary glazing was removed from most of the windows in the past. Traffic noise disturbs Service Users in the two front bedrooms and Staff have changed their sleeping in room to the rear Staff room to avoid the noise. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 17 A pain of glass in the kitchen has been broken and boarded up. One drawer front in the kitchen is missing. Difficulties have been experienced with the central heating since it was turned on at the beginning of the cold weather recently in October. At the time of the inspection the central heating was not working and the home was being heated by small electric radiators and the water heated by the emersion water heater. Water from the taps was noted to be far above hand hot. Each bedroom is single occupancy with a wash hand basin and each is individually furnished with items chosen by the Service User. All four Service Users are fully mobile and do not need specially adapted equipment. One Service User has hand grips to use when getting in and out of the bath. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 35 Service Users benefit from Staff who are well trained and clear of the their roles and responsibilities. EVIDENCE: Staff interviewed were able to demonstrate their knowledge in the respective roles and the responsibilities they held. The Registered Manager provided a copy of a Careworker’s job description that was clear and comprehensive. Staff receive induction training from Ealing Consortium that includes all mandatory subjects like food hygiene, fire safety, infection control, moving and handling and health and safety at work. Staff also receive training in dealing with aggressive behaviour. Staff receive regular one to one supervision at least quarterly and have an annual appraisal to review progress and assess training needs. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 43 The Registered Manager is competent and experienced and Service Users benefit from a well run home with an accountable management structure. EVIDENCE: The Registered Manager has a sound background in care management at a senior level. She was able to demonstrate her knowledge and management skills during the course of the inspection. The Registered Manager is in the process of completing the NVQ level 4 and is aware that this should be completed in 2005. The Registered Manager undertakes mandatory and update training provided by Ealing Consortium. The home has up to date policies and procedures provided by Ealing Consortium and these are endorsed and implemented by the Registered Manager. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 20 Certificates of registration were on display and insurance cover details confirmed that the home is covered for Employer’s Liability, Public Liability and Medical Malpractice at a level in accordance with the activities in the home. Fire drill is carried out on a quarterly basis and names of Staff are listed. The last drill was in September 2005. The Registered Manager said that she instigated drills at busy times, to ensure that Staff could cope in unexpected and realistic situations. The Registered Manager has input into annual budget setting for the capital and revenue budgets of the home and is responsible for monitoring them. The home has general support from Ealing Consortium for things like payroll and human resources services. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 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 x x x x 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score x x x 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 3 3 x 3 3 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 x 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harefield Road, 156 Score x x 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x 3 DS0000027063.V260557.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 13 (4) 23(2)(b) Requirement 2. YA24 The central heating and hot water system in the home must be repaired. The hot water system temperatures must comply with Standard 43.3 iv. of the National Minimum Standards. 23(2)(b)(d) Maintenance and re-decoration of the home both externally and internally must be carried out. Timescale for action 06/01/06 01/03/06 Previously required with a date of 01/11/05. Not Met. Harefield Road, 156 DS0000027063.V260557.R01.S.doc Version 5.0 Page 23 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 YA22 YA33 YA39 Good Practice Recommendations Service Users’ representatives should have access to copies of the Service Users’ Guide and the complaints procedure. The Registered Manager and 50 of the staff team should achieve NVQ level 4,3 & 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 DS0000027063.V260557.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection West London Area Office 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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