Inspection on 08/11/07 for Harefield Road, 156

This inspection was carried out on 8th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 5 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 21/09/06

Harefield Road, 156 22/12/05

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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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 Harefield Road, 156 Uxbridge Middlesex UB8 1PP Lead Inspector Pauline Griffin Key Unannounced Inspection 8 November, 2007 13:00 TH Harefield Road, 156 DS0000027063.V341503.R02.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 Harefield Road, 156 DS0000027063.V341503.R02.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. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 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 hm156harefield@ealing.org.uk Ealing Consortium Limited Miss Nina Peters 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.V341503.R02.S.doc Version 5.2 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 21st September 2006 Date of last inspection Brief Description of the Service: 156 Harefield Road is home to four men with learning disabilities who also have mental health needs. The home is owned by Notting Hill Housing Association and the service is managed by Support for Living Organisation (formerly Ealing Consortium) that is a not-for-profit organisation. In addition to registered care and support, Support for Living Organisation also provides supported living, a short break service and activities for people with learning disabilities. A team of 6 ½ care workers support the Registered Manager and the deputy Manager. The residents enjoy a variety of activities that are mostly facilitated by staff members. Some of the bedrooms have been re-decorated since the previous inspection and the communal areas have been re-arranged. The two offices on the second floor are used by the new Registered Manager and the deputy Manager. The office used by the deputy Manager is also used as the staff sleep-over room and the medicine cabinet has also been re-sited there. The property has a well maintained garden but parts of the house, especially the 1st floor toilet and bathroom are in urgent need of refurbishment. The home is situated in a pleasant residential area and has easy access to public transport networks and is close to good shopping and community facilities. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 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 a duration of just over 5 hours. The inspection concentrated on the key Standards under the Care Homes for Adults, Care Homes Regulations. The inspection consisted of the examination of records and policies. Interviews with the Registered Manager and a care worker and conversations with two of the residents. Two representatives of clients were spoken to on the telephone. The inspection also included a tour of the premises and the inspector observed the evening meal being prepared by a member of staff. Two representatives of people who use the service were spoken to on the telephone and both had positive things to say about the home, one said “I am very happy with the home. They bend over backwards to please my son”. The other said “The Registered Manager is the best we have ever had and her positive approach has made a difference because she makes so much effort”. What the service does well: What has improved since the last inspection? A marked improvement in the demeanour and general behaviour of two of the residents was observed. The Registered Manager said that she has set in place new ways of interaction with the residents which has had positive outcomes. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 6 The home received a programme of re-decoration both inside and out during 2006. 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. Harefield Road, 156 DS0000027063.V341503.R02.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 Harefield Road, 156 DS0000027063.V341503.R02.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): 2. Quality in this outcome area is good. Residents’ needs are assessed at the time of admission and reviewed at regular intervals to ensure their needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One file was examined and found to be up to date and comprehensive. Assessments identify all areas of care including health, self care, leisure, and social interests. The file reflected the needs of the individual at the time of admission to the home and ongoing assessments are made to identify improvements or deterioration. Reviews are carried out both monthly and six monthly. Harefield Road, 156 DS0000027063.V341503.R02.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 & 9. Quality in this outcome area is good. Assessments reflect the changing needs, choices and personal goals. Choices are facilitated and are only limited in a risk managed framework. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home uses a person-centred planning approach to their assessments. A ‘pen picture’ of the individual residents needs giving general information for easy reference is kept for easy reference. The home also keeps daily logs recording the daily routine of each resident. Residents prefer not to meet as a group but were able to confirm that their individual preferences were acted upon and only limited by a risk managed process. The Registered Manager said the three of the residents had Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 10 decided they did not wish to attend a day centre anymore. This has increased the responsibility of the staff team to provide alternative activities. The daily log showed evidence of how the staff carried this out. At the time of the inspection one resident had returned after a pub lunch with a staff member. He then took an afternoon sleep but was able to contribute to the inspection in the late afternoon. Another resident preferred to stay in his own room during the course of the inspection whilst another was out on his own or the day. The fourth resident was present in the house throughout the inspection and contributed to it. One resident is still expressing a wish to move to another care home and the Registered Manager said that he has been displaying some difficult behaviour to re-inforce this wish. The possibility of finding a suitable alternative is being investigated by the resident’s care manager in the social services department. To date no suitable alternative has been identified. Risk assessments are carried out to minimize or eliminate identified risks and hazards involved in the care of the individual residents. Harefield Road, 156 DS0000027063.V341503.R02.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): 12,13,15,16 & 17. Quality in this outcome area is good. Residents are able to make choices about their lifestyle and are supported to develop their life skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager was able to describe how the residents are encouraged to develop their skills. One of the residents helps with small tasks in the home like laying the table for dinner. Another resident has a part time gardening job and attends a panel representing people with learning disabilities. Residents are encouraged to take part in the local community and make regular visits to the Uxbridge shopping centre with cafes, pubs, cinema and theatre. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 12 There is liaison between two other local homes run by Support for Living and this enables residents to have a choice of who they might like to join for holidays and trips. Staff support residents in maintaining contact with family and friends. One resident spends weekends with his family and another has regular visits from his family and goes for a meal with them each week. Two of the residents hold keys to their rooms and the other two prefer not to. Staff were observed to be interacting with the residents in a relaxed and attentive manner. The kitchen continues to be locked overnight due to one resident tending to drink too much coffee and others tending to spoil the food. The previous inspection identified this but asked that staff consider ways to manage this so that residents still had access to some refreshment, food or snacks at night. The evening meal was being prepared at the time of the inspection. The meal was chicken breast casserole with dumplings, potatoes and mixed vegetables. Although the menu was put together with consideration to the fact that the four residents share the same cultural background and enjoy mostly traditional meals – the chicken casserole was being prepared in an unfamiliar manner. Staff who prepare and cook meals for the residents must receive assistance and supervision to ensure that it is carried out in a manner that is familiar to and within the culture of the residents. Harefield Road, 156 DS0000027063.V341503.R02.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): 18,19 & 20. Quality in this outcome area is good. The health and personal care that residents receive is based on their individual health needs. The principles of respect, dignity and privacy are put into practice. None of the residents manage their own medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager confirmed that each resident has a key worker who they choose themselves and the choice includes that of gender. The home recruits mainly male care workers to ensure the residents receive same gender care if they choose to. New staff are given a ‘shadow checklist’ that details all aspects of the duties of the key worker for each resident. The Registered Manager said that this is a useful working tool and ensures a consistent approach in the caring Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 14 role. For instance, one checklist examined gave information as to what a resident liked for a packed lunch. The Registered Manager said that she has introduced a pictorial rota for one of the residents and an activity/information board to suite his needs. There is also a pictorial daily staff rota with photographs of the staff on duty to ensure the residents know who is coming in each day. Assessments on the residents’ files include a section on their health care with detailed information on medical appointments, specialist consultations, medication and health procedures. None of the residents administer their own medication. The Registered Manager was able to demonstrate that there were special checking measures in place for the administration of a controlled drug taken by two of the residents that is not prescribed in a pre-dosed package. All medication coming in and returned to the pharmacist is recorded. Boots Pharmacy send a representative every three months to check that their Monitored dosage system is being used correctly. The Registered Manager confirmed that all staff administering medication (including agency staff) would undertake the training approved by Support for Living under the medication administration and practice guidance produced for the home dated January 2005. The medicine cabinet and medication records were not examined on this inspection. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 15 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): 22 & 23. Quality in this outcome area is good. Residents are facilitated to express their concerns and have easy access to a robust complaints procedure. Staff receive training in adult protection every two years. Residents are protected from abuse and the different forms it can take and have their rights protected. Residents feel confident about raising concerns or making a complaint without the fear of any type of reprisal. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a satisfactory complaints procedure. There have been no complaints received since the January 2004. Residents and their representatives spoken to by the Inspector confirmed that they feel confident in expressing a view. Two of the residents’ representatives spoken to both spoke positively about the way the home was run. One said that the new Registered Manager was the best one they had ever had and her positive approach had had a beneficial influence on the health of two of the residents in particular. Both said that they felt the staff team was approachable and caring. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 16 The home has a policy on the Protection of Vulnerable Adults (POVA) and the Registered Manager said that staff have all received training at two yearly intervals. The subject of ‘whistle blowing’ should be included in POVA training and the home’s policy used as part of staff supervision/training. Staff are required to deal with some challenging behaviour in the home and have received training in the ‘de-esculation of aggression’ to enable them to deal with unpredictable and aggressive behaviour. The Registered Manager should ensure that this type of training is provided at regular intervals for all staff. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 17 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): 24 & 30 Quality in this outcome area is poor. There are several areas in the home that require urgent attention to ensure the residents are living in a safe, hygienic and well maintained environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection included a tour of the premises and during the course of this, a strong mal odour was noted close the bathroom, toilet and two of the bedrooms on the first floor. The Registered Manager said that they could not get rid of the smell because of the leak seeping into the flooring which is made of a non-permeable material. The Registered Manager said that despite a repair being made, the problem persisted. The bathroom adjacent to the toilet was in a poor state of decorative order. There was black mould between the tiles which had been painted in different colours in an effort to brighten it up. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 18 Other parts of the home had been improved in a re-decoration programme and were of a satisfactory standard. Taps in the residents’ rooms and communal bathrooms have been fitted with valves to govern the temperature of the hot water. The taps used by staff had warning notices that the water was very hot. The water temperature was tested on the taps in the kitchen and laundry and this was far too hot for staff to use safely and also unsafe for the residents who might use the water in the kitchen and laundry. The laundry was maintained in an orderly manner and the washing machine has a sluicing facility and can wash at an appropriate hot temperature to deal with soiled linen. The Registered Manager had received an annual visit from an accredited company to test the water in the home under the Water Supply Fittings Regulations 1999. The current test certificate was still valid. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 19 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, 34 & 35 Staff in the home are trained and in sufficient numbers to support people who use the service, according to their terms and conditions and to ensure the smooth running of the service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staffing structure of the home has 6 ½ care workers who support the Registered Manager and the deputy Manager. The Registered Manager has one full time position vacant and is hoping to negotiate these hours to include some domestic assistance in the home to support the care workers. The care workers have been responsible for the cleaning, gardening and decorating in the home the past and some domestic assistance for cleaning and laundry would be welcome support. During the inspection, the Registered Manager and one newly recruited care worker were interviewed by the Inspector. The newly appointed care worker Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 20 was positive about working for Support for Living and was enjoying the work and the prospect of receiving ongoing training and NVQ training. He confirmed that he had received induction training, shadowing and Learning Disability Award Framework (LDAF) training. Recruitment for the home is carried out in line with the Support for Living organisation recruitment policies, who have satisfactory systems for selection and carry out checks and verifications to ensure the residents are protected. The Registered Manager produced a training chart to show ‘at a glance’ who has received training, in what subject and when the received it. The chart also indicates when refresher training is due so that updates are planned into the training year. Staff receive an annual training and development assessment provided by the Support for Living organisation and staff working in learning disabilities are provided with the LDAF training to underpin their knowledge. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 21 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 & 42 Quality in this outcome area is good. The staff team are supported and the residents are treated with respect. The residents’ representatives said that the quality of the service provided has improved through the positive management style of the Registered Manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager demonstrated her knowledge, skills and commitment to the care of the residents throughout the inspection. The Registered Manager has a background and experience in caring for people with learning disabilities and has achieved the Registered Managers Award. The core staff team have achieved NVQ qualifications at an appropriate level. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 22 The Registered Manager has overall responsibility of the home within the confines of a budgetary framework. The Registered Manager was able to demonstrate her enthusiasm and is committed to motivating staff in providing a high quality service to the residents. The Support for Living organisation provide regular training for all staff that is maintaining knowledge and skills. Quality is monitored each month through assessment of the home through senior managers of the Support for Living organisation and copies of these are forwarded to the CSCI. The Registered Manager is required by the Support for Living organisation to complete a quarterly quality report that includes all areas of the service. The monitoring system includes staffing levels, training, complaints, accidents/incidents and aspects of the building maintenance. The Registered Manager said that the home obtains views from service users and their representatives informally and also hold a monthly ‘options group’ meeting where issues are discussed and are actioned accordingly. The people who use the service are involved in the development of their own service profiles and this is used as part of the recruitment process in order to ensure the right person is selected to suit the needs of the residents. Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 23 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 3 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 4 23 3 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 1 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 x 3 x 3 x x 3 x Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 24 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA17 Regulation 16(2)(i) Requirement Staff preparing traditional meals and food stuffs for the residents must receive support and guidance as to how this must be carried to suite the cultural preferences of the group. The toilet on the first floor requires re-furbishment to eliminate the mal odour. The Registered Manager reported that this had been rectified on 04/02/08. 3. YA24 23(2) The flooring must be replaced in the first floor toilet to eradicate the strong mal odour exuding from it. The Registered Manager reported that this had been rectified on 04/02/08 4. YA24 23(2) The bathroom on the first floor must be re-decorated. 01/04/08 01/04/08 Timescale for action 10/12/07 2. YA24 23(2) 01/04/08 Harefield Road, 156 DS0000027063.V341503.R02.S.doc Version 5.2 Page 25 5. YA30 23(2) Water temperatures in the wash 10/12/07 hand basin in the kitchen, laundry sinks and ground floor staff bathroom are far too hot and require safety valves to ensure the safety of the staff and the residents (who may use these facilities). The Registered Manager reported that this had been rectified on 11/12/07. 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 YA23 Good Practice Recommendations The subject of ‘whistle blowing’ should be included in the training and supervision of staff. 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