Inspection on 12/11/07 for Haroldstone Home

This inspection was carried out on 12th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haroldstone Home 09/11/09

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Haroldstone Home 8 Harold Road Leytonstone London E11 4QY Lead Inspector Sean Healy Unannounced Inspection 12th November 2007 11:00 Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Haroldstone Home Address 8 Harold Road Leytonstone London E11 4QY 020 8257 7094 TBC 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) Clearwater Care (Hackney) Ltd Ozgur Khan Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category 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. Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 Date of last inspection First Inspection Brief Description of the Service: Haroldstone Home is a Care Home providing accommodation and personal care for up to five people with a learning disability, currently all men. The home can provide care for either men or women. It is a newly registered home registered with CSCI having first opened in May 2008. The home has a staff team consisting of six full time and one part time care workers, a deputy team manager and a team manager who is qualified. Care is provided by two care staff during daytime hours and one waking staff at night, supported by an evening and weekend on call management support system. The service is provided by Clearwater Care (Hackney) Ltd, a private limited company who has other care homes in other areas. The company provide line management support, human resource support and training for the homes staff and manager. The home is located in Leytonstone, close to shops, pubs, the post office, library and other amenities. It is also within a few minutes walking distance of Leytonstone underground station and is serviced by regular bus services. Haroldstone home is a small family sized house, which is modern and has been recently refurbished and decorated throughout. It has 5 bedrooms all with ensuite toilet and hand washbasin. Separate bathroom and toilet facilities are provided. Resident’s bedrooms are comfortable and well maintained and reflect Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 5 the residents own personal choices of decoration and personal items. All the home’s bedrooms are single. The home has a garden to the rear. The home is not suitable for the use of wheelchairs. Information about the service provided is made available to current and potential residents in the homes Statement of Purpose and Service Users Guide. CSCI reports will be kept at the home, and will be made available to residents, relatives, visitors and staff. (None have as yet been produced by CSCI) At November 2007, the homes fees are set at between £1,400 and £1,700 per week for accommodation and support, and are paid for by the commissioning agent, currently Waltham Forrest local authority. The reason for the varying charges is due to different levels of support provided. However these charges are not made explicit by the home in either resident’s contracts or in the homes Statement of Purpose/Service User Guide. Transport is not provided by the home and any costs are payable by each resident. Residents have to pay for other personal expenses such as hairdressing and personal shopping. The provider’s email address is: barbara.walker@clearwatercare.co.uk The home’s email address is: khanozgur@hotmail.co.uk Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection site visit took place on the 12/11/07. The inspection ended on the 7/1/08 following discussion with a senior manager for the provider regarding registration issues and following discussion with Citizens advocacy and social services about their involvement. The Registered Care Manager facilitated the inspection. Four residents were present for part of the inspection and one was able to give his views about how he felt living at the home. Observations were made of staff working with all residents in the living room and kitchen area. The inspection included discussion with the homes manager, the deputy manager and two staff. The building was also inspected for health and safety, suitability for residents and cleanliness. Resident’s records and other documentation about how the home is run were examined. Care assessments and care plans were examined to ensure that care needs were being planned for, and the manager and staff were questioned about these plans, to check that these plans were understood and being put into action. Social services were also consulted about their views on the quality of care provided. A senior manager for the Registered Provider was contacted regarding registration issues, to assess whether all of the registration requirements are being met. Citizen’s advocacy, who has been involved in providing support for all residents, gave their views on how residents were being supported. A representative from the Waltham Forest Planning and Regeneration office was also consulted regarding clarification of the homes current status in relation to meeting the required planning regulations. There was one resident vacancy at the time of the inspection, and two of the current residents are on a temporary placement while arrangements are made for a placement in another home managed by the same care provider. What the service does well: There is a welcoming and friendly atmosphere in the home, which is reflected in the experience and comments of other visitors to the home. There is evidence of good care, and residents’ needs are assessed with their input. There is good help provided by health care professionals such as psychology, Gps, dentist, and community nurse, and there are plans for involvement from chiropody and a speech and language specialists to improve the care provided. Citizen’s advocacy support has been facilitated by the home for all residents who have moved in, and the advocacy team comment that the home has provided a good level of support, and communicated well with them throughout the move in period and since. This has helped the residents to settle in more easily to their new home. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 7 Relationships with family and friends are encouraged and supported, and three residents have regular contact with their family. The home has worked to forge links with family for one resident and this is now proving fruitful. Staff are enthusiastic about working at the home, and help residents to go out very regularly to shops, day centres and other activities. One resident is supported to do a part time job and said that staff are very helpful and that the manager is always there to talk to about any problems. The staff support the residents to shop and cook meals that they like, and are very sensitive and helpful in the way the provide support. There are good written care plans and guidance for staff describing how to best support each resident, and staff show that they understand these. The home is warm and homely, the residents have been involved in decoration of their own rooms, which are well maintained. The home is clean and everything works well. The home has in a short time managed to put in place good facilities, information and systems to provide residents with a good level of support since recently opening. The written information about residents and staff is clear and well written and is well organised. What has improved since the last inspection? What they could do better: The information the home provides to residents and potential residents must be updated to include the range of fees or charges for living in home, and who is responsible for paying these charges. Resident’s contracts with the home are not yet provided to residents and the home must agree these with residents and give them copies. These must also include the fees charged. The information the home provides to residents and potential residents should be updated to include more information about the homes beliefs about how residents should be supported (Philosophy of care) and there should be better information about how to make a complaint to someone outside of the home such as social service or senior managers in the company. This information should be provided in a way that the residents can more easily understand such as on tape or using pictures. The home should think about how to involve residents in a meaningful way in planning the service they get, and about better ways of writing down or recording information for each resident about their care plan such as using pictures or tapes, so that they can remind themselves about what will be happening. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 8 There should be more involvement from people who are trained in communicating with people who need extra help in making themselves understood, so that staff can further improve the way they work with residents. The homes management need to help residents to develop a better relationship with their neighbours, as there may be some concerns being raised by neighbours. This does not means that the residents or staff have done anything wrong but residents would benefit more if the management met with the neighbours to talk about any concerns. The management have decided themselves that they will do this. The home should think again about whether residents hold their own keys to the home and to their rooms and discuss this with them and their family or advocates. The registered provider must reach agreement with the local council about whether the council are going to give them their full agreement for the home to operate in the borough. This is important but does not affect the care and support the residents get from the home. There must be more training for staff about how to support people with learning disabilities and mental health support needs, and in how to best help residents who needs more help in saying what they want. (Non-verbal communications) Training in how to help these residents be better involved in their care planning should also be provided (Person Centred Planning) The manager should do some further awareness training in what the government says should be included in providing services for people with learning disabilities and mental health support needs. (The manager is already qualified and experienced, but this would help to improve the overall management of the home) 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. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 9 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 Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 10 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): 1,2 and 5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Most of the information is available to help residents make a choice about whether to live at the home, but there is not enough information about the fees, what is included or who pays them. Care and support needs are very well assessed but the residents do not yet have written contracts or statements of terms and conditions. EVIDENCE: Haroldstone home has produced a Statement of Purpose setting out the aims, objectives and philosophy of the home. The Statement of purpose is clearly written, and was reviewed in November 2007. It includes the purpose of the home, facilities, description of the accommodation, number of rooms, manager and staff qualifications, and the summary of the complaints procedure. The home facilitates introductory visits by prospective residents. Introductory visits normally consist of three half-day visits for breakfast, lunch, dinner and at least one overnight stay. However the Statement of Purpose does not contain the required information about the fees or charges made by the home for care support and accommodation. This document must contain this information so that residents and commissioners can be clear about the fees charged and who is responsible for paying them. (Refer to Requirement YA1) Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 11 In addition to this it is recommended that the following amendments be made to the Statement of Purpose when it is next being reviewed: 1. Include in the home’s philosophy of care a reference to the learning disability White Paper Valuing People, and philosophy for support references such as the five accomplishments/Person Centred Approaches 2. Re complaints: there needs to be a clear reference to whom specifically to complain to in the first instance, including telephone numbers, address, and the reference to CSCI as having a role in dealing with complaints should be rephrased to show that CSCI is the regulator whose role it is to prompt the appropriate complaints process to be facilitated by the home, the provider or by social services. There should also be some reference to the local social services contact details and their role in relation to dealing with complaints. (Refer to Recommendation YA1) The home carries out appropriate assessments so that prospective residents needs are known and to enable a judgement to be made about whether the home is able to provide services that will meet the individual residents needs and aspirations. These assessments are very well written and include good details of health and social care and religious support needs. A range of risk assessments are also included covering areas such as: challenging behaviour, risk while going out in the community, mobility, epilepsy, self-neglect or harm, exploitation, and safety in and out of the home. All residents have a core assessment provided by social services, which enables the planning for individual residents. All of the current residents have been placed at the home by Waltham Forest local authority. The current residents have moved into the home over the past four months. None of them at had been yet provided with a contract or a statement of terms and conditions by the registered provider. The home and provider must ensure that all residents have such a contract showing the services to be provided, whether any additional or specialised services are to be provided, the fees to be paid, who is responsible for paying them, the bedroom to be occupied, and all other information required by Standard 5 of the Care Standards Act National Minimum Standards. (Refer to Requirement YA5) Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents assessed needs are adequately reflected in individual care plans, and the residents are fully supported to make important decisions about their lives. Risk assessments do adequately protect residents and staff. EVIDENCE: The home has a good system for care planning which is linked to individual residents needs assessments. Care plans are being initially set up with each resident quickly after moving into the home, identifying objectives and review dates. I examined three residents’ care planning files and each was seen to have been very well written, typed and up to date. Care plans clearly described the support specifically needed by each resident, and show how best to support the resident with the use of risk assessments and written guidance for staff. They also show where residents are independent and should be allowed to do things for themselves. This enables the staff to provide support only where it is necessary and to help residents to Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 13 be more independent. Some residents care plans include a skills teaching plan which direct staff clearly in how to engage the resident and focus their attention in house activities. This is an excellent achievement given the length of time the home has been open. All of the residents have learning disability support needs, some of which are very complex and require a very good understanding of how the person communicates through non-verbal means. Comments received suggest that the home has planned well, and that this has enabled the residents to settle in well, and to date has minimised the instances of potentially difficult situations. Care plans include a personal profile which describes residents likes and dislikes, activities, personal care needs, behavioural issues, and the way in which they like to communicate. At least one of the residents has only moved in within the previous month, the care plans for this residents have been quickly put into place ensure good level of detail about a full range of support areas, and comments received from visiting professionals suggest that this person has settled in very well and has been well supported. The home does not yet have a person centred planning approach or system for enabling planning to be more controlled by the residents, but the personal profile which is currently being used would form a good basis for person centred planning if some minor adjustments were made. It is recommended that the home include Person Centred Planning for staff in its training profile, and implement a system that enables residents to express specific issues that are important to them, and that these are written or recorded in a way that the resident can best understand. People other than staff, such as family or friends, should support this planning system if possible. It is understood that introducing such a system effectively will be done over time. (Refer to Recommendation YA6) (See also Recommendation Standard YA35 of this report) One residents care plan provided information about how to support him in communications as verbal communication is limited. It is recommended that for this person the care plan more clearly identify how he communicates, specifically what words or facial expressions are used, and whether the use of pictures objects are symbols will be beneficial. More involvement from a speech and language therapist is also recommended. (Refer to Recommendation YA6) Care plans are recorded in writing only and resident’s ability to read is limited. It is recommended that the home explore alternative means of recording key elements of care plans for residents who cannot read appropriate to their level of understanding such as use of picture book plans or cassette/video tapes. (Refer to Recommendation YA6) Each residents care plan include a weekly plan specifying activities such as cooking, doing puzzles, playing games such as snooker and dominoes, Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 14 gardening, and social activities such as parties. Overall the care plans were seen to be good, clearly recorded and plans in place for regularly review. Staff communicate well with residents and include them in day-to-day decision-making. They were seen to be very respectful of residents in the way they spoke and in how they acted such as letting residents go first when going through doorways, and not entering residents bedrooms when they weren’t present. Advocacy services are used and have been fully involved in helping residents to move into the home, and advocacy comment highly on the staff attitude and support provided. It is envisaged that advocacy will be maintained in future for important decision making when needed. The home provides new residents with information about how to get advocacy support. The residents have only recently moved in and there have been some complications about making arrangements for appointeeship on behalf of residents who cannot manage their own benefits or bank accounts. Advocacy have been involved on behalf of residents in the process of discussion about the best means of managing and protecting residents money and benefits. This has not yet been resolved but comments from advocacy and social services suggest that the homes management are acting responsibly in trying to set up the most appropriate system to best protect residents interests. This area should be further clarified at the next inspection. Examination at three residents files showed a range of good standard risk assessments being done on admission to the home, and plans are in place for these to be reviewed at least every six months, but more often in some cases. Risk assessments seen included: challenging behaviour, risk while going out in the community, mobility, epilepsy, self-neglect or harm, exploitation, and safety in and out of the home. Staff interviewed were able to show that they understood these assessments and written guidance for staff is also provided in how to deal with specific situations. There are no serious concerns about risk assessments, which seem to be very adequate but the following recommendations are made which may be helpful: 1. Ensure that all risk assessments clearly show the level of risk involved. (This is currently asked for in the homes risk assessment form but has not been completed in all cases) 2. Ensure that all areas related to a particular risk are included, for example one risk assessment dealing with outings in the community did not deal with risk regarding road traffic or crossing the road, although this was relevant to this residents support needs. However this was dealt with in a separate risk assessment but would be better included in this particular assessment so that new staff can find it more easily. 3. There are many risk assessments and it would be beneficial to place the more important high-risk assessments to the front of the risk assessment section of resident’s files so that staff when needed can more quickly find them. (Refer to Recommendations YA9) Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 15 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 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents have opportunities for personal development, and are able to take part in age/peer and culturally appropriate activities. They are part of their local community, and are supported to have relationships. Resident’s rights are respected, and good meals are provided. EVIDENCE: It is the Haroldstone home’s stated belief that every resident has the right to personal, social and intellectual development, and must be given the opportunity to achieve his or her potential in learning, and that the home will help residents to find and keep appropriate jobs and therapeutic work placements. The home has completed assessments of need for each resident, which include social and leisure activities as well as objectives for learning skills, education and work where appropriate. All residents have high support needs and the care plans reflect a good range of activities including gardening, Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 16 car washing for one resident. This resident be also has plans to get involved in an information technology course, and is being supported by the home to do this. Two residents receive support from a local daytime activities group, who help them to get involved in activities such as that outings to the park, football, trainspotting and going on shopping trips to the West End. One other resident also wants to join this group. One resident spoke of how supportive staff have been in establishing and maintaining his activities. Residents are actively supported to go out in the community, and to participate in a range of activities such as: some house work, going to the cinema, bowling, attending daytime social club in order to meet people, and going to a disco once a week. The residents care plans individually show the activities they would like to get involved in, and there are good records kept to show what people have done with their time. Residents are supported to choose from a range of appropriate activities in the local community and inside the home. Residents are supported to go out on a daily basis, and in the short time that most residents had lived at the home, a broad range of activities have been put in place for each resident. Comments from social services and from independent citizens advocacy, are that the staff are very good at taking residents out and offering them opportunities to do activities in the local community. One advocate said that “ people are always out doing things when I visit and the home do very well in safely supporting people to lead very active lives”. Both social services and advocacy said that residents had settled in very well and that despite some expected problems associated with settling in, the staff are always very busy with residents, and the home has managed any difficulties very well. It was noted that there has been some objections raised in the local community in relation to the appropriateness of this care home in a residential area. The management of the home, and senior management within the provider organisation, Clearwater Care, has said that they are sensitive to local residents concerns, and want to have facilitated discussions with local residents in order to help overcome these concerns, and to develop a good neighbourly relations within the community. This is an important area for development for this home in order for residents to feel welcome and fully participate in their local community. It is recommended that the registered provider make a concerted effort to ensure that well facilitated meetings take place with local residents as soon as can be arranged. (Refer to Recommendations YA13) Residents have opportunities for both developing and maintaining approriate personal, and family relationships. Residents are able to choose who they want to see, and can have visitors in the home when they want to. Three residents have regular contact with the families and the home has made a concerted effort to find a relative for one resident and is now in the process of encouraging and supporting regular contact with his family. The home has a Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 17 visitors policy, which welcomes visitors whether they be family or friends throughout the day. Personal relationships are encouraged and supported and one resident commented positively about how the home make his visitors feel welcome. Due to the nature of the support required staff have to regularly enter residents bedrooms and bathrooms to provide support. There is clear sensitive guidance for staff describing how to do this. It is the homes stated philosophy that each individuals personal dignity and privacy is respected, for example staff will always knock before entering a service users room and give them choices of housekeeping tasks, e.g cleaining rooms, laundry or cooking/making snacks. Having spent eight hours in the home I observed staff in a range of settings, such as the kitchen, dining room, the sleepover room and supporting residents in hallways entering and leaving the building, and I always saw staff to be acting are very supportive manner allowing residents to go through doorways first, and inviting residents to come and sit and speak with staff when they wished. It is the homes policy to enable residents to hold keys for their own home, but currently no residents have keys to the front door. It is recommended that the wishes of each resident regarding holding keys to their rooms and to the front door of the home be included in the care review process, and appropriately risk assessed to best benefit to residents. (Refer to Recommendation YA16) The home provides residents with the opportunity to decide what food is bought and cooked and to participate in these activities. Weekly menus are drawn up and residents are able to choose different meals when they wish on a daily basis. Residents particular likes and dislikes are catered for, including special diets or allergies and alternative dishes are offered to suit their needs and taste. Cultural tastes and requirements are included and some greek dishes appear on the menus. Meal times are relaxed, unrushed and flexible to suit residents schedules. I examined the menus which showed a variety of meals being provided including salads for fruit and and meat dishes. Each Monday is a special cooking day which includes involving residents in cooking home-made bread and cakes, and there is a teaching plan in place for some residents to do this. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 18 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 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Personal care support for residents is provided in the way that they prefer and is in accordance with assessed needs. Respectful and sensitive support is provided for residents regarding health care and emotional needs, and they are supported to retain administration of their medication when appropriate. EVIDENCE: All residents have a comprehensive personal care plan, which has been completed following a personal care assessment when they first moved in to the home. Personal care needs are included in a Personal Profile, which is carried out prior to admission, and is used to make a judgment as to whether the home can provide the personal care support needed. Three residents files showed that these plans include information for staff about how to maintain independence for residents, while allowing them to do things for themselves when possible. The residents need personal care support of varying levels; some need full support while others just need some prompting. Personal care plans are very detailed and are supported by risk assessments and guidance for staff in how to provide personal care while maintaining residents independence. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 19 One residents care assessment shows a weakness on the right side and an assessment has been put through for specialist advice from an Occupational Therapist. Some residents have other specific care needs during personal care such as mobility support, or epilepsy, and risk assessments are in place to ensure these residents are kept safe during personal care. There are good support plans in place to cater for his health care needs. All residents are registered with the GP, dentists, and opticians and have support from health care professionals on the Multi Disciplinary Team. Referrals have been done for all residents to receive chiropody support, and the community nurse visits the home every two to three week to provide specialist health care services for two residents. A referral has been done for one resident for specialist input from a speech and language therapist to focus on improving his ability to communicate. All residents have a health care action plan in place, which caters for a range of health care needs. Good records are being kept of contact residents have with healthcare professionals. The mental health support team are fully involved in providing support and advice for a resident and for staff, and social services at actively involved in monitoring the homes ability to manage mental health and any behavioural issues. This ensures that residents, staff and others are not put at any risk. Social services have commented that the home has done a good job in setting up the service for residents, and have done very well in providing the level of care and support needed to help residents confidently settle into their home. There is full involvement from psychiatry and psychology and specialist a good level of support and advice is provided for staff in the management of care. A social worker involved in a recent review in December 2007 said that he and the psychiatry specialists involved were very happy with the care being provided. A second social worker confirmed this opinion. The medication policy was last reviewed in March 2007, and includes all of the areas required by this standard. Staff are trained in the administration of medication and are able to give medication when required. Boots chemists provide medication for the home and replenish stocks monthly. Blister packs are used and none of the current residents self medicate. Examination of records of administration of medication shows that residents consistently except medication offered to them as specified in their care plan. The home manages the medicines for all residents and in addition to the training provided by the registered provider, Boots chemists provide additional training support in relation to storage and administration. None of the current residents are able to manage their own medication and the home is in the process of finalising written agreements with residents, family and social services in relation to them administering medication on residents behalf. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 20 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that they are listened to when they have any concerns but the homes complaints policy does not adequately direct residents as to the best means of making a complaint in a way best understood by them. The homes written policy on Adult Protection does provide for the protection of residents. EVIDENCE: The home has an up-to-date complaints policy, which was last reviewed in March 2007. There is a complaints logbook in place, to help to track and monitor the complaints process. No complaints have been recorded from residents, families or from anyone on behalf of residents since the home opened in May 2007. A concern has been raised by local residents about the appropriateness of having the home located in the road, this is being formally processed by the Waltham Forest local council who are responsible for dealing with the matter. This concern is mainly related to an allegation of noise from the home and the general effect of having a staffed care home in the road. The provider and manager have made staff aware of the concerns in order for them to be sensitive to the needs of local residents, and comments from social services and independent advocacy suggest that the manager and staff have been successful in managing residents behaviours, which may have been a trigger for concerns being raised. The registered provider is in the process of arranging meetings with local residents to listen further to their concerns and to engage in a dialogue to resolve any outstanding concerns. (Refer to Recommendation in this report Standard YA13) Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 21 Staff showed a good knowledge of how to respond to complaints. However there are a number of areas where the written complaints policy could be improved as follows: 1. The complaints policy should more clearly identify whom to complain to by job title or position in the organisation, should a complainant want to raise his or her concerns with anybody outside of the home. The contact number and address for this person should be included. 2. Social services role in dealing with complaints should be included in the policy, including their contact details. 3. An abbreviated version of the policy should be made available to residents in a format that they can easily understand, such as using pictures or audio/video tapes. (Refer to Recommendation YA22) There is a copy of the organisations adult protection policy at the home and the staff and manager showed a good knowledge of how reporting should happen. This policy was reviewed in March 2007. The manager and staff understand the lines of responsibility for the provider and the local authority. There have been no adult protection referrals since the home opened in May 2007. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The Residents live in a comfortable And safe home, with bedrooms, which suit their needs. Appropriate bathing and toilet facilities are provided and the home is a safe clean and hygienic place to live. EVIDENCE: The home is located in Leytonstone, close to shops, pubs, the post office, library and other local amenities. It is also within a few minutes walking distance of Leytonstone underground station and is serviced by regular bus services. Haroldstone Home is a small family sized house, which is modern and has been recently refurbished and decorated throughout. It has 5 bedrooms all with ensuite toilet and hand washbasin. Separate bathroom and toilet facilities are provided. Resident’s bedrooms are comfortable and well maintained and reflect the residents own personal choices of decoration and personal items. All the home’s bedrooms are single. The home has a garden to the rear. The home is Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 23 not suitable for the use of wheelchairs. The home is well maintained and is in good decorative order throughout. Resident’s bedrooms are nicely decorated and residents are being offered choices in how they would like their rooms to be decorated. A repairman is regularly available to quickly carry out repairs when necessary and there are no outstanding repairs. Each residents bedroom has an ensuite toilet and sink and there are two bathrooms in the house, one on each floor available for use by residents. A separate bathroom is attached to the staff room for their use. These are in good working order and are sufficient for the needs of the current residents. Resident’s bedrooms are in good decorative order and residents have their own personal items about them in their rooms. Each bedroom contains a comfortable bed, an easy chair, a wardrobe, a chest of drawers and a wash hand basin. Social workers involved in placing the residents and monitoring the care provided have carried out 6-week care reviews, and said that they feel that the home is providing a suitable environment for the residents. The home has an integrated fire alarm system, which is under maintenance contract. There is a fire risk assessment in place and regular evacuation drills take place. The home is kept clean and tidy and well maintained. The home first opened in May 2005, and during the registration process CSCI required that the home be able to provide either a certificate of lawfulness from the local council, to show that the home has their approval to operate in the borough, or to provide written evidence that a certificate of lawfulness was not required. The home and registered provider have not yet been able to provide either of these documents. The reason for this is that the registered provider has applied to Waltham Forest Council for a certificate of lawfulness, but this application has been refused, and the council has said that Clearwater Care Ltd are instead required to put in a separate application for planning permission. The registered provider has stated that they strongly believe that planning permission is not required, giving an example of a local council in another borough in which the provider has similar care homes, specifically telling them that planning permission was not required. The registered provider is now appealing the Waltham Forest councils decision and has lodged an appeal in December 2007. A representative from the Waltham Forest Council planning office has confirmed that the appeal has been received, and is being considered before being processed. They also said that this process could in some cases take up to six months before a decision would be reached. In the meantime the representative confirmed that the home is not operating illegally, but is rather operating without their permission. While the appeal issue is being considered, the council planning office intends to investigate concerns raised by local residents regarding noise, and any undue impact the home may be having, if any, before considering any further action. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 24 The registered provider agreed to immediately inform CSCI should the council take a decision for enforcement action, and regarding the outcome of their appeal when it is known. At this point no additional requirement is being made by CSCI regarding the provision of a certificate of lawfulness, as the registered provider seems to be acting appropriately to try and address the problem and to gain a certificate. A certificate of lawfulness or written confirmation stating one is not required must be provided in due course to CSCI, in order to meet the registration requirements for this home in order to maintain registration status. It is recommended that the registered provider continue to act to get the appropriate certification for the property from the council, and to notify CSCI immediately regarding the outcome of the appeal. (Refer to Recommendation YA24) The registered provider confirmed that the homes insurances are not affected unduly by the current situation. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 25 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): 32,33,34,35 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are supported by competent and qualified staff, but further training is needed for staff to meet the specific support needs of residents. Residents are protected by the homes recruitment policy and practices and staff are well supervised and supported by the homes management. EVIDENCE: The staff team consists of a manager, a deputy manager and seven others support workers of varying levels of experience and training in working with people with people with learning disabilities. More than half of the care staff are qualified to NVQ level 2/3, with four of the eight care staff being now qualified to NVQ level 2/3. There are at least two staff on each shift during the daytime with one night waking staff providing support at night. There is a separate management on call support system to provide backup support if needed. At the time of the inspection there were two staff vacancies to which new appointments had been made. These two new staff were due to start working at the home within a few weeks. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 26 The staff and the manager were very knowledgeable about the individual needs of residents, and work sensitively in communicating with residents some of whom have limited verbal communications skills. Discussion with one resident suggested that the staff and a manager are very approachable, and very flexible when asked to provide help. The resident says that the staff do listen, and that he has settled in well with their help. The home provide support for people with learning disabilities, some of who may have other support needs such as mental health and emotional support needs, challenging behaviour, some physical support needs, and communications support needs. The home’s induction and training programme needs to include more in-depth training regarding a number of these areas. It was my observation from the care plans, and from how staff relate to residents, that they are able to work well to meet these care needs. (See standard 35 regarding further training needs for staff). Professionals involved in monitoring the care provided also commented that staff have provided a good level of competent care and support, which have enabled residents to settle in well to their new home. Examination of six staff files showed that excellent recruitment processes are in place and are being consistently applied. Very good records are being kept about staff recruitment including health and police checks, references, and checks on gaps in employment history. These are well organised, enabling the management of the home to make sure that everything is in place properly before staff begin employment. All staff undergo comprehensive induction and there are excellent records maintained of this induction, which are signed by the supervisees. Six staff files examined showed that all of these staff had undergone a detailed induction provided by the organisation and the homes manager, and other experienced staff. Good records of this induction are on file. Two care staff said that they found the induction to be very good. There is a good standard of training offered to staff, and the registered provider coordinates training. More specialised training such as medication, health and safety, fire safety, first aid, and moving in handling are contracted in from trained professionals. Training needs of staff are identified at annual appraisal and through supervision. Staff induction training includes: medication, moving and handling, fire prevention, protection of vulnerable adults, first aid, food hygiene, health and safety, death dying and bereavement, and the organisations policies and procedures. However given that the primary support needs of residents is learning disability support, the home needs to have more in-depth training regarding understanding learning disabilities included in the induction and training programme for staff. Some mental health support needs also feature amongst care needs of residents, and again more in-depth training for staff in the area of mental health support specific to the needs of the residents is needed. Non-verbal communications is another feature of residents support needs, and while residents care plans include some good information about how to work with residents in this area, Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 27 this needs to feature more prominently in the induction and training programme for care staff. (Refer to Requirement YA35) It is also recommended that the home include Person Centred Planning into the whole team-training plan. (Refer to Recommendation YA35) (See also Recommendation YA6 re person Centred Planning) The homes manager provides formal supervision for staff, and examination of six care staff files showed that staff are receiving consistent formal supervision regarding their work, residents care and support needs, training and development, and employment issues. Staff interviewed commented that they find supervision to be very consistent and very beneficial to their work. There is also an appraisal system in place, which will be used when staff employed complete their six-month probation period. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is well managed by a qualified manager who receives good support from the registered provider. Resident’s views are included in the homes system for quality assurance and planning. The home and registered provider promotes the health and safety of residents and staff. EVIDENCE: The registered manager has been in post at the home since it opened in May 2007. She has previous experience in working for the same registered provider since September 2006, managing another of the providers care homes. The manager is registered with CSCI, and is qualified to NVQ level 4 in management, having acquired an RMA and CMS qualification. She is currently in the process of completing the level 4 component, and expects to complete this in May 2008. Discussion with the manager and staff, and examination all of the homes many systems for a support for staff and residents, showed that Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 29 the manager has good management and organisational skills, and communicates well with staff and residents to give good direction and support. However there is a need for the manager to undertake some development training in some of the broader issues related to the learning disabilities field of work, and it is recommended that suitable training in relation to the learning disabilities White Paper “Valuing People”, and in relation to more current developments in mental health, such as the implications of the Mental Capacity Act 2007, be identified and completed. (Refer to Recommendation YA37) The registered provider has in place an Annual Quality Audit system for auditing the quality of the care for residents and the management of staff. This has not yet been implemented but when it is it will include a development plan for the home. Senior management for the registered provider visit the home at least every month and carry out and monitoring visit completing a short report about the care provided and observations made. The home has started to carry out twice yearly satisfaction questionnaires with residents and their family, including advocacy, and one of these has been distributed but not yet been completed. Given the home has only recently opened the quality assurance standard is not yet possible to properly assess, and this will be examined further at the next inspection. Health and safety within the home is well managed and all documentation was found to be in order and up-to-date. The home has an adequate health and safety policy, which includes risk assessment, fire safety, food hygiene, moving and handling, and all of these are included in the staff induction and training programme. Fire equipment checks are being done on a weekly basis and the home has certificates for electrical and gas appliances, which are up to date. Kitchen and bathroom areas are maintained to a high level of cleanliness and safety. Good risk assessments regarding residents support needs are also in place for the protection of residents and staff. There have been no reports under RIDDOR. Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 30 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 2 2 3 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 4 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 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NA 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 YA1 Regulation 5 Timescale for action The homes Statement of Purpose 31/03/08 must include the range of fees to be paid and state who is responsible for paying fees 29/02/08 The registered provider and manager must ensure that all residents have in their possession contracts or statements of terms and conditions, which have been agreed and signed by them or their representatives. These must include fees to be paid and all of the information required by this standard as discussed in this report The registered provider and 31/03/08 manager must ensure that the homes induction and training programme includes good foundation training in the areas of learning disability, mental health and non verbal communications, for the whole staff team as discussed in this report. Requirement 2 YA5 5 3 YA35 18.1 c i Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 32 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 YA1 Good Practice Recommendations The registered provider and manager should include more information about the philosophy of care and additional information regarding the complaints procedure as discussed in Standard YA1 of this report The registered provider and manager should begin working towards using Person Centred Planning approaches in the residents care planning system, in order to increase the residents level of involvement and ownership of their care plans The registered provider and manager should include more non verbal communications methods in care planning for one resident as discussed in this report Standard YA6 The registered provider and manager should work towards using alternative means of recording key aspects of residents care plans, so that they can be better understood by residents who cannot read or cannot easily understand the written care plans. This should be in addition to the written care plans. The registered provider and manager should consider implementing improvements to the risk assessments for residents as discussed in this report Standard YA9 The registered provider and manager should follow up on their plans to meet with local residents to discuss concerns they may have in relation to the home with a view to improving resident’s neighbourly relations. The registered provider and manager should formally review the wishes of the residents individually in relation to the holding of keys to their home and bedrooms as discussed in this report Standard YA16. The registered provider and manager should include in the next review of the homes complaints policy the issues recommended in this report Standard YA16 As requested as part of the registration process for the home, the registered provider should pursue the process that has been embarked upon as discussed in this report Standard YA24, to acquire a certificate of lawfulness for the home. CSCI should be kept informed of progress and advised immediately should they find it not possible to acquire this certificate. DS0000069518.V351691.R01.S.doc Version 5.2 Page 33 2 YA6 3 4 YA6 YA6 5 6 YA9 YA13 7 YA16 8 9 YA22 YA24 Haroldstone Home 10 YA35 11 YA37 The registered provider and manager should include Person Centred Planning in the homes training profile for staff, and consider how best to make residents aware of this process. (It is accepted that this process will take time to implement) The registered manager should undertake further additional training regarding learning disability and mental health legislation to include the White Paper Valuing People and the Mental Capacity Act 2007 Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Haroldstone Home DS0000069518.V351691.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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