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Inspection on 15/12/05 for Harrow Road, Flats A, B and C

Also see our care home review for Harrow Road, Flats A, B and C for more information

This inspection was carried out on 15th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides residents` with a good service, meeting their needs on a day-to-day basis.

What has improved since the last inspection?

Three requirements from the last inspection were met.

What the care home could do better:

Lack of a settled staff team and staff vacancies has meant that whilst residents` immediate needs are met on a daily basis, longer term planning around care provided, goals set within care plans, monitoring of progress made and recording have lapsed. This is due to time constraints imposed by staff vacancies, particularly the lack of team leaders to support the Care Manager who is doing a professional job under difficult circumstances.

CARE HOME ADULTS 18-65 Harrow Road, Flat C, 291 Flat C 291 Harrow Road London W9 3NF Lead Inspector Wynne Price-Rees Unannounced Inspection 15th December 2005 10:45 Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Harrow Road, Flat C, 291 Address Flat C 291 Harrow Road London W9 3NF 020 7266 3072 020 8968 9165 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) The Westminster Society for People with Learning Disabilities Miss Nikky Ajiboye Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th July 2005 Brief Description of the Service: The home is located in the Harrow Road with access to transport links, local shops and amenities. It is registered for up to five people with learning disabilities with each resident having their own bedroom and access to shared amenities. The home is fully equipped with aids required to enable the residents to pursue a full and active life. In particular, there are hoists connected to ceiling rails that enable two residents to walk rather than spend the majority of their time in wheelchairs. The Westminster Society for People with Learning Disabilities is the registered provider. There is currently a full occupancy. The home also has access to a minibus that increases residents opportunities to develop interests outside the home and much time is spent attending activities at day centres and on trips out. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection focused on staffing and the impact that this has on some aspects of the service. The inspection took place over three hours and three residents’ files were case tracked. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 6 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 Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not inspected. EVIDENCE: Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6. Standard six was not met. The case files tracked did not all contain up to date goals and reviews. EVIDENCE: Three residents’ files were case tracked. These contained goals and information pertinent to each individual although some of these were not up to date and reviewed within timescale or if reviews had taken place the minutes had not been written up. In a number of instances the reviews were cancelled by the relevant social workers rather than the home. One resident had short term goals dated 17/01/05 with a review date set for 21/07/05. The review was cancelled twice as social workers were not available to attend. The quality and depth of information and frequency of review varied widely within the care plans inspected. The explanation for this was that the home had not had a full staff compliment since January 2005 and those in post had concentrated more on meeting the day-to-day needs of the residents rather than forward planning. This was highlighted at the previous inspection with the staff team intending to work towards updating goals although it wasn’t achieved due to a lack of permanent staff, particularly team leaders. The staff have introduced two weekly internal case reviews and some residents had regularly received Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 9 these whilst others had not. Weekly staff meetings take place during which the needs of all residents are discussed and outlined so that staff are aware of any changes on a daily basis. Risk assessment plans were in place. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not reviewed. EVIDENCE: Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20. The medication administration records are correctly filled in and policies and procedures followed. EVIDENCE: The medication administration records for each resident were checked and found to be correctly filled in. Any gaps in the recording are checked, highlighted and followed up although staff need to record the reason for the gaps. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): This section was not inspected. EVIDENCE: Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 & 30. Residents live in a homely and safe environment, they have adequate and suitable bedroom and toilet and bathroom provision. The home is clean and hygienic. EVIDENCE: A tour of the premises showed the residents live in a safe, comfortable environment that is clean and hygienic. Requirements were made, at the last inspection for a night fire evacuation to take place and a shower chair to be repaired or replaced. Both requirements were met. The residents’ bedrooms are scheduled for refurbishment in February 2006 and they have already chosen the colour schemes. The bed in the red bedroom is old, worn and requires replacement. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Whilst competent to carry out their roles and responsibilities that are clearly defined, on a day to day basis, the lack of a consistent and permanent staff team particularly in the key team leader areas has made it difficult for staff to keep care plan information up to date and reduced their effectiveness in longer term planning. Whilst well supported by the Care Manager they do not receive adequate support from the organisation. EVIDENCE: The case files inspected demonstrated that the long time span of two team leader and support workers vacancies has meant that the longer-term planning and development progress of residents within the home has lapsed. This is counter balanced to a degree as many of the activities are provided at day centres during the week and there are adequate staff on duty to carry them out on the weekend. A full programme of Christmas activities is planned including each resident accompanying their key worker on shopping expeditions. The staff shifts have been covered by a combination of bank and agency staff that meets needs in the short term with one agency worker put on a short contract to provide continuity. However the home has not had a full staff compliment since January 2005. A team leader was recruited in July but only stayed for two months. This indicates that either the role is not clearly defined as part of the recruitment procedure or the procedure requires re-visiting. The staff spoken with said that staff moral within the home is high due to having a Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 15 good Care Manager in post although they feel increasingly frustrated by a lack of support from the organisation which they feel consists of “Empty words”. The care practices observed were professionally pursued and appropriately carried out. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 39. The home benefits from a well run home on a day-to-day basis although this does not appear to be underpin by an efficient quality assurance system. EVIDENCE: The home has an experienced and efficient Care Manager who is performing well under difficult circumstances stemming from the lack of team managers in post, meaning it has become difficult to delegate areas of responsibility and resulted in an unacceptable workload for one individual. This is exacerbated by staff feelings that they receive only tacit support from the organisation and reflected by the failure to pick up these problems within the monthly unannounced management visit reports that are forwarded to the CSCI local office. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 2 X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 2 2 3 2 CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Harrow Road, Flat C, 291 Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X X X DS0000010875.V273122.R01.S.doc Version 5.0 Page 18 YES 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 YA6 Regulation 15 (1) & (2) Requirement The care plan information system must be reviewed with all current relevant information contained in one working file. Outdated information must be archived. This is a repeat requirement. Care plan reviews must take place within timescale and be written up within two weeks. The bed in the red bedroom must be replaced. The organisation’s recruitment procedure, job description and person specification must be reviewed. Vacant posts must be recruited to. This is a repeat requirement. The organisations’ quality assurance system must be reviewed so that it reflects the situation within the home and more organisational support given to the staff team and care manager. Timescale for action 01/03/06 2. 3. 4. YA6 YA25 YA34YA33 15 (1) & (2) 16 (1) (c) 18 15/12/05 01/02/06 01/04/06 5. 6. YA33 YA39YA36 12(1)(a) & 8(1) (a) 18 & 24 01/04/06 01/01/06 Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 19 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 YA20 Good Practice Recommendations Any gaps in the medication administration records should have a written explanation. Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harrow Road, Flat C, 291 DS0000010875.V273122.R01.S.doc Version 5.0 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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