Inspection on 16/10/07 for Harrow View, 157

This inspection was carried out on 16th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harrow View, 157 08/11/06

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 Harrow View, 157 157 Harrow View Harrow Middlesex HA1 4SX Lead Inspector Judith Brindle Key Unannounced Inspection 16th October 2007 08:30 Harrow View, 157 DS0000065615.V346195.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 Harrow View, 157 DS0000065615.V346195.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. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harrow View, 157 Address 157 Harrow View Harrow Middlesex HA1 4SX 020 8537 5392 020 8537 5392 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) Residential Care Providers Ltd Mr Nigel Brookarsh Care Home 5 Category(ies) of Learning disability (5), Physical disability (2) registration, with number of places Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2006 Brief Description of the Service: 157 Harrow View is a care home providing personal care, and accommodation for up to 5 adults with a learning disability, two of whom could have a physical disability. The registered owner is Residential Care Providers Ltd. The registered manager is Mr Nigel Brookarsh. The care home was registered by the Commission for Social Care Inspection in March 2006. The home is situated in a residential street close to central Harrow; within a few minutes walk from a variety of shops, restaurants, library, banks and other amenities. There are also a variety of local shops, and public bus and train facilities accessible close to the home. The property is in keeping with other houses in the vicinity, and consists of four single bedrooms rooms and a self contained flat. Two of the bedrooms are located on the ground floor. The flat has been designed to meet the needs of a resident who requires residential care support, but who does not benefit from communal living. There is parking for 2 cars at the front of the house. There is an enclosed garden at the rear of the property. Information and documentation about the service is accessible to prospective residents, residents, and significant others. Fees vary in regard to the needs of the individual residents, and this information is available from the registered manager. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout a day in October 2007. There was one vacancy at the time of the inspection. I was pleased to meet two people living in the home. The staff on duty that were very helpful during the inspection, and supplied all documentation, and information that I requested. Due to the severe learning disability and vocal communication needs of a person living in the home, the person was unable to respond to questions, so observation was a significant tool used in this inspection. Documentation inspected included, resident’s care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. The registered manager was present during a significant part of the inspection. Assessment as to whether the requirements and recommendations from the previous key inspection (8th November 2006) had been met also took place during the inspection. 28 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. Prior to this unannounced key inspection the registered manager supplied the Commission for Social Care Inspection a completed Annual Quality Assurance Assessment (AQAA) document. This document includes required information from the owner/registered manager about the quality of the care home and about the plans to improve the service. All sections of this document were comprehensively completed. Reference to some aspects of this AQAA record will be documented in this report. The inspector thanks the people living in the care home, staff and the manager for their assistance in the inspection process. What the service does well: The home has a welcoming and homely atmosphere. The manager and staff show a high level of enthusiasm and commitment to their work in the home to ensure that residents receive a quality service. The manager and staff demonstrated a good knowledge of the people living in the service and were able to recognise their individual needs and how to respond appropriately to them. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 6 The home provides a high standard of care, and support to a group of people with a range of complex/multiple needs, and seeks to ensure that residents are supported in enabling them to lead a quality life, based on these needs. The home by working consistently and professionally with the residents in partnership with other care professionals is able to support the residents to make significant progress with their personal development. The home is very clean, comfortable and homely and the residents each have an attractive single bedroom. Some of the people living in the home have close contact with families and friends and this is promoted by the home. People living in the home are supported in participating in a variety of preferred activities and leisure pursuits. 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. The summary of this inspection report can be made available in other formats on request. Harrow View, 157 DS0000065615.V346195.R01.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 Harrow View, 157 DS0000065615.V346195.R01.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): Standards 1,2,4 and 5 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live. Arrangements are in place to ensure that prospective resident’s needs are assessed. EVIDENCE: The care home has a statement of purpose and a service user guide. The service user guide is available in pictorial as well as written format. The manager could continue to review the format of the service user guide (for example audio, and other innovative methods) to make the information meaningful to those residents who are unable to read or understand picture format and have complex communication and significant sensory needs. This was discussed with the manager. The care home has an admission procedure. This includes the manager/provider carrying out a comprehensive initial assessment of the needs of the prospective resident. The care home has had one person admitted to the care home since the previous key inspection (8th November 2006). One completed initial assessment carried out by the manager was available for inspection. Following the inspection the manager confirmed that Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 9 he would ensure that copies of all initial assessments carried out by him would be accessible in each plan of care. The manager confirmed during the previous inspection that family, and significant others are included in the assessment process, particularly when the prospective resident has complex needs, which include communication needs. An assessment completed by the Local Authority, which was funding that person was available for inspection. Prior to their admission the manager informed the Commission for Social Care Inspection (CSCI) of details of the person most recently admitted to the care home. It was evident that significant assessment information is obtained from the previous placement. Staff spoke of the importance of this information being incorporated into the resident’s plan of care. I was informed that the assessment process continues following the person being admitted to the home, and that regular review of the resident’s needs take place. The manager spoke of a ‘6 week’ review, following a resident’s admission was in the process of being planned. Care plans inspected included evidence of assessment, and personal profile information. This includes assessment of health, personal care needs, mobility, and sensory needs, social and religious and cultural needs. It was evident from speaking with the manager that he had knowledge and understanding of the importance of carrying out his own comprehensive assessment of prospective residents as well as receiving assessment information from the funding Local authority. I was informed that the transition process for people moving into the care home varies depending on their needs and preferences, and with the full involvement of Care Managers and relatives/significant others. The manager informed me that introductory visits are planned prior to making any decisions about admitting the prospective resident to the home. Records and staff confirmed that most residents had had several visits to the home prior to their admission, and that their relatives and the Care Manager also visited the care home prior to resident’s admission. AQAA (Annual Quality Assurance Assessment) information confirmed that overnight stays are offered, and that a key worker is allocated to the prospective resident to assist the person in the transition process. Records and staff confirmed that there had been numerous transition meetings with family and health and social care professionals prior to the person most recently admitted to the care home, moving in. AQAA information confirmed that there are contracts between the resident and the home (statement of terms and conditions). Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 10 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): Standards 6, 7 and 9 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all residents have a plan of care, which reflect their needs, changing needs and goals. Initial care plans could be more comprehensive to ensure all initial needs are included in the plan of care. Residents are supported and encouraged to make decisions and choices, and are supported to take risks as part of an independent lifestyle. There could be some development in risk assessment. EVIDENCE: All the residents have a plan of care. These include a record of individual identified assessed needs including physical, personal, and social needs. There was evidence that these are regularly reviewed, and that there is recorded staff guidance to ensure that people using the service have their needs met. The manager spoke of being in the process of completing the care plan for a resident newly admitted to the care home. The various files incorporating the Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 11 information about the resident were inspected. These contained information from the previous placement, the Care Manager, and from a variety of health professionals. A document recorded the care and support needs and the action to meet those needs. This included an individual plan update dated 3/10/07, and included behaviour, communication needs, family contact, medication, personal care, and day care needs. This could have included the significant sensory needs, dietary needs (in regard to weight loss and religious dietary needs) and particular medical needs (including epilepsy needs), of the person, particularly as information about these needs were not easily accessible in the large care plan file. This was discussed with the manager who spoke of the care plan being in the process of being developed. Following the inspection the manager supplied the Commission with a copy of an individual plan update following a review of this residents needs. This included much more comprehensive information and included staff guidance to meet these assessed needs and timescales in which goals/needs were to be reviewed, and the manager confirmed that an epilepsy protocol had been completed for a resident. A previous requirement in regards to this issue was judged to have been met. Staff guidance to ensure that individual needs are being met was documented in the care plans inspected. Other care plans inspected had been further developed and included some evidence of a person centred approach, including ‘mapping’ with the resident being central to their care plan. Care plans from the placing/funding Local Authorities were accessible in resident’s personal care plan files. Daily’ and night resident’s progress records are documented. Staff were observed to interact with residents (who were at home during the inspection) in a sensitive and respectful manner during the inspection, and it was evident that staff had a good understanding of the significant needs (particularly communication needs) of one of the residents. Choice was offered to a resident frequently during the inspection, and the person was supported in making decisions. A staff member was observed to frequently interact with a resident, talking to the person and supporting them to make decisions. Recorded guidance from a speech and language therapist (from the previous placement) was in place to facilitate staff to support a resident to make choices and to aid staff to communicate with the person in a positive and constructive manner. This includes information for staff to enable them to assist the resident to make choices, such as encouraging them to use their other senses such as touch and smell. AQAA information informed me that the care home has difficulty in accessing advocates for each resident, but that efforts continue to be made to achieve this objective. Staff who spoke with me had knowledge, and understanding of their key worker role. They gave examples of the activities that they participated in as a key worker, which included being fully involved in the review of their key Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 12 person’s (the resident) varied needs, and supporting the residents to purchase personal items, including toiletries and clothes. Risk assessments include areas of potential risk that are managed positively to help the people using the service to lead the life that they want. These recorded evidence of having been recently reviewed. Risk assessments, which included bathing, eating and drinking, choking and moving and handling, and ‘unsociable behaviours’ such as spitting. These could be further developed to include other risk assessments such as nutritional assessment and risk of falls. Behaviour management strategies are in place to ensure that staff are consistent in managing possible ‘challenging’ behaviour from residents using the service. AQAA information informed me that ‘challenging behaviours’ from residents have reduced since living in the care home. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 13 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): Standards 12, 13 14, 15, 16, 17 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the care home have the opportunity to take part in a variety of activities including those promoting personal development. Arrangements are in place to enable people living in the care home to maintain contact with family/significant others, as they wish. The people living in the care home has their rights respected, and their responsibilities are recognised in their daily lives. Meals are varied and wholesome. EVIDENCE: The home focuses significantly on ensuring that residents have a quality social life. Residents each have an individual activity programme. Staff and records confirmed that the people living in the home had the opportunity to participate in a variety of preferred activities. I was shown an album of pictures of Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 14 activities, which was used as an aid by staff to communicate with a resident about various activities and places (such as shopping, favourite restaurants, places for day trips). A resident attends a day resource centre during the weekdays. Records confirmed that activities are varied and include regular local walks, shopping, college, cooking sessions, relaxation sessions, massage, foot spa sessions, attending a gym, and going on trips out. Some of these activity sessions were intermittently recorded, for example the last record of a ‘meal preparation session’ for one resident was 13/08/07, and a ‘room tidy’ session in regard to a person using the service was recorded as 5/9/07 (the plan records that the ‘room tidy’ session should take place weekly). Staff should ensure that all records are kept up to date to ensure that it is evident that activities are recorded. Several residents are unable to verbally communicate their preferences in regard to activities, but it was evident from talking to staff that they have a good understanding of the leisure pursuits that meet the preferred needs of residents. Activity plans are drawn up to ensure that they are focused on the preferences and abilities of each person using the service, and activities for each resident are planned daily. A record is maintained of a resident’s (who is unable to verbally communicate, but makes sounds) response to activities, for example laughing. A staff member spoke of a resident ‘loving music’. This resident had the opportunity to listen to a variety of music during the inspection. Another person using the service went shopping with a staff member during the inspection, and a resident received a hand and foot massage, which they appeared to enjoy very much. This resident also went for a walk with a staff member, and it was evident that this was an activity that she got pleasure from. Staff informed me that this resident, when living in their previous care home had seldom accessed the community, due to their particular unsociable behaviour. Since the last key inspection the care home has purchased a passenger vehicle adapted to carry residents, with varied mobility needs, including those who use a wheelchair. This is positive. Staff spoke of the vehicle being used frequently and commented that residents enjoy trips out in the vehicle, and of how it is regularly used by residents for visiting their families. I was informed that residents are supported by staff to travel significant distances to enable them to continue with previous day care arrangements, and to attend preferred clubs. I was informed by staff that a resident regularly attends a place of worship, and that another resident attends an Asian social club. Another resident regularly visits a pub in Harefield, which he spoke of enjoying meeting the regulars. I was informed that this was an activity that he enjoyed prior to living in the care home. Staff spoke of the support given to residents in assisting them with participation in everyday living skills such as helping with the laundering of their clothes. The people using the service have the opportunity to develop and maintain personal and family relationships. Staff spoke of the close contact that some Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 15 residents have with their families. A resident was visiting their relatives at the time of the inspection. I was informed that another resident goes to his parent’s home regularly, and enjoys regular holidays in their company. Daily routines that promote independence and choice are assessed and documented in the care plan. Staff spoke of how family members and others were fully involved in the care plans of people using the service. Visits by relatives and others are recorded. Care staff cook the meals. AQAA information confirmed that all staff have received training in safe food handling. Each resident has an individual menu. These recorded varied wholesome meals. Changes to the menus are documented. Staff spoke of shopping for food once a week, and of using pictures to help residents who have communication needs to choose their food preferences. A staff member went food shopping with a resident during the inspection. Staff informed me that fresh produce is bought locally as, and when needed. A staff member spoke of the ways that staff ensure that residents have fruit in their diet, which include adding it to breakfast cereal. . Staff were knowledgeable of the cultural dietary needs of residents. A staff member spoke of cooking particular ‘Asian’ meals for one resident. Clear recorded staff guidance for meeting a resident’s dietary needs, and assistance needed with their meals was accessible. This included information about the person’s food preferences. Records and from talking to staff confirmed that staff had knowledge and understanding of possible ‘high risk’ foods which a resident should not be offered due to the risk of choking. Records of food eaten were generally documented but there were some gaps in recording some meals. All meals eaten by residents should be recorded. Residents weight is monitored. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 16 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): Standards 18, 19, 20 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s personal and healthcare needs are met. Medication is stored and administered safely. EVIDENCE: The care plans recorded assessment of resident’s personal care and health needs. It was evident that the people living in the care home have the support and care that they need to meet their personal care needs. Resident’s preferred morning and evening routines are documented. Staff respected privacy when they assisted residents with personal care. Records confirmed that the personal care needs of residents were issues in which family members were much involved and it was evident that views of relatives were listened too. Personal care needs are discussed and agreed during the review of the care plans. Health needs of people using the service are monitored, and appropriate intervention by staff taken as and when needed by people using the service. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 17 Records confirmed that residents have their health needs monitored, and have access to care and treatment from a variety of healthcare professionals. These include GP appointments, optician, dentist, psychiatrist, and chiropodist. Hospital appointments are attended by residents as and when needed. A care plan included a comprehensive up to date Health Action Plan, and evidence of an annual health check for that person having been carried out. AQAA information informed me that the home plans to focus upon health action planning for residents within the next twelve months. The home has a medication policy/procedure. This needed to be further developed, for example it is important to include the course of action to be taken by staff if there is an error regarding the administration of medication. Following the inspection the Commission for Social Care Inspection was supplied by the manager/provider with a copy of a reviewed and improved medication policy/procedure. The medication is stored securely, and medication administration records inspected had no gaps in recording. The manager reported that all staff complete comprehensive medication training, and that generally two staff administer and/or witness the administration of medication to the residents. Staff had received appropriate training from a community nurse to administer this medication. The manager reported that all staff have received specific training regarding the administration of medication to be used if a resident has a prolonged seizure. Records confirmed that a resident’s agreed (with family) wishes after death and during serious illness were recorded in their care plan. This is positive. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 18 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): Standards 22, and 23 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled appropriately. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints policy. There are no recorded complaints. A staff member who kindly spoke with me was fully aware of the reporting and recording procedures in response to a complaint/concern made from a resident and/or visitor. Though there was evidence of the complaints procedure being in pictorial format, the manager could examine ways of developing the complaints procedure format (such as audio) to improve its accessibility to people using the service. The manager spoke of plans to improve and develop the format of documentation within the care home. Staff who spoke with the inspector were knowledgeable of the reporting and recording procedures in regard to an allegation or suspicion of abuse. Records and staff confirmed that staff had received protection of vulnerable adults training. I was informed that abuse awareness was part of the staff induction programme. I was informed that some residents have their allowances and other finances managed by their family or the Court of Protection. The manager has to Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 19 request funds from family members/solicitor for any purchases needed by the residents. Relatively small amounts of resident’s cash is kept in the home. Two residents’ financial records of expenditure and incoming funds were inspected. These records were up to date with receipts of expenditure available for inspection. The manager should include individual assessment of the financial needs including benefit allowance entitlement, of each resident in their care plans (as part of ‘person centred planning), and ensure that these needs are reviewed regularly. A member of staff has the responsibility to ensure that resident’s financial records are documented appropriately. The manager said that he audits receipts and balances regularly. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 20 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): Standards 24, 26, and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. EVIDENCE: The inspection included a tour of the premises. The home is in keeping with other houses in the vicinity. It is suited for its stated purpose. The home consists of 4 single rooms, and a self contained flat. The flat is on the first floor of the home and has a bedroom, living/dining / kitchen area, shower /toilet and small utility room. The registered /manager could examine ways improving the orientation of the home for residents and others, such as using signage on doors of bathrooms, and could seek advice from organisations such as the RNIB (Royal National Institute for the Blind). The home has ramps at front and back with suitable gradients for wheelchair users. Handrails are located throughout the care home. Public transport facilities are accessible close to the care home. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 21 A resident kindly showed me his accommodation. He spoke of enjoying living in the flat. The flat and the rest of the home are light, clean and odour free. There are pictures and paintings displayed throughout the care home. A staff member reported that a resident had painted several of these pictures. A large television is located in the communal sitting room. Furnishings and fittings were judged to be of quality. The ground floor of the care home is accessible to wheelchair users. The garden is attractive, well maintained and accessible to residents. I was informed that residents often enjoy spending time in the garden during warm weather. AQAA information informed me that there were plans to develop a day resource centre in out buildings at the rear of the garden. The garden at the rear of the property is enclosed and there is a patio area with seating for people living in the care home. It was observed that when staff were in the kitchen with the door closed they were unable to hear the doorbell. Staff spoke of the plans to carry out work to ensure that the doorbell could be heard from the kitchen area. This needs to be completed promptly. Bedrooms were observed to be attractive and individually personalised. The home has an infection control policy/procedure. Soap and hand towels were located in the bathrooms/toilets inspected. Staff were observed to wear protective clothing as and when needed. Care staff carry out the household duties. A ‘cleaning’ rota was available for inspection. Following the inspection the Commission for Social Care Inspection was informed by the manager that a dishwasher was now in place in the home. This was a previous inspection recommendation, judged to have been met. Laundry facilities are located away from food storage and food preparation areas. There is an industrial washing machine and clothes dryer. AQAA information informed me that all staff receive infection control training. The manager and records confirmed that the home had recently received an award of four stars following a food safety inspection from the Environmental Health department. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 22 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): Standards 32,34, 35 and 36 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. EVIDENCE: The staff rota was available for inspection. Each staff shift is clearly documented. This documentation confirmed that there were two to three care staff on duty during the day. Two care staff and the registered manager were on duty during the inspection. There is one ‘wake night’ staff member on duty at night. There are photographs of the staff employed in the home displayed in a communal area of the home. I was informed that there is a low staff turnover rate, and that agency staff were not employed by the care home. The care home has a staff communication book, which was seen to be well used by staff for messages to each other about issues to do with the home and the service provided to residents. There is also a staff ‘handover’ file, which includes a shift planner that records the daily individual duties of staff. It was Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 23 evident from speaking to staff that they had a good understanding of each residents needs and of how to support residents in meeting those needs. Staff informed me that staff meetings take place regularly. The home has a recruitment and selection policy/procedure. Two staff files were inspected. These contained most of the required information and documentation, including evidence of an enhanced Criminal Record Check. The manager obtained copies of some staff references (which had not been accessible in one staff file) during the inspection. Following the inspection he confirmed that he would ensure that each staff file included all required staff personnel information. The registered manager reported that care staff have completed NVQ (National Vocational Qualification) level 2 and/or level 3 in care, and that a member of staff is planning to complete a relevant NVQ 4 qualification. A staff member spoke of having completed NVQ level 2 care qualification, which she reported had been helpful in developing her skills and knowledge for her role and responsibilities. The staff member spoke of having received training that had included medication training, health and safety training, food and hygiene training basic 1st Aid, and other appropriate training. She confirmed that she had received a significant amount of training including managing ‘challenging behaviour’, which is relevant to the specific needs of some residents. The manager confirmed that all staff receive statutory training and other training relevant appropriate to their roles and responsibilities. This staff training includes ‘in house’ training with the use of videos/DVDs and questionnaires. Certificates of staff training were available for inspection. There should be an up to date staff training plan. This was a previous inspection recommendation. The manager said that he was in the process of completing this. The manager informed me that all staff receive an induction programme when they start work in the home. AQAA information informed me that there were plans to further develop and improve the staff induction. A staff member started their first shift in the care home during the inspection. This staff member spoke of having visited the home during the recruitment process, and was observed to be reading care plans. AQAA information informed me that equal opportunities training is included as part of the staff induction programme, and that there were plans to ensure that staff develop their understanding of the religious and cultural background of residents and families. This is positive. Staff spoke of receiving regular staff 1-1 supervision. A supervision session was planned for the day of the inspection. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 24 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): Standards 37,39 and 42 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the care home. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The registered manager has many years experience of working with residents who have a learning disability. He has worked in care support services for adults with a learning disability since 1986, and has worked in a variety of care and support settings including day services and residential care services. He has also managed a care home with adults with a learning disability prior to Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 25 managing 157 Harrow View. He has a Diploma in Social Work, BA (hons), and completed in June 2005 a NVQ 4 in management, and is a qualified moving and handling instructor. The registered manager spoke of ensuring that he regularly updates his skills by completing varied appropriate training. He comprehensively completed the AQAA documentation, which he supplied to the Commission prior to the inspection. It was evident from this record that the manager/provider is committed with his staff team to provide a quality service to residents, which is based upon their individual needs. The manager is motivated and proactive in developing and improving the service and participates fully in the provision of care and support to the people using the service, and ensuring that the staff have the qualities and competencies to carry out their roles and responsibilities. The manager recognises where improvements to the service are needed (such as some aspects of paperwork) and responds appropriately. He promptly acted upon issues noted in the inspection, and the Commission was informed of improvements to the service made by him. The home has a quality assurance policy/procedure. The manager informed me that there had been an independent audit of the service recently carried out, and had included a strategy for development. He confirmed that action would be taken to meet the recommendations from this. Following the inspection the Commission for Social Care Inspection was supplied with a Service Development Plan completed by the manager. This included information in regard the issues regarding the service that needed to be addressed, and a record of the plans to improve and develop the service. The manager and records informed me that there was positive feedback from relatives, professionals and others about the service provided by the care home. The manager carries out a monthly check in regard to the health of residents, accidents, behaviour issues of people using the service and care plans. The AQAA information informed me that the manager understands the importance of listening to stakeholders who use and/or are involved in the service. Appropriate policies and procedures are accessible in the care home and recorded evidence of being up to date. Certificates of worthiness including servicing of gas, fire and electrical systems were up to date. Fire drills take place as required, and the care home has an up to date fire risk assessment. Individual fire safety risk assessments are recorded, and fire safety guidance is displayed. Records confirmed that staff receive regular fire training. There were no obvious health and safety issues apparent during the inspection. Household cleaning products are kept securely. Accidents and action taken to prevent further occurrence of accidents/incidents are recorded. Fridge and freezer temperatures are monitored closely. An up to date employers liability insurance certificate was displayed. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 26 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 3 2 3 3 X 4 3 5 3 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 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 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 3 12 3 13 3 14 4 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 4 X 4 X X 3 X Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 27 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 YA24 Regulation 23(2) Requirement A system needs to be in place to ensure that the doorbell from the front door can be heard in the kitchen. Timescale for action 01/01/08 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 manager could continue to review the format of the service user guide (for example audio, and other innovative methods to make the information meaningful) to improve its accessibility to those residents who are unable to read or understand picture format and have complex communication and/or sensory needs. Initial care plans could include all the primary needs of a resident, to ensure that this information is easily accessible by staff. Risk assessments could be further developed to provide evidence that risks are managed positively to help people using the service to lead the life that they want, and that any limitations on freedom, choice or facilities are always in the person’s best interests. DS0000065615.V346195.R01.S.doc Version 5.2 Page 28 2 3 YA6 YA9 Harrow View, 157 4 5 YA12 YA17 6 7 YA22 YA23 8 YA24 9 YA35 Staff should ensure that all records are kept up to date to ensure that it is evident that activities are recorded. • The format of the menu should be reviewed to improve its accessibility to residents, and it should be prominently displayed. • The registered person should ensure that there are no gaps in the recording of meals eaten by residents. Previous recommendation The manager could examine ways of developing the complaints procedure format to improve its accessibility to people using the service. The manager should include individual assessment of the financial needs including benefit allowance entitlement, of each resident in their care plans (as part of ‘person centred’ planning), and ensure that these needs are reviewed regularly. The registered /manager could examine ways of improving orientation of the home for residents and others, such as using signage on doors of bathrooms, and could seek advice from organisations such as the RNIB (Royal National Institute for the Blind). Staff should have an up to date individual training plan. Previous recommendation. Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Harrow View, 157 DS0000065615.V346195.R01.S.doc Version 5.2 Page 30 - 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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