Inspection on 22/05/06 for Harwood Road

This inspection was carried out on 22nd May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harwood Road 16/06/08

Harwood Road 23/05/07

Harwood Road 08/03/06

Harwood Road 04/10/05

Harwood Road 21/03/05

Harwood Road 04/10/04

Harwood Road 09/02/04

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

CARE HOME ADULTS 18-65 Harwood Road Harwood Road 95-99 Harwood Road Fulham London SW6 4QL Lead Inspector Sheila Lycholit Unannounced Inspection 22 May 2006 10:30 Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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 Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Harwood Road Address Harwood Road 95-99 Harwood Road Fulham London SW6 4QL 020 7731 7142/45 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) stuart.johnston@hestia.org Hestia Housing Mr Obinna Chukwudi Agunwah Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th March 2006 Brief Description of the Service: Harwood Road is a registered care home providing accommodation and support for fifteen people with mental health needs. Three women and eleven men are living in the home and there is one vacancy. The service is provided by Hestia Housing in a building owned and maintained by Shepherd’s Bush Housing Association. The building consists of three Victorian terraced houses that have been converted into an inter-connecting building. Thirteen service users have a selfcontained flat with kitchen facilities and an en suite shower or bath and lavatory. Two people have a single room and share a bathroom and kitchen. The flats are situated on the ground, first and second floor of the building. There are two sitting rooms, one smoking and the other non-smoking, on the lower ground floor. There is also a patio/garden area to the rear of the home. The service is not suitable for anyone with a mobility problem, as there is no lift and all areas are accessed by a number of steps, including the front entrance. Staff provide support throughout the day and evening, with two members of staff sleeping-in at night. The home is well located close to Fulham Broadway, providing good access to transport links and local amenities. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place from 10.30AM until 3.40PM on Monday 22nd May 2006. The Manager had recently completed a pre-inspection questionnaire. Three Project Workers were on duty. The Manager arrived at 12PM. Fourteen service users were in residence. By the afternoon most of the service users had left the building to attend activities or keep appointments. The Inspector met the majority of service users when they called into the office or on a tour of the building. One service user was interviewed in her room. The Inspector spoke with the Manager and two staff in private. 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. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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 Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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): 1, 2, 3 and 5 The quality of outcomes for these standards is good. Comprehensive information about the service is available, although some updating is required. Staff work with the local multi-professional mental health teams to ensure that a full assessment is available before a service user is admitted to the home. EVIDENCE: The statement of purpose is available in the office and the Inspector looked at a copy of the guide, which a service user had in his room. Both documents were comprehensive but contained some out of date information. The statement of purpose and guide should be dated and be regularly reviewed and re-issued to service users. Three service users’ files were looked at, including the file of the most recently admitted tenant. Each contained an assessment of the person’s needs, a care plan and risk assessment. Hospital discharge reports provided detailed information about the person’s mental health history and treatment. Each file had a copy of a tenancy agreement. The recently introduced induction checklist for new service users had been completed for the newest tenant. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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, 7, 8 and 9 The quality of outcomes for these standards is good. Care plans are well written and are regularly reviewed. Service users are supported to live as independently as possible and to make their own decisions. EVIDENCE: The three care plans seen were up to date and regularly reviewed. Review dates are monitored on a white board in the office. Care plans show that service users are supported to manage their mental health problems and to develop daily living skills and a routine, with the longer term objective of moving on to more independent accommodation. It is accepted that some service users will continue to need the level of support provided at Harwood Road. Many of the service users are supported by the Care Management Approach. Each service user has a key worker, with whom they have regular one to one sessions. The key worker writes a monthly summary, which is agreed and signed by the service user. Key worker summaries were well written, showing progress made and setting out plans for future work. Daily notes are also written for each service user. Service users were positive about the support they received and the accommodation provided. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 9 Risk assessments were well written and regularly reviewed. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 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): 12, 13, 14, 15, 16 and 17 The quality of outcomes for these standards is good. Service users are well supported to take part in a range of activities outside of the home and to maintain links with the community. EVIDENCE: Records show that service users take part in a range of activities, including attendance at local mental health day services and adult education classes. Most service users go out each day, either to an organised activity or to shop for food or to use local services. The Inspector found only two service users were at home in the afternoon to discuss their views of the service. There is a bookcase in the non-smoking sitting room, with a range of books, including novels and reference books. There is also a PC but it is not connected to a printer, nor does it have internet access. As a number of service users have expressed an interest in developing computer skills, a PC with internet access should be considered. The smoking sitting room has a TV with connection to Sky. Minutes of service users’ meetings show that day trips and summer holidays are arranged. One service user said that he was going to Ireland for a week, which he was arranging himself. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 11 Service users meetings take place every two weeks. The notes of the meeting are typed up and displayed on the notice board. The notes show that attendance and participation at meetings is good and that a range of issues are discussed. Some service users undertake work in the building, for which they are paid. Service users are provided with breakfast, consisting of toast and cereals, which is available in the main kitchen. Staff prepare Sunday lunch for all service users. The menu, usually a roast, is chosen at the service users’ meetings. For other meals, service users are given an allowance for food of £23 per week. Staff say that all but two service users are able to prepare meals without assistance. One of the service users normally eats out. One service user is prescribed a food supplement. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 12 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): 18, 19 and 20 The quality of outcomes for these standards is good. Service users receive individualised support from staff to manage their mental health problems. Attention is paid to service users’ health care needs, with referrals to GPs and specialist services. A system to support service users to handle their own medication is in place, although risk assessments must be reviewed more frequently. EVIDENCE: Staff provide psychological support rather than physical care to service users, although one service user does need help with bathing and others need prompting with personal hygiene. The care plan for the service user who needs assistance with bathing is generally well written but it is recommended that additional information is available regarding bathing to ensure that other staff follow the same routine as his key worker. Records show that health care needs are given attention, with referrals made to GPs. Service users are supported to keep appointments with Opticians, Dentists, Podiatrists, Audiologists and other health professionals, as well as members of the Mental Health Team. The home uses the Boots system for prescribed medication. The Boots Pharmacist visits every 3 months and carrys out an audit . The report of her last visit on 31st March 2006 was not available on file. Issues raised in her previous report in December 2005 have been addressed; no sticky labels are Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 13 used on MAR sheets; no alterations to MAR sheet entries were seen and codes were used appropriately. Four service users have been assessed as being able to manage their own medication to a varying degree. A system to enable suitable service users to gradually take responsibility for their medication is in place. Service users have a lockable drawer in their rooms for medication. The file of one service user who manages his own medication was seen. The risk assessment for selfmedication had not been reviewed since 2004 and it was not clear from the file that the Mental Health Team had been involved in the original assessment regarding self-medication. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality of outcomes for these standards is good. Systems to protect service users and to handle concerns and complaints are in place. EVIDENCE: The complaints record showed that 13 complaints were dealt with in the past 12 months. These mainly concerned maintenance problems, in particular problems with the lack of hot water. The Manager confirmed that hot water is now available via an immersion heater but that one of the boilers’ needs to be repaired or replaced. Complaints records and notes of service users meetings show that concerns and complaints are taken seriously and that staff take steps to resolve issues raised. The home has an adult protection procedure. Training records show that all permanent staff have attended training in the protection of vulnerable adults. A new procedure for handling service users finances has been introduced. Staff hold money for only one service user at present. His finance record sheet was seen, showing that he is given small amounts each day, with the balance remaining noted. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 and 30 Harwood Road provides a good standard of accommodation, with the majority of service users having a private flatlet with facilities for independent living. Communal areas are well maintained and kept clean and tidy. EVIDENCE: The Inspector looked at all communal areas and three bedrooms, including the vacant room. The building consists of 3 Victorian terraced houses that have been adapted to provide 13 self-contained flatlets and two rooms with a shared kitchen and bathroom. The flatlets have kitchen facilities, including a full size cooker and an en suite bath or shower room. Rooms seen were in a good state of decoration. One service user was in need of a lampshade on a ceiling light, though she commented that she was happy with her room, having moved from elsewhere in the building. The vacant room was in need of cleaning, with food left on the floor. The notes of residents’ meetings indicate that there have been problems with the hot water and heating system, which the Manager confirmed. The home is relying on an immersion heater for hot water. The Manager has expressed his concern to the Housing Association about the delay in replacing or repairing the boiler. There are two communal sitting rooms on the lower ground floor, which are spacious and pleasantly furnished. Both rooms have TVs and music centres and there is also a piano. The non-smoking sitting room leads out to the Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 16 garden, which is on two levels. There was some furniture and equipment waiting to be disposed of, which staff said that the Council would be collecting shortly. The main kitchen is also on this floor. There is a laundry room with a commercial washer and a drier. A service user doing his laundry commented that these newer machines washed well compared with the old equipment. All communal areas were clean and tidy at this unannounced visit. Sash windows open on the stairs had no restrictors. Staff undertook to ensure that these were fitted and said that the restrictors must have been removed when the frames were painted and not replaced. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 17 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): 32, 33, 35 and 36 The quality of outcomes for these standards is adequate. There are sufficient staff to provide individual support to service users. While staff have access to NVQ training, the Manager has experienced difficulty in ensuring that all staff attend basic training, including health and safety training. A system of regular staff supervision needs to be established. EVIDENCE: The staff team does not currently meet the standard of 50 of staff holding a NVQ2 or above but this should be rectified later this year, as a number of staff, including temporary staff, are undertaking NVQ training at level 2 or 3. Staff training records show that new staff have not completed basic training including health and safety and fire safety. The Manager explained that there has been a delay in issuing the training programme for 2006/7, which runs from April 1st. He has been trying to obtain funding to arrange training for the staff team at the home because of the delay. Staff rotas allow for 3 staff on duty during day shifts, with two staff sleeping in overnight. The Manager normally works office hours. Rotas allow for a handover period. Records show that regular staff meetings are held weekly or every 2 weeks. Good records of team meetings are kept. In view of the issues discussed, including support for service users, it is recommended that all staff sign the notes of the meeting to confirm that they have been read. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 18 A regular system of staff supervision is not in place. The current Manager, who is acting up, explained that this had not been re-established following the move of the previous Manager to another home, leaving him with supervision of all the staff. Other senior staff need to complete training before some supervision can be delegated. There is a system of annual staff appraisal. Recruitment is undertaken by the Manager with Hestia Housing’s HR team. Staff personnel files are kept at head office and were not seen at this inspection. Confirmation of CRB checks has been provided to the CSCI. The Manager said that few agency staff are used as cover is provided by Hestia’s bank staff. Where agency staff are used, the agency is asked to confirm the details of all checks in writing before the person works at the home. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 and 43 The quality of outcomes for these standards is good. The service is well managed. Recording is of a good standard and attention is paid to health and safety issues. EVIDENCE: The Manager, who is registered with the Commission, is in an acting position following the move of the previous Manager to another Hestia Housing service. As he has been the Deputy Manager for a number of years, he knows the service well. He is undertaking NVQ4/RMA. Records of residents meetings show that a number were planning to attend the next Tenants’ Forum, which is held by Hestia Housing every 2 months. A poster for the meeting was displayed in the home. A bulletin for tenants is published regularly. Recording is of a good standard and service users contribute to their care planning and to key working notes, which they counter sign. Senior Managers from Hestia Housing visit monthly and produce a detailed report, copies of which are sent to the Manager and the CSCI. The Manager Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 20 was expecting a full day visit in July as part of Hestia Housing’s QA programme. Attention is paid to health and safety, with an annual health and safety audit and a 2 monthly check of all areas of the building. Staff training in health and safety is incomplete as noted under standard 35. The LFEPA visited on 3rd April 2006 and found the fire precautions to be of a satisfactory standard. The fire risk assessment was completed on 15th May 2005. Fire drills take place every 3 months and the fire alarm points are tested weekly. Risk assessments show that staff are aware of the possibility of fire caused by service users who smoke and take steps to minimise the risk. The fire detection system and fire fighting equipment are regularly serviced. Accidents and incidents are carefully recorded. Problems with the front door not closing securely, noted in the residents’ meeting notes remain a concern, as it was open on the day of the inspection. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 3 4 x 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 2 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x 3 2 3 Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 22 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 YA1 Regulation 6 Requirement The Statement of Purpose and service user’s guide should be regularly reviewed to ensure that the contents are up to date. Risk assessments for service users who manage their own medication must be regularly reviewed and the assessment of the Psychiatrist or CPN noted. Restrictors must be fitted to windows to which service users have access. All staff must receive induction training, including health and safety training and have access to refresher training. A system of regular staff supervision must be established. Timescale for action 31/07/06 2 YA20 13 31/07/06 3 4 YA24YA42 YA35 13 18 30/06/06 31/07/06 5 YA36 18 31/07/06 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 YA12 Good Practice Recommendations Consideration should be given to providing a PC with DS0000019149.V291685.R01.S.doc Version 5.1 Page 23 Harwood Road 2 3 YA18 YA33 internet connection for the use of the tenants. Detailed guidelines regarding any personal care given would ensure that all staff follow the same procedure. Staff should sign to confirm that they have read the notes of team meetings. Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 24 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 Harwood Road DS0000019149.V291685.R01.S.doc Version 5.1 Page 25 - 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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