Inspection on 24/10/07 for Helena House

This inspection was carried out on 24th October 2007.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Helena House 04/10/06

Helena House 01/11/05

Helena House 02/06/05

Helena House 02/11/04

Helena House 27/07/04

Helena House 13/02/04

Helena House 09/07/03

Helena House 18/07/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Helena House 1 Brownlow Road Reading Berkshire RG1 6NP Lead Inspector Sandra Grainge Unannounced Inspection 24 October 2007 09:30 th Helena House DS0000011061.V346516.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 Helena House DS0000011061.V346516.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. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Helena House Address 1 Brownlow Road Reading Berkshire RG1 6NP 0118 958 7000 0118 956 0716 manager.hhr@prospects-uk.org 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) Prospects For People With Learning Disabilities Mrs Sophie Mwiinga Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2006 Brief Description of the Service: Helena House is registered to offer 24-hour residential care to ten adults of both sexes who have learning and associated disabilities. The house is owned and the care provided by Prospects for Living, a Christian voluntary organisation. The home is a large two-storied old house, with bedrooms on both floors. It is situated in a residential area of Reading, close to the town centre. The property has a large secluded garden at the rear. There are two parking bays at the front of the house where the service keeps its own vehicles. Public transport services are close by. Fees, at the time of the inspection visit range from £611---£ 1019 per week. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit was carried out by Mrs Sandra Grainge, Locum Regulatory Inspector for the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. The site visit took place over six hours; Mrs Sophie Mwiinga the Registered Manager was present in the home during this time when 9 service users were living in the home. One service user had recently been transferred to another home because her condition deteriorated and the home did not have the capacity to provide nursing care. A tour of the premises was carried out and records and documents were sampled; these included policies and procedures, residents’ individual files, medication records and staff recruitment and training files. I was introduced to all the service users; no service users’ relatives or friends came to visit them during the visit. I spoke to most of the staff who were on duty and also to staff from the day centre who came to collect service users. An Annual Quality Assurance Assessment (AQAA) was supplied to the Manager before the inspection and this was completed and returned to CSCI. Information provided in the AQAA is used to inform this report. A number of CSCI feedback forms were supplied to residents, their relatives and friends, and to healthcare professionals involved in the support of residents. These forms were held up in the postal strike and were not available prior to my visit. However 10 surveys were eventually delivered to CSCI. These contained mainly positive comments and all expressed satisfaction with the care that is provided. One relative thought that the staff could improve communication with service users’ families. A health care professional expressed concern about communication, especially the ability of staff to share and pass on information and advice about care for service users. Both healthcare professionals had been involved in the recent care of the service user who’s increased needs the service had not been able to meet. There was evidence that action had been taken by the management of the service to meet the requirements of the previous inspection. What the service does well: What has improved since the last inspection? A new user-friendly statement of purpose has been produced. An improved recruitment of staff procedure is now followed. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 6 Service user rooms have been decorated. Staff have received more frequent training and regular supervision. 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. Helena House DS0000011061.V346516.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 Helena House DS0000011061.V346516.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): Quality in this outcome area is good. Prospective Service users are given the information and assistance that they need to enable them to make a choice about living in the home if their assessed needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new statement of purpose and a service user-friendly version have been produced. No new service users have been admitted since the last inspection visit. The Manager was able to outline process of assessment and acceptance of a new Service user. Social service and local authority assessments and plans are used as a base for the home’s own assessments and plan. Visits and trials are organised. All those who live in Helena house have a contract for care services. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users living in the home have their changing needs assessed and are provided with care that is agreed with them and is detailed in their individual care plan. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All service users living in the home were found to have a plan to meet their individual assessed needs. The manager had undertaken a review of the information contained within care plans to ensure information is accessible, relevant and up to date. Advocates, relatives, and social service care Managers had been involved as appropriate. Each person has a key worker who is responsible for care, record keeping and planning. Risk assessments are in place and strategies are used for management of aggression. There was evidence during the Inspector’s visit to the home that staff follow the planned action to be taken to prevent the escalation of a service user’s aggressive behaviour. Service users participate in their care planning and process and have ownership of files. They choose where to keep their own “All about me folder”. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 10 I observed good practice by staff in the management and recording of service users’ money made available for outings. There is no known long term plan or strategy in place for the care for those whose condition has deteriorated due to illness or old age and the service may be unable to meet increased needs. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users who live in the home have a lifestyle that gives them opportunity for personal development, leisure activity and relationships as respected individuals in the community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Helena House is operated by a Christian charity. The spiritual needs of service users are of fundamental importance to the organisation. Staff are expected to support service users to participate in worship and prayer in order to follow their chosen spiritual belief. Further education is pursued and staff support service users who are able to be in paid employment. For example one service user does part time administrative work. The building is situated near the centre of Reading; community facilities are near at hand and service users enjoy participating in leisure, shopping, eating out and attendance at the day centre. The home has its own vehicles; these are also used to take people on outings. Family and friends of service users are very involved with the service and the life of the home. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 12 The garden contains a greenhouse and workshop that are available for activities with service users. A person centred approach is taken for the operation of the home; daily routines in the house are around the occupants’ needs and service users are encouraged to express their views. Bedrooms are individual and in most cases very large, giving opportunity for use of an exercise bike and storage for other hobby equipment. Staff have been trained to respect equality and diversity for service users and their work colleagues. During the visit they were seen to knock on Service users’ bedroom doors and to treat them all with courtesy and respect for their individuality. Staff told me that the philosophy is “ people are key”. It was noticed how well the Manger supported a service user, who’s care was being case tracked, to say when and where he wished to speak to the inspector. Tasks in the home are shared and discussed at residents meetings. Menus are planned with each person with consideration of nutritional need and a healthy diet. There are two dining rooms, one on each floor and meals are taken to suit the needs of each individual. Everyone who was asked replied that the food and meals are “good”. This view was not reflected in one survey that was returned by a member of staff who was concerned that not all staff have the ability to cook. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users are given appropriate support and care to meet their personal, emotional and physical needs by staff who respect their privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: It was clear that service users are choosing their own clothing and style to suit themselves. Male and female staff work in the home to meet service user need and choice. Each person has a key worker who is responsible for their care and liaison with family friends and to organise review meetings. One relative commented in the returned survey that communication with the family could be better. The manager is aware of the problem and steps are in place to improve communication. Medication storage records and ordering were inspected. It was not possible to observe the administration of medication by a member of staff because no medicines were prescribed for the hours when I was in the home. Staff confirmed that they receive training in the administration of medication. The record charts were complete and up to date. No one in the home had been assessed as being able to self-administrate their own medication. The Manager explained the reason for the empty bedroom and described the care that the staff recently gave to a resident who became ill and developed Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 14 dementia. Care was given in the home for as long as possible but the layout of the building has not been adapted for use by disabled people and staff do ot have the skills to provide nursing or dementia care. The Service user who was unwell was given a downstairs room because the home has no lift. Staff sought medical and nursing care for her and worked with the specialist nurses to provide care for as long as possible. Eventually it became necessary for her to be transferred to a nursing home where her needs could be met. It was distressing for the staff and other Service users when she had to leave her long-term home and relationships. The Manager was able to demonstrate that the others had been given support to reach understanding and to cope with their loss. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users feel safe in the home and the staff have been trained to safeguard them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been made to CSCI in the last year and none have been made to the service. A complaints procedure was available in the home and a copy was in service user files. On the visit the service users and staff on duty told me that they know how to make a complaint themselves or respond on behalf of someone who needed protection. Service users were confident that the manager and staff would take action to “put things right”. In one of the returned surveys a relative was less certain about the action to be taken. A requirement was made following the last inspection that all staff should receive training in the protection of vulnerable adults. This has been done and a copy of the latest local authority guidance is available in the home. In response to the last inspection report the system for the safe management of service users’ personal spending money was reviewed. During the inspection visit staff were seen to operate the system safely and routinely. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. Service users live in a house that is old and has not been designed to meet the needs of those who are aging or have physical disability. Investigations are in progress to find the cause of water penetration of the ceilings of the building. The first floor bathroom needs to be refurbished. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Helena House is large and old. It has not been adapted to offer accessibility to those who have a physical disability. There is no lift to the first floor. Water has penetrated some ceilings and walls in rooms on the second floor. This has caused the closure of the sensory room that had been enjoyed by service users. The Management team of the charity is aware of the problem and the manager reported that investigations have been made prior to finalisation of plans for repair work and adaptation of the building for long-term use. Plans for the refurbishment of the first floor bathroom have been discussed; the floor is stained and damaged, the assisted bath chair is damaged and it is austere with no curtains and a bare light bulb. Sanitary fittings in other parts of the building are also worn and due for replacement. Work is in progress throughout the home to fit new door catches and closures. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 17 Service users all have single bedrooms that are spacious, individually decorated and contain personal fittings and furnishings. The bedroom walls of some service users were used to display lists about personal care; these could be stored more discretely. The building was very clean, tidy and there were no offensive odours present. The laundry equipment is capable of sluice and hot cycles to operate to infection control standards. At the time of the inspection repair work was being carried out on a broken washing machine. Outside there is a pleasant large accessible garden that is equipped with seats and leisure equipment including swings, a greenhouse and workshop areas. The latter may not be in current use. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is good. Service users are given care and support from a team of staff who are properly recruited, trained and supervised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous requirement had been made for all staff to be given opportunities for NVQ training. This had been achieved and a lot of training had been given to staff but the certificates had not been filed in their folders. This was said to be because the administrative office had been moved due to the penetration of water into the building. The manager had paperwork stored in a smaller office and in an office situated on the second floor. In addition staff receive supervision, though this is in its early days and a staff survey form indicated that not all staff understand the concept of supervision. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. The service is managed to provide safe care for service users. Some health and safety checks must be more rigorously carried out and recorded. The Registered provider must ensure that provider inspection reports are available in the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is qualified, competent and experienced to run the home. There was an open and inclusive atmosphere in the home and there is a commitment to equal opportunities and respect of diversity and individuality. During this last year the manager has been included in the Charity’s executive meetings for budget and future planning of the long-term development of the property and the service. She had found this helpful and it had given her an improved perspective of the service. The manager was also able to demonstrate that a new quality assurance programme is being devised; Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 20 however, although it was stated that regular provider visits had been carried out each month the last report on file in the service was dated 25.05.07. It was made a requirement of this report that a copy of these reports is made available to the Manager and kept in the home. A requirement had been made following the following the previous inspection that the manager seek advice form the fire authority about fire safety arrangements in the home and review the fire risk assessment. This had been done. Regrettably there was no evidence that the weekly fire safety checks had been carried out and recorded since 28.09.07 Nor was there evidence that hot water safety checks had been carried out since 01.10.07. Both these omissions were to be rectified immediately. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 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 3 2 3 3 3 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 2 25 3 26 3 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 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 3 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 3 3 2 3 3 3 3 2 3 Helena House DS0000011061.V346516.R01.S.doc Version 5.2 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 2 Standard YA24 YA27 Regulation 13(4)(a) 23(2)(J) A plan for refurbishment of the bathroom on the first floor must be sent to CSCI Records of regulation 26 inspection visits must be made available to the home Tests of the fire safety equipment must be carried out and recorded weekly Tests of hot water safety checks must be carried out and recorded weekly. Requirement A plan for the repair of the building must be sent to the CSCI Timescale for action 31/01/08 31/01/08 3 4 5 YA41 YA42 YA42 26 23 23 31/10/07 31/10/07 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000011061.V346516.R01.S.doc Version 5.2 Page 23 Helena House 1 2 Standard YA10 It is recommended that lists of instructions for staff be displayed discretely. YA19 It is recommended that the provider makes plans for provision of care for service users whose needs have changed due to the effects of the ageing process or illness. Helena House DS0000011061.V346516.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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. 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