Inspection on 30/08/07 for Homelands

This inspection was carried out on 30th August 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Homelands 26/07/06

Homelands 14/12/05

Homelands 26/04/05

Homelands 09/12/04

Homelands 11/05/04

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

CARE HOMES FOR OLDER PEOPLE Homelands 101 Lennard Road Beckenham Kent BR3 1QS Lead Inspector David Lacey Unannounced Inspection 11:00 30 August 2007 th X10015.doc Version 1.40 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 DS0000006954.V345077.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 Older People. 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. DS0000006954.V345077.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homelands Address 101 Lennard Road Beckenham Kent BR3 1QS 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) 020 8659 3633 020 8778 6379 Mr Rohit Jawaheer Mrs Sherine Jawaheer Mrs Sherine Jawaheer Care Home 12 Category(ies) of Dementia (12), Mental disorder, excluding registration, with number learning disability or dementia (12) of places DS0000006954.V345077.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit people who fall into the above Service User categories aged 60 years and above. One Service User whose name and circumstances are known by the NCSC can be under the age of 60 years. 1 place registered for named service user under the age of 60. 2. Date of last inspection 26th July 2006 Brief Description of the Service: Homelands is a detached house situated in a residential area of Beckenham. The home is registered for twelve residents. There are five double bedrooms. There is no lift, which means the home is only suitable for residents that are mobile. Support for the home is offered via the local community health provisions. Specialist services are accessed via the GP, including the district nursing services and community psychiatric services. The fees for this home range from £450 - £525 per week (information provided to CSCI September 2007). DS0000006954.V345077.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection included an unannounced visit to the home. The manager and members of staff on duty assisted with this visit to the service. During the visit, I spoke with residents and staff members and am grateful for their contributions. I toured the premises, observed interactions and practice, and examined documentation. What the service does well: What has improved since the last inspection? What they could do better: Keep all care plans under regular review and increase the involvement of residents and/or their representatives in these reviews. Improve record keeping, to ensure it is always evident that care has been given. DS0000006954.V345077.R01.S.doc Version 5.2 Page 6 Review the adult protection procedure to ensure it reflects local (Bromley) guidance. Ensure all staff members are supervised in line with the national minimum standard. Make sure the inspection and testing of all the home’s utilities are up to date. 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. DS0000006954.V345077.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000006954.V345077.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have access to the information they need to make a choice about whether to move into the home. Residents are assessed to ensure the home can meet their needs and are provided with a contract. The home does not offer intermediate care, thus standard 6 does not apply in this instance. EVIDENCE: The home has a statement of purpose and a service user’s guide, both dated June 2006. These documents were inspected and found to comply with legislation. They are made available to residents and their representatives as required. I discussed with the manager that it may be helpful to place copies in the hallway of the home, in a wall-mounted holder (recommendation 1). DS0000006954.V345077.R01.S.doc Version 5.2 Page 9 There had been no new admissions since the previous inspection and none were forthcoming. Thus, it was not possible to assess any recent outcomes for newly admitted residents in relation to their choice of the home. Discussion with the home’s manager confirmed the previous requirement (requirement 1) could not be evidenced yet as fully met. Three files of existing residents that I sampled each had contracts/statements of terms and conditions. The sample of care documentation I saw during the visit confirmed that assessments of residents’ needs had been carried out before they had moved into the home. Residents, their families, and professionals supporting the residents had contributed to these pre-admission assessments. DS0000006954.V345077.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have a care plan, based on assessment of their needs. Residents’ health care needs are met, though it is not always evident that particular aspects of care have been delivered and reviewed. Residents are treated with respect and their privacy upheld. Medicine administration is satisfactory. EVIDENCE: Residents appeared well looked after, clean and well groomed. They were being treated with respect and staff were ensuring residents’ privacy and dignity were maintained while giving personal care. Residents who were able to communicate said they were happy with the care provided and that the staff were kind to them. The three residents’ files I sampled contained care plans drawn up from assessment of the individual resident’s needs, however there was only indication on how often plans are reviewed on one of the files (requirement DS0000006954.V345077.R01.S.doc Version 5.2 Page 11 2). Evidencing the care given to residents needs to be strengthened, and I discussed this with the manager. Booklets titled “Assessment for Good Care Planning” are being introduced at Homelands. They are already in use at the other care home in the group and are a potentially helpful format. However, it was evident their implementation at Homelands is not yet complete, as they had not all been completed fully in the plans I sampled, with some entries not signed or dated. The arrangements for meeting residents’ health care needs are satisfactory, with health services being accessed promptly when required. A local GP practice provides medical support to the home, with visits as needed. There is good support from the local district nursing service, for example, in the management of indwelling catheters for two of the residents. Residents who were able to give their views confirmed that they saw the doctor when they needed. Staff had referred a resident I case-tracked to the GP when they observed swelling to his foot and difficulty in walking. The GP had then arranged for a hospital admission for treatment. He told me his leg is comfortable now and he has no pain. As advised, staff were ensuring his leg was elevated while he was sitting in his chair. There were satisfactory arrangements for the storage and administration of medication, and staff members responsible for this task had completed relevant training. I saw part of the lunchtime medicine round taking place, and medicines were administered safely, in accordance with procedures. There were no residents taking responsibility for their own medication. Staff members should sign the medicine administration records when they apply aqueos creams that have been prescribed as required (recommendation 2). DS0000006954.V345077.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents choose how they spend their time and are supported to maintain contact with their families and friends. There are opportunities to go on trips out from the home. The content of menus inspected was balanced and nutritious, and residents’ food preferences and choices are taken into account. EVIDENCE: There was a calm, relaxed atmosphere in the home when I arrived in the morning. Residents were either in the lounge or their rooms. Staff enable residents to make choices about their day-to-day lives, for example, choices about what clothing to wear and which meals to eat. I saw a staff member talking with a resident after lunch to help her decide how she wished to spend the afternoon. Just after lunch, a resident told me she was going to her room for a lie-down, as she liked to do this each day at this time. The interactions I saw between residents and staff were positive and friendly. Residents are encouraged and supported to make their bedrooms as personal as possible, by bringing their own personal items, family photographs and small pieces of furniture. DS0000006954.V345077.R01.S.doc Version 5.2 Page 13 Friends and relatives are encouraged to visit and there is an open visiting policy where visitors are allowed in the home at any reasonable times during the day and evening. Residents who were able to give their views felt their visitors are warmly welcomed and the arrangements for visiting are flexible. There are some in-house activities, such as card games and bingo, but these are limited. The manager said group activities such as painting were not popular so activities were usually tailored to each individual resident. Outings include shopping and having a coffee in Bromley town centre, and going to the cinema. The previous week, the manager had taken five residents to Crystal Palace Park. One of the residents told me about this trip, which she had clearly enjoyed very much. Residents took lunch in the dining room. Sensitive, unhurried assistance with feeding was provided by staff as needed. Residents were offered a choice of meal, and could ask for an alternative if they did not want what was on the planned menu. Residents said they enjoyed their meal. The menus indicated a well balanced diet was being provided. The kitchen was clean, tidy and well organised, with equipment in good working order. DS0000006954.V345077.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their representatives have access to the procedure for making a complaint if they are unhappy with the care or service they receive. Staff receive training about safeguarding adults but the home’s adult protection procedure needs to be reviewed. EVIDENCE: The home’s complaints procedure is included within its service user guide and also displayed on the dining room notice board. Thus, residents and their representatives have access to the information they need to be able to make a complaint. Neither the home nor the commission has received any complaints since the previous inspection. The manager said there were no complaints records in the home. Staff spoken with were aware of their reporting responsibilities if they witness or suspect abuse of a resident. A carer spoke about her adult protection training and said “the most important thing is to know your residents and their health and well being, then you can tell if something is wrong”. Another carer said if she witnessed abuse she would make sure the resident was safe and immediately report it to the person in charge of the home. I saw examples throughout the day of positive, relaxed interactions between residents and staff. DS0000006954.V345077.R01.S.doc Version 5.2 Page 15 The home’s procedure “Elder Abuse” was on file in the policy and procedure folder. This is a generic document, prepared by a third party, personalised for the home. It stated that allegations should be reported to the former NCSC. It did not mention the need to follow local multi-agency procedures and did not acknowledge the lead responsibility of social services in safeguarding adults (requirement 3). The manager stated the other care home in the group has an appropriate procedure, which she will ensure is adopted at Homelands. She will also make sure the local multi-agency guidelines are made readily available for staff. DS0000006954.V345077.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and homely environment, which is well maintained. EVIDENCE: On the day of my visit, the home was clean, tidy and had a homely atmosphere. There is no lift thus residents living on the upper floors need to be able to get up and down stairs. The manager and her staff team are very aware that ensuring residents can manage the stairs safely requires continual monitoring. Residents with restricted mobility live on the ground floor. Residents live in comfortable bedrooms where they are able to have their own possessions around them. Window restrictors were in place to ensure residents’ safety. The shared bedrooms have screens in place. The screens are the mobile type (i.e. on wheels) rather than being hung from ceiling tracks. This means there are gaps above and below the screens, but staff said they take care to ensure residents’ privacy and dignity is maintained while giving DS0000006954.V345077.R01.S.doc Version 5.2 Page 17 personal care. One of the residents showed me her room, which she shares with another resident. She said she is happy to share, as she gets on well with the other resident. She likes her room as it has what she needs and is comfortable. Some rooms had been redecorated since the recent completion of structural works to the building. Communal areas were generally well maintained. The extractor fan in the ground floor bathroom was not working and needs repair/replacement and cleaning, particularly as there is no natural ventilation in this room. Also, some missing tiling in this bathroom needed attention (requirement 4). There is a call alarm system throughout the home, which was working well on the day of my visit. The manager confirmed the system is tested each week. Hot water temperatures are monitored regularly and kept at an appropriately safe level by pre-set valves fitted to residents’ hand basins. The premises were free from unpleasant odours, and policies and procedures for infection control are followed. The back garden is spacious and well maintained. The gardener spent the day working on the garden while I was there. There is a new patio and pathway in the back garden for residents to use. DS0000006954.V345077.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitably qualified staff members were working in the home in sufficient numbers to enable good care delivery to the residents. Recruitment procedures provide protection for residents. Staff members are provided with training that is relevant to their work in the home. EVIDENCE: The home has an experienced staff group, with little turnover of staff. All but one have achieved at least NVQ level 2 in care, with that one staff member working towards this award. Staff members were clear about their roles and responsibilities in caring for the residents, and showed a good understanding of residents’ individual needs. I saw and heard good interactions between staff and residents, which were indicative of the positive rapport between them. Staff members were working well as a team, appearing supportive of each other and keen to ensure the residents’ needs are met to a high standard. A carer said she puts the residents first, “it’s their home and I like to make sure they get what they like and need”. Enough staff are on duty each day and night to meet residents’ needs. A staff member who regularly does the sleep-in cover at night was not named on the DS0000006954.V345077.R01.S.doc Version 5.2 Page 19 staff rotas. This omission was raised with the manager who agreed to ensure the staff member was added to the rota in future (requirement 5). Two staff files were sampled for inspection. They contained satisfactory recruitment information but no documented evidence of induction or supervision. Staff confirmed they had undertaken induction when taking up their posts and, particularly as this is a relatively small home, they have daily contact with the home’s manager who provides guidance and support. (Comment about staff supervision is made under standard 36). DS0000006954.V345077.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in an open manner that ensures residents’ needs and choices are met. Satisfactory arrangements are in place to maintain a safe environment for residents and staff, though two maintenance checks were overdue. Quality assurance strategies are developing. Staff need to be supervised in accordance with standards. EVIDENCE: From observations and discussions, it was evident the registered manager of the home is approachable and committed to meeting the needs, preferences and choices of the residents. She is a qualified nurse and has considerable experience of care provision to people with mental health problems or dementia. DS0000006954.V345077.R01.S.doc Version 5.2 Page 21 Quality assurance strategies are being developed, in conjunction with the group’s main care home. There is some evidence to show underpinning of quality assessment by seeking residents’ and others’ views, although this could be strengthened. It was evident that staff have ready access to support and guidance from the manager as they require. However, the manager acknowledged that formal supervision was not being carried out regularly at the present time, though pointed out there is documentation relating to staff appraisals filed at another care home (Oatlands) where all staff appraisals are conducted. Supervision needs to take place at the appropriate intervals and be recorded (requirement 6). Administration is mainly carried out from the other care home in the group (Oatlands). It was understood this means that records relating to Homelands is often filed there. I discussed this with the manager, as there is certain documentation that should normally be kept on the premises. The provider should consider how records filed at Oatlands is made available for future unannounced inspections at Homelands (recommendation 3). A sample of health and safety documentation was inspected and mostly found to be up to date and within the appropriate timeframes. The last full inspection of the electrical installation had taken place in June 2002 and was now due to be repeated (requirement 7) and the testing of portable appliances was last recorded in December 2005 (requirement 8). DS0000006954.V345077.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 DS0000006954.V345077.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement The registered manager must ensure that all residents are appropriately assessed prior to admission and must confirm in writing that the home’s ability to meet the service user’s needs. Previous requirement, not yet met in full. The registered person must ensure it is evident that all care plans are reviewed regularly and that, whenever practicable, residents or their representatives are consulted when reviewing their care plans. The registered person must ensure the home’s adult protection procedure reflects the local multi-agency guidelines. The registered person must ensure the extractor fan and missing tiling in the ground-floor bathroom are repaired or replaced. The registered person must ensure that the names of all staff working in the home appear on the staff rota. Timescale for action 30/09/07 2 OP7 15 31/10/07 3 OP18 13 31/10/07 4 OP19 23 30/09/07 5 OP27 18 30/09/07 DS0000006954.V345077.R01.S.doc Version 5.2 Page 24 6 OP36 18 7 OP38 13 8 OP38 13 The registered person must ensure all staff members are supervised in line with the national minimum standard. The registered person must ensure the fixed electrical installation is inspected and tested by a competent person, and any defects remedied. The registered person must ensure it is evident that portable electrical appliances in the home are inspected and tested regularly. 31/10/07 31/10/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP1 OP9 OP37 Good Practice Recommendations The registered person should consider displaying the home’s statement of purpose and service user’s guide, in the hallway of the home, in a wall-mounted holder. The registered person should ensure staff sign the medicine administration records when they apply aqueos creams that have been prescribed as required. The registered person should consider how documentation filed elsewhere is made available for future inspections at Homelands. DS0000006954.V345077.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup Kent DA14 5RH 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 DS0000006954.V345077.R01.S.doc Version 5.2 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!