Inspection on 12/09/06 for Homemead

This inspection was carried out on 12th September 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Homemead 17/07/08

Homemead 09/10/07

Homemead 24/01/06

Homemead 17/06/05

Homemead 28/09/04

Homemead 14/05/04

Homemead 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Homemead 28 Park Road Teddington Middlesex TW11 0AQ Lead Inspector Sharon Newman Unannounced Inspection 12th September 2006 10:00 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 Homemead DS0000017373.V309909.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. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homemead Address 28 Park Road Teddington Middlesex TW11 0AQ 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 8977 5002 Central & Cecil Housing Trust Ms Carmel Regan Care Home 29 Category(ies) of Dementia - over 65 years of age (29) registration, with number of places Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: The service is operated by the Central and Cecil Housing Trust, a not-for-profit provider. The home provides accommodation for a maximum of twenty-nine older people who may have dementia. Staff support is available to residents twenty-four hours a day. The home is situated in a residential area of Teddington. The nearby high street provides a range of community facilities, such as shops, banks, pubs and restaurants. Bushy Park is a short walk away and the River Thames is close by. The Central and Cecil Housing Trusts mission statement reads as follows: We aim to maintain and improve the quality of life, independence and dignity of all within our care by providing comfortable, secure homes in an environment of support. Fees are £600 per week for those residents who are self funding and £561 to £580 for residents placed here by the local authority. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day and was conducted by one regulation inspector. The manager was present throughout the visit and was spoken to at length. Three staff members were also spoken to during the visit. Records examined included care planning documentation, health and safety information and medication records. A tour was also taken of the premises. The manager was very helpful throughout the visit and gave the impression of being genuinely committed to her work and to the residents. Surveys were left at the home for health professionals, relatives, residents and staff to complete and return. None were returned prior to completion of this report. Many residents were spoken to and they were very complimentary about life at the home. What the service does well: The manager is committed, caring and supportive to residents and staff. This home has a pleasant homely atmosphere. Staff are kind and caring and have a good rapport with residents. They respect resident’s dignity, choice and privacy. Residents are consulted about life at the home. This home provides wholesome nutritious meals in pleasant surroundings and residents are offered a choice of menu. A varied range of activities is offered to residents. Staff actively look for different activities that they can offer to the residents. The home is clean and hygienic. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 6 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. Homemead DS0000017373.V309909.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 Homemead DS0000017373.V309909.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Assessments of need are in place for all residents which helps detailed care plans to develop from this documentation. Prospective residents can visit the home before moving in to decide if they would like to stay here. EVIDENCE: Assessments were in place for the residents whose files were examined. The manager explained that one resident had been admitted as an emergency and therefore not all the assessments could be carried out prior to their admission. However, an assessment was seen to have been carried out by a social worker and the manager said that she would carry out further assessments. The manager reported that this resident has now settled well at the home. A case conference for this resident was observed to be held at the home involving the social worker, family and staff from the home. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 9 The assessment process at this home is usually a detailed process and preadmission reports from nursing staff, social workers and physiotherapists were seen in the residents’ files. The manager also carries out her own assessment of each prospective resident before admission. Each individual is invited to come and spend a day at the home where further assessments are made. The manager reported that this is carried out in a very discreet way as she feels it would be intimidating for a staff member to sit in front of the resident filling in assessment forms. A prospective resident was seen to be spending a day at the home on the day of inspection. They were observed to be treated with respect and were supported to participate in life at the home. Staff reported that the home is well supported by local mental health teams, GP surgeries, district nurses and pharmacists which enable them to help meet the needs of the residents. A relative reported that their family member was looking well since coming to the home. Homemead DS0000017373.V309909.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 at least once during a 12 month period. 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 the service. Resident’s health needs are met and the manager takes the health needs of the residents seriously. Measures are in place to ensure the safe recording, administration and storage of medication. EVIDENCE: Care plans were seen to be detailed and thorough, they covered needs such as rising and retiring to bed, dressing, personal hygiene, interests and hobbies, mobility, relationships, sexuality, religion and culture. Not all care plans had been reviewed monthly. They need to be reviewed monthly to ensure that any changes in the residents needs are noted. One new resident did not yet have care plan in place and requires a care plan to ensure that their needs can be met. The home has started to compile life histories of the residents these are helpful and allow staff to build up a picture of the residents as individuals. The home is in the process of introducing a computerised system of care planning and records management. The manager reported that this process is nearly complete. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 11 Evidence was seen in care plans of input from health care professionals including GP’s, district nurse’s, social workers physiotherapists, hospital consultants and community psychiatric services in the care of the residents. When residents’ needs increase the home works together with local social workers and health professionals to help to meet those increasing needs. The manager reported that district nurses visit the home regularly to provide support to those residents requiring more care. Specialist equipment such as pressure relieving mattresses and hoists are used to help ensure that residents increasing needs are met. A district nurse was observed to visit some of the residents on the day of inspection. A community psychiatric nurse and social worker were also seen visiting residents at the home. Medication was stored securely within a locked trolley on the day of inspection. Most of the medication is provided in a monitored dosage system. The medication administration records were in good order and no omissions in recording were seen. All residents with allergies had these recorded clearly to help ensure the safety of the residents. Where residents do not have an allergy this is also recorded on the MAR sheets. There are comprehensive medication policies in place at the home, including one for homely remedies. Residents were seen to have the choice to walk around the lounge and dining room freely, some chose to walk out into the garden. Staff were seen to treat them with dignity and respect and to have a good understanding of their needs. Staff spoke about the respecting the residents relationships and sexuality and ensuring that they never feel guilty or ashamed of natural feelings. Homemead DS0000017373.V309909.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 at least once during a 12 month period. 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 the service. Activity provision is good and residents are encouraged to participate in activities. They are also encouraged to maintain contact with family and friends. Relatives are made to feel welcome. Residents are offered a choice of nutritious meals in a pleasant, homely setting. EVIDENCE: Residents are supported to take part in a range of activities. There is a member of care staff who has also taken on the role of activities cocoordinator. They reported that they had recently surveyed all the staff about their views regarding the activities on offer at the home and asking for more ideas about activities to provide. They said that staff put forward many ideas and were very helpful. All residents have an activities care plan in place which contains information about their past interests and hobbies, present interests, special requirements and any disabilities they may have. Some residents went out in a minibus on a trip to Richmond Park during the inspection visit. Residents were seen to be given a choice about whether they Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 13 wished to go. Residents can choose to take part in activities such as arts and crafts and painting, knitting and musical bingo. Residents artwork was observed to be displayed on walls throughout the home. There is a film show once a month, and the residents are all offered ice-cream cones. The manager said they very much enjoy this activity. Entertainers visit to play the piano and sing and an aromatherapist visits once a week and carries out individual therapy with the residents. Cultural theme days are also held such as Caribbean day. The residents took place in a project with a local school called Homefront Recall. This enables older people to meet up with school children and talk about their experiences of World War Two. The manager reported that the home purchases different newspapers on occasions and this allows the residents and staff to discuss different issues that are in the news. The manager said that on residents’ birthdays they celebrate with a cake and candles and generally ensure that they make special effort for the resident. A birthday list for all the residents was seen to be kept at the home. The home has a pet budgie and one resident was observed to be very fond of it and was talking to it and changing it’s water. The manager reported that the home is trying out a change to the menu system. They are now offering a different alternative menu as the previous one was too complicated. The main menu remains the same and this continues to be rotated on a four-weekly basis. The new menu offers a range of choice if residents do not wish to choose from the main menu. It includes food such as omelettes and sandwiches with a choice of fillings, soup, salads and yoghurts. The manager reported that fresh fruit is always on offer and residents were seen to be offered a selection of drinks throughout the day. Residents were seen to take their lunch in an unhurried manner in the pleasant dining room. The food looked appetising and nutritious and residents spoken to said that they enjoyed their lunch. Some residents took lunch in the lounge, another resident chose to eat lunch in their room. The chef was spoken to and reported that they loved working at the home. They had a good knowledge of individual residents dietary needs. Homemead DS0000017373.V309909.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 inspected at least once during a 12 month period. 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 the service. Policies and procedures are in place to help protect residents from abuse, however all staff need to undertake training in abuse awareness to ensure that residents are not placed at risk. EVIDENCE: The home follows the London Borough of Richmond’s’ Protection of Vulnerable Adults policy and a copy of these procedures was available at the home. Staff spoken to had a good knowledge about this area and the importance of whistle blowing in maintaining good practice at work. A whistle blowing policy is also available at the home. The manager reported that not all members of staff have received up-to-date training in abuse awareness and the protection of vulnerable adults and this needs to be put in place. She reported that she was arranging to send staff on the London Borough of Richmond’s protection of vulnerable adults training. The complaints procedure is displayed in the home and there are also leaflets available to show residents and relatives how to make a complaint. The complaint log was seen and contained two issues which had been fully documented and the outcome recorded. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. 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 the service. Residents live in a homely and attractive environment. The bedrooms are well personalised and comfortable. There are some areas within the home, which require redecoration. The home is clean and hygienic. EVIDENCE: There is a large dining room which contains sturdy attractive wooden furniture. It is a well-decorated and bright room in which residents’ paintings are displayed on the walls. The kitchen is situated off the kitchen and was observed to be clean on the day of inspection. The lounge is spacious, well decorated and has a homely feel. It contains brightly coloured armchairs which were chosen by the residents. There is a large television and music equipment in this room. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 16 Although the lounge is a pleasant room it is let down by the windows. These are showing signs of age and many do not close properly this could make the room cold in winter. This needs to be addressed. The hallways on the first and second floors would benefit from redecoration, as the décor presented as tired. Scuffmarks were seen on some of the walls and skirting boards and some of the wallpaper has come away from the wall in areas. Bedrooms were observed to be personalised to individual taste, they were homely and contained many of the residents own possessions and some of their furniture. There is a small secure garden and the manager reported that they are hoping to redesign this area and have had plans drawn up. She said that this would benefit the residents and provide them with a more pleasant environment. A range of adaptations and equipment such as specialist baths and hoists were seen to be available in the home to help meet the needs of the residents. Wheelchair access to the building is available. Sufficient bathroom facilities to meet the needs of the residents were seen. The tiling has been renewed in one of the bathrooms. The home was clean and hygienic on the day of inspection. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. 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 the service. Sufficient numbers of staff are available to meet residents’ needs and they have a kind and caring manner. Staff are encouraged to keep up-to-date with their mandatory training including moving and handling, first aid and food hygiene. A lack of recruitment information could place residents at risk. EVIDENCE: Staff were observed to be kind and caring toward the residents and they had a good knowledge of their needs, likes and dislikes. The manager spoke positively about the staff and said that they were ‘a good team.’ A staff member commented that ‘everyone pulls together at this home.’ The manager reported that the home is going to begin recruiting more staff soon. Sufficient numbers of staff were on duty on the day of inspection. A staff member said that they ‘enjoyed working at the home’ and the manager and deputy manager were ‘very approachable.’ They reported that they were up-to-date with training in moving and handling, first aid and food hygiene. Another staff member said that they were up-to-date with this training and had also undertaken the NVQ Level 4 qualification. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 18 Evidence was seen to show that most care staff are up-to-date in mandatory areas such as first aid, moving and handling and food hygiene. Staff recruitment files are not kept at the home but at the organisations’ head office. Therefore these could not be examined. A checklist which contains all the information about the pre-employment checks should be in place at the home. This checklist should be signed and dated by a staff member at head office to validate that this information is in the staff files. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The manager has an open and inclusive management style that benefits the home as staff and residents find her approachable. She provides clear direction and leadership within this home and is committed to maintaining high standards of care for the residents. Appropriate systems are in place to manage residents’ finances. EVIDENCE: The manager is very experienced and has obtained the NVQ Level 4 qualification. Staff spoke highly of her and said that she was ‘approachable.’ A staff member said that she was ‘a good manager’ and they felt ‘well supported.’ Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 20 She was observed to have a very good rapport with the residents and to speak to them in a kind and caring manner. Residents obviously felt happy to approach her for a chat. A quality assurance system is in place at the home. The manager reported that questionnaires have been previously sent out to relatives and that they will be sent out again this year. This helps the home to gain the views of the relatives. Staff surveys were conducted by the activities co-ordinator this year to try to find out if the activities on offer were suitable for the residents and to seek new ideas. The home actively seeks the views of the residents and residents/relatives meetings are held three times a year. Catering meetings are held with the residents three times a year as well. This enables the catering staff to meet with the residents and plan the menus. Appropriate systems are in place regarding residents’ monies. All transactions a recorded on file and receipts are kept and numbered for cross-referencing purposes. Two people sign the log sheets, one of whom must be senior member of staff. Up-to-date certificates were in place for portable appliance testing, the five yearly electrical wiring check, and gas safety. This helps to ensure the safety of staff and residents. It was discussed with the manager that all those involved in the handling and preparation of food, including the voluntary workers must have attended upto-date training in food hygiene. This will help to ensure the safety of the residents. The manager said that she would address this issue. Homemead DS0000017373.V309909.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 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 X X 3 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 2 X X X X X x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 Requirement The registered person must ensure that care plans are in place for all residents and are reviewed monthly. The registered person must provide evidence that all staff have completed training in the Protection of Vulnerable Adults. Previous timescale of 30/03/06 not met. The registered person must ensure that the maintenance issues outlined in Standard 19 of this report are addressed The registered person must ensure that there is evidence that the staff files contain all the information required in Schedule 4 of the Care Homes Regulations 2001. The registered person must ensure that all those involved in the handling or preparation of food completes food hygiene training. Timescale for action 01/10/06 2 OP18 13(6) 01/11/06 3 OP19 23 (2) (b) 01/03/07 4 OP29 19 (4) 01/10/06 5 OP38 13 (4) 01/10/06 Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 23 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 OP9 Good Practice Recommendations Ensure that printed names and recent photographs are in place for all residents on the appropriate section of the monitored dosage system. Homemead DS0000017373.V309909.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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. 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