Inspection on 24/01/06 for Homemead

This inspection was carried out on 24th January 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 12/09/06

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 Simon Smith Unannounced Inspection 24th January 2006 10:50 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.V281417.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 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.V281417.R01.S.doc Version 5.1 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.V281417.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th June 2005 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. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the course of a single day and involved discussion with residents, the manager, staff and a visiting healthcare professional. A sample of records was examined and a tour of the premises made. The inspector was made welcome and wishes to thank residents and staff for their help during the visit. The home met 20 of 26 National Minimum Standards assessed at this visit. Six Standards were almost met and seven Requirements were made, three of which were reinstated from the last inspection in June 2005. There was one resident vacancy at the time of inspection. There were enough staff on duty to meet residents’ needs. Staff interacted positively with residents and encouraged them to make informed choices. Residents said that staff are polite, friendly and that they provide good care. What the service does well: What has improved since the last inspection? A computerised system of care planning and records management has been introduced and training for staff arranged. A volunteer driver has been recruited for the home’s minibus. New chairs have been purchased for the lounge. The recording of fire drills has improved so that potential areas for improvement (including additional training) are identified. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 6 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.V281417.R01.S.doc Version 5.1 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.V281417.R01.S.doc Version 5.1 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, 5, 6 Residents’ needs are assessed prior to admission. Prospective residents are able to visit the home before moving in to establish its suitability. EVIDENCE: All prospective residents have a needs assessment before moving into the home to ensure that the service is able to meet their needs. The manager reported that she performs all prospective residents’ assessments. People thinking of moving to the home are able to visit with their families before doing so. Admissions are made initially on a trial basis. A review is held at the end of this period. The home does not admit residents for intermediate care. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 9 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, 11 There is a commitment to improving systems of care planning and records management. Standards of medication storage and administration are high, although some areas for improvement were identified. EVIDENCE: The home is in the process of introducing a computerised system of care planning and records management. The deputy manager demonstrated some of the benefits it is hoped that the new system will realise. These include centralised information for staff about the residents with whom they work. Information including residents’ initial assessment, risk assessments and daily care notes will be held on computer. Residents’ care plans will also be transferred from written documents to computerised records. The deputy manager advised that senior staff have attended three days training on the system and that care staff will have training to enable them to use the system effectively. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 10 The inspector was able to speak to a district nurse who visited the home on the day of inspection. The district nurse advised that nurses provide support in the management of issues such as wound care and are able to make referrals to specialist services where necessary. The district nurse also said that nurses are able to obtain specialist equipment such as hospital beds and pressure relieving equipment where these are needed by residents. The district nurse reported that the standard of care at the home is good and that staff liaise well with visiting healthcare professionals. A Primary Care Trust pharmacist provides the home with advice and support on all aspects of medication and visited the service on 18 January 2006. The pharmacist’s report found that standards of medication storage and administration at the home are high. The pharmacist made two recommendations following the visit, which should be implemented by the home. All medication was stored securely at the time of inspection. All staff authorised to administer medication must have attended appropriate training prior to doing so. The ‘homely remedies’ procedure was agreed with residents’ general practitioner in 2005. A sample of medication administration records for seven residents contained two errors. See Requirement 1. Residents’ names and photographs are in place on their section of the monitored dosage system. This is good practice but some residents’ names were hand written and their photographs missing. The home should ensure that printed names and recent photographs are in place for all residents. The district nurse spoken to during the inspection advised that she and her colleagues visit as often as necessary when a resident is terminally ill. The manager reported that the home is always represented at/staff always attend residents’ funerals. Correspondence from the families of residents who had died demonstrated that the home had provided valued support and assistance at the time of their relative’s death. The religious and spiritual needs of residents and known and recorded. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 11 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 The programme of events and activities is stimulating and varied. Residents receive good support to maintain links with their friends and families. Residents have opportunities to contribute their views to the running of the home. The menu is developed with input from residents. EVIDENCE: The home provides a range of in house activities and occasional trips to places of interest. One member of care staff is the nominated activities co-ordinator. Another person visits the home to provide two weekly to run a couple of sessions. A volunteer driver has been recruited since last inspection, which should improve opportunities for trips and outings. Residents receive support to maintain are encouraged to take residents out that she had visited the local pub for One resident celebrated his birthday Homemead contact with their families and relatives when they visit. One resident reported lunch with her brother at the weekend. at the home on the day of inspection. Version 5.1 Page 12 DS0000017373.V281417.R01.S.doc Residents were served cake by a volunteer, who used her hands for this purpose. Staff and volunteers should use tongs or similar when serving food in future. See Requirement 2. The home is proactive in seeking the views of residents and their representatives. (See also Standard 33). Residents/relatives meetings are held three times per annum and the home’s caterers also meet with residents three times each year to review and plan the menu. Both these meetings had taken place in the week prior to inspection. Most residents chose to eat lunch in the communal dining room, although a number decided to eat elsewhere and staff supported this choice. The inspector shared lunch with three residents, who reported that they usually enjoy the food provided and that staff help them at mealtimes if necessary. Staff advised that the home has a regular chef, who works from Monday to Friday and another chef who works at the weekend. A replacement chef was on duty on the day of inspection. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 13 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 The Complaints procedure is clear and readily available. Training is provided in the Protection of Vulnerable Adults, although the home must demonstrate that all staff have attended this session. EVIDENCE: The home has a clear Complaints procedure, which is available in a number of locations around the home. A record of complaints received is maintained. The last complaint on file was received in May 2004. The record demonstrated that the complaint had received an appropriate response from the home. The home works within the Protection of Vulnerable Adults policy developed by the London Borough of Richmond. This policy sets out the action the home must take should an allegation of abuse or neglect be made. There is a Whistle-blowing policy in place, which provides staff with a mechanism to register any concerns they may have about poor practice. The deputy manager advised that staff attend training in the Protection of Vulnerable Adults as part of NVQ level 2 or during induction. However training records seen did not provide evidence that all staff employed at the home have yet attended this training. The home must provide evidence that all staff have completed training in Protection of Vulnerable Adults. See Requirement 3. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 14 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, 20, 21, 25, 26 The home is attractively decorated and well maintained. Communal spaces are welcoming and well used by residents. EVIDENCE: The home has a large communal lounge and separate dining room. Both areas were well used by residents on the day of inspection and it was apparent that there are no restrictions on residents’ movement around the home. New chairs had recently been purchased for the lounge and the manager advised that new blinds and curtains for the lounge and dining room would be installed in the near future. The manager reported that residents had been involved in choosing the new furniture and décor. The front door of the home is controlled by a keypad entry system for the security of residents. Wheelchair access is available to the side of the building. The home has a passenger lift. A handyman is employed one day each week to Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 15 attend to non-urgent, minor repairs. The home has dedicated laundry and drying rooms, including sluice facilities. The home has sufficient toilet, washing and bathing facilities to meet residents’ needs. All toilets and bathrooms were clean and hygienic on the day of inspection. Tiling around the bath in the first floor bathroom required repair or replacement. See Requirement 4. Radiators have been covered to prevent the risk of scalding, although one radiator remains uncovered. This appliance should also be covered to eliminate risk to residents. See Requirement 5. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 16 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, 30 Staff are available in sufficient numbers to meet residents’ needs. Staff are encouraged to attend appropriate training and to achieve relevant National Vocational Qualifications. EVIDENCE: At the time of inspection the home had staffing vacancies for around 70 hours at night and 75 hours during the day each week. Interviews to fill these vacancies were planned for the day after inspection. There were enough staff on duty to meet the needs of residents during the inspection. Residents said that staff are available when they need them and spoke highly of the care they provide. Staff attend programmes of induction and training appropriate to their roles. The probation period for new staff is six months. The home has a commitment to enabling staff to achieve relevant National Vocational Qualifications (NVQ). The training summary on file demonstrated that 50 of the staff team have achieved NVQ level 2. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 17 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, 32, 33, 35, 38 The manager is experienced and committed to the development of the service. There is a commitment to seeking residents’ views about the home. Appropriate systems are in place to manage residents’ personal finances. Improvements must be made in some areas to ensure the safety of residents. EVIDENCE: The manager has good experience of the home and has achieved relevant qualifications in management and care. The manager is committed to the development of the service and presented a good role model for staff in her interactions with residents. Staff spoken to during the inspection confirmed that the manager is approachable and supportive. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 18 The home is effectively managed and systems of review and evaluation are in place. The Central and Cecil Housing Trust carry out internal monitoring of the service on a regular basis. As highlighted in Standard 14, the input of residents and their relatives is sought at regular meetings. Where residents’ personal monies are handled by the home, appropriate systems are in place to record transactions and demonstrate accountability. All transactions are recorded on file and two people sign to record expenditure, one of whom must be a senior member of staff. Receipts are kept and numbered so that they can be cross-referenced with residents’ expenditure. A fire risk assessment for the building was last performed in July 2005. All fire fighting equipment was checked in August 2005. The deputy manager delivered fire training for staff in September 2005. The last fire drill on file took place in December 2005. The home has improved the recording of drills so that potential areas for improvement (including additional training) are identified. For example, staff are now given fire scenarios to manage and their response assessed. The last inspection report identified a number of issues for attention in the home’s hairdressing salon. The majority of these had been addressed but some were outstanding. There was no evidence that the fuse box had been retested. See Requirement 6. Some portable appliances require testing to ensure their electrical safety. See Requirement 7. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 19 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 X X X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 2 X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 20 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 OP9 Regulation 13(2) Timescale for action The Registered Person must 15/02/06 ensure that the administration of all medication is accurately recorded. The Registered Person must 15/02/06 ensure that all food must be served with appropriate utensils. The Registered Person must 30/03/06 provide evidence that all staff have completed training in the Protection of Vulnerable Adults. The Registered Person must 30/03/06 repair or replace the tiling around the bath in the first floor bathroom. The Registered Person must 28/02/06 ensure that all radiators are guarded to eliminate the risk of scalding. This Requirement is reinstated from the last inspection. The Registered Person must arrange for testing of the fuse box situated in the hairdressing salon. This Requirement is reinstated from the last inspection. Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 21 Requirement 2 3 OP15 OP18 12(4)(a) 13(6) 4 OP21 23(2)(b) 5 OP25 12(1) 13(4) 6 OP38 13(4) 23(2) 28/02/06 7 OP38 13(4) 23(2) The Registered Person must arrange testing for electrical items situated in the hairdressing salon. This Requirement is reinstated from the last inspection. 28/02/06 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 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.V281417.R01.S.doc Version 5.1 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Homemead DS0000017373.V281417.R01.S.doc Version 5.1 Page 23 - 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!