CARE HOME ADULTS 18-65
Matthew Residential Care Home 1 Milton Avenue Kingsbury London NW9 0EW Lead Inspector
Davina McLaverty Key Unannounced Inspection 9th March 2007 10:30 DS0000059266.V329761.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 DS0000059266.V329761.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. DS0000059266.V329761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Matthew Residential Care Home Address 1 Milton Avenue Kingsbury London NW9 0EW 020 8907 8435 020 8907 8435 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) Matthew Residential Care Limited Darren Matthew Forde Manager post vacant Care Home 4 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (4) of places DS0000059266.V329761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Matthews Residential Care Ltd is registered to provide accommodation and care support for up to 4 residents at 1 Milton Ave. The home is a five bedroom semi-detached property located in the residential area of Kingsbury, Northwest London. It has five bedrooms, including one ensuite. It also has a communal lounge, kitchen, dining room, designated smoking area, one bathroom and toilet, one shower room and toilet, a utility and laundry room. The home has a well maintained garden. It is close to the town centres of Harrow and Wembley with a variety of local shops, public transportation services, health and social care facilities and services, plus leisure and recreational facilities. At the time of this inspection the Responsible Person reported that the weekly fees were £1,295 per week. Fees do not cover, hairdressing, dry cleaning, chiropody or purchase of clothing and personal effects. DS0000059266.V329761.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 on the 9th March 2007, and was conducted by one regulation inspector. The inspector met one of the two residents, (there are currently two vacancies) the proprietor and two support staff. A number of records were examined, which included resident’s care plans, medication records, daily logs, health and safety, and staff records. A tour of the premises also took place. The resident spoken with was positive about the support received at the home with comments as follows “its nice here”, “staff are kind and the food is good”. The atmosphere was relaxed with a good rapport being observed between the resident and staff. What the service does well: What has improved since the last inspection? What they could do better:
Each staff member must have a training profile, which clearly evidence when mandatory training has been provided, with dates. This must also include refresher courses. Evidence of all staff who work at the home details must be available in the home. DS0000059266.V329761.R01.S.doc Version 5.2 Page 6 Protocols of when to administer medication prescribed PRN must be devised. Tippex must not be used on Medication Administration Sheets. All staff must receive medication training from an external source. 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. DS0000059266.V329761.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 DS0000059266.V329761.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): 1,2,3 & 4 Quality in this area is good. This judgement had been made using available evidence including a visit to this service. Prospective representatives of residents are provided with information about the home to help them to make a decision about its suitability. The needs of prospective residents are assessed prior to admission to make sure that the home will be able to meet the person’s needs. EVIDENCE: A Statement of Purpose and Service User Guide are available in the home. Both documents had recently been updated. The service users guide is in a format which best meet the communication needs and abilities of the residents. A copy of the most recent inspection report is displayed on the notice board in the dining room. Sufficient information is available to assist a resident’s representative to make an informed choice as to whether the home can meet the prospective residents needs. The organisation’s assessment and admissions policy is comprehensive and includes visits to the home for the prospective resident and their representatives, as well as visits to the prospective persons current home to
DS0000059266.V329761.R01.S.doc Version 5.2 Page 9 assess their suitability. In discussion with the proprietor she was aware of the need to ensure that assessment reports from professionals were current when carrying out assessments of potential residents for the home. No new residents have been admitted since the last inspection and the home continues to carry two vacancies. DS0000059266.V329761.R01.S.doc Version 5.2 Page 10 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): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home continues to meet the assessed needs of the current residents. The resident’s right to make decisions about their life in the home is respected. There are good systems in place to help ensure any changes in care needs are recognised and appropriate action plans developed to meet those needs. EVIDENCE: The Care Plan of one of the residents was examined by the inspector and found to contain a lot of information regarding the persons care needs and how they were to be supported in the home. Daily logs examined by the inspector showed that staff monitor changes in resident’s daily lives and these are reflected in the care planning and support offered. Evidence of multi disciplinary input was evident on the file and regular reviews/meetings was seen to have taken place to ensure that the residents identified needs are being met. Updated risk assessments were also seen to be in place. Residents are supported to take risks as part of an independent lifestyle and reviewing
DS0000059266.V329761.R01.S.doc Version 5.2 Page 11 these on a regular basis ensures that the changing needs of residents are identified and addressed. Residents are supported to develop their individuality and access services in the local community. The resident spoken with spoke of what she liked to do in the home and the community, although it was acknowledged that due to significant delay in a wheelchair assessment, this was impacting on the resident’s choices. This however, is being addressed by the staff in the home, and the resident’s care manager. Correspondence was seen on the resident’s file and also the resident’s key worker spoke of her involvement. The home operates a key worker system and the resident spoken with was aware of her key worker. Residents are consulted about how the home is run. In discussion with the resident she spoke of her right not to go to a day centre, and decided what time she got up and went to bed and what she wanted to eat. Both the proprietor and the staff spoken to demonstrated a good knowledge of the residents individual needs and a commitment to supporting them to lead a life which makes them happy and fulfilled. DS0000059266.V329761.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16 & 17 Quality in this area is good. This judgement had been made using available evidence including a visit to this service. This home continues to maintain links with the community. The home provides a pleasant environment for residents to develop their social skills, as far as they are able. Staff continue to encourage and support residents to be as independent as possible. EVIDENCE: The provider informed the inspector about the range of opportunities and activities the current residents are involved in. The inspector examined the activity timetable and it included in-house and local community activities and programmes. The activities for one resident included swimming, attendance at college to do a cookery course, personal shopping, eating out, bingo and meeting with her relatives. This resident has made the choice not to attend structured day care services and prefers outings and other activities with staff from the home.
DS0000059266.V329761.R01.S.doc Version 5.2 Page 13 Unfortunately, due to her health needs, activities outside of the home have had to be reduced until a new wheelchair has been obtained. The resident and staff were frustrated with the length of time it was taking to get a new chair. Evidence of the home’s consultation with the resident’s social worker and Primary Care Trust was evident in the file. The resident stated she enjoys eating out and likes listening to her music. The inspector was informed that one of the residents maintains contact with their mother who visits her at the home every month. Holidays are encouraged and supported by staff. One resident is a regular visitor to Euro Disney as they enjoy it there. The same resident spoke of her birthday celebrations in the home. Staff stated that visits take place with residents at the proprietors other home and vice versa, which go well. The resident confirmed this and said it’s nice to see other people. Staff reported that they encourage residents to plan their meals to reflect their nutritional and dietary care needs. The resident spoken with said that she liked the food although she could not have as much coke as she liked, due to the effect it had on her. A copy of the menu was seen, which appeared varied and nutritionally balanced with fresh fruits, vegetables and salads included. DS0000059266.V329761.R01.S.doc Version 5.2 Page 14 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): 18,19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Healthcare needs of the residents continue to be adequately assessed and carefully monitored. There were appropriate measures in place to ensure regular health checks and reviews are carried out, however, further training is needed to help enhance staff practice in the understanding and administration of medication. EVIDENCE: Evidence was seen in the care plans of input from health care professionals including: GP’s, social workers, opticians and dentists. Good health and social care support is provided by a local specialist community team. The support staff stated that the home fully support both residents with personal care, although both residents are encouraged to do as much for themselves as possible. Residents are encouraged and supported to choose their own clothes. As stated, one resident, due to her “swollen leg”, is in need of new wheelchair. Despite numerous letters /phone calls to get a new chair the matter has not
DS0000059266.V329761.R01.S.doc Version 5.2 Page 15 been resolved, which is causing the resident and staff great frustration. Staff stated that trips out still take place via Dial-a- ride and taxis, which is more costly. A medication policy and procedure are in place in the home. Medication was seen to be stored securely and evidence of visits by Boots pharmacists have taken place with written advice being left following quarterly visits. A sample of the Medication Administration Records (MAR) was examined. The inspector noted Tippex had being used on the Medication Administration Sheet. Also there was not always a written protocol for medication, which was to be administered PRN. Staff training was not clearly evident on staff files examined. Training must be provided by an external source. Requirements were made to address these issues. DS0000059266.V329761.R01.S.doc Version 5.2 Page 16 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): 22 & 23 Quality in this area is good. This judgment had been made using available evidence including a visit to this service. An organisation complaints procedure is in place as well as policies and procedures to help protect residents from abuse and harm. Residents are aware of their right to complain if the care that they receive is not satisfactory. EVIDENCE: A complaints procedure is in place in the home. The proprietor stated that there have been no formal complaints received in the home since the last inspection. The Commission had not received any complaints either. No issues were raised regarding the operation of the home by staff or the resident spoken with. Policies and procedures are in place for the protection of vulnerable adults. The staff member spoken to were aware of the organisation’s abuse policy and said that they did not have any concerns or issues. A copy of the local authorities procedures was also available in the home. DS0000059266.V329761.R01.S.doc Version 5.2 Page 17 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): 24,25,26,27,28 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s benefit from being in a clean and pleasant environment that meets their needs. EVIDENCE: A homely atmosphere was very apparent, with a high standard of cleanliness and hygiene being maintained throughout the home. Both residents rooms were nicely decorated, but with a limited degree of personalisation. When raised with the proprietor she reported that one resident, due to their individual needs, can exhibit quite challenging behaviour and would throw things, which is why the room appears a little bare. The recommendation made at the previous inspection regarding a window restrictor remains outstanding. The manager reported that this is due to the difficulties in securing an appropriate restrictor. Staff will only open the window from the top for ventilation and risk assessment is in place for the resident concerned.
DS0000059266.V329761.R01.S.doc Version 5.2 Page 18 The other resident who resides on the ground floor has mobility difficulties. Her room has been adapted for her wheel chair access. This resident reported that she was pleased with her own private accommodation. Communal areas were seen to be homely and relaxing with adequate furniture being available. Both bathrooms areas, laundry room and kitchen/dining rooms were clean and hygienic on the day of the inspection. A large secure garden area is available at the back of the house, which is used extensively during the warmer months. DS0000059266.V329761.R01.S.doc Version 5.2 Page 19 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): 32,34,35 & 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff team are able to support residents in meeting their needs. Staff records evidence that appropriate checks were being carried out prior to employment commencing although the records could be better organised. Training and supervision records failed to clearly evidence what training staff had taken place and when supervision had occurred. EVIDENCE: Staff record of four staff were examined. Records showed that the home carries out all necessary recruitment checks prior to staff starting in the home. However, the proprietor needs to ensure that the front record sheet is accurately recorded on the sheet once checks have been received. The proprietor stated she has two staff on duty when both residents are at home as one resident requires one- to- one support. At night there is a waking night staff, as well as a staff who sleeps, but is on call. Details of the on call management rota were on display on the office notice board. The staff member spoken with was clear as regards her role and responsibilities. She stated that she enjoyed working in the proprietor’s homes
DS0000059266.V329761.R01.S.doc Version 5.2 Page 20 as they were very homely and one could get to know the residents and their needs more quickly than in a large home. Training records seen failed to clearly evidence individual training and development needs of staff. The inspector was not able to see clearly what core training had been carried out and when refresher courses would take place. The proprietor stated that she was in the process of addressing this now that she had relinquished her managers role at her other establishment and submitted an application for approval as manager at this home. At the previous inspection the inspector had stated that the home needed a permanent manager to bring stability to the daily management of the home. This should be achieved once registration is approved and the proprietor is spending more time in this home, as there is a registered manager at her other establishment. Supervision of staff must take place more frequently than currently seen in staff files. A communication book is used for day-to-day information sharing. The staff member spoken with felt that they were adequately supported and she felt that the staff team worked well together for the benefit of the two residents. DS0000059266.V329761.R01.S.doc Version 5.2 Page 21 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): 37, 39 & 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Health and safety systems are in place to ensure the safety and welfare of the residents although not all records were available in the home. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Service satisfaction questionnaires help to monitor the quality of the service provided to residents and contribute towards the development of the service. EVIDENCE: All staff spoke positively of the proprietor’s style of management stating that she was approachable, and involves the staff in decision-making, which they all said they welcomed as it made them feel valued. The proprietor stated that she has submitted an application to the Commission to be the registered manager at this home, which is being addressed.
DS0000059266.V329761.R01.S.doc Version 5.2 Page 22 The inspector was told that that the organisation sends out questionnaires to all residents, social workers and relatives as part of the home’s quality assurance system. However, evidence of this was patchy within the home. The inspector recommended that a record be maintained as to when and who are sent questionnaires. Policies and procedures were in the process of being reviewed and where necessary, updated. The Commission continues to be notified regarding significant events in the home. Staff must ensure that where any review takes place that the date of the review is clearly recorded along with the name of the person carrying out the review. Health and safety checks are carried out regularly on the premises to ensure that the home is safe for residents and staff. A sample of records were looked at these included fridge and freezer temperature, portable appliance tests, and fire records, which was found to be in order. A copy of the most recent gas certificate was not available on the day. The home must also keep a weekly check on the hot water temperatures within the home, which must not be in excess of 43 degrees in resident’s bedrooms and bathroom areas. Also COSHH assessments seen require updating. DS0000059266.V329761.R01.S.doc Version 5.2 Page 23 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 X 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 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 2 X DS0000059266.V329761.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement The Registered Person must ensure that written protocols are in place where medication is prescribed to be taken PRN The Registered Person must ensure that Tippex is not used on the Medication Administration Sheets. The Registered Person must ensure that staff with responsibility for administration of medication receive appropriate training and update in this area of care service and written evidence is available. Timescale of the 30/04/06 not met. Timescale for action 30/05/07 2 YA20 3. YA34 13(2) 09/03/07 13(2) 30/06/07 4 YA35 5 6 YA36 YA42 18(1)(a)(c) The Registered Person must ensure that staff training record are kept up to date and evidence all training undertaken. This must include core and refresher training courses. 18(2) The Registered Person must ensure that regular recorded supervision takes place. 13 (3) The Registered Person must ensure :DS0000059266.V329761.R01.S.doc 30/06/07 30/05/07 30/05/07 Version 5.2 Page 25 • • • that COSHH assessments are updated. A current gas certificate for the home is available A weekly record is taken of the hot water temperatures in the home. 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 YA39 Good Practice Recommendations The Responsible Person should keep a record of questionnaires sent out to resident’s relatives and stakeholders, which forms part of the homes quality assurance system. DS0000059266.V329761.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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
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