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Inspection on 18/06/05 for Milbury 694 Pinner Road

Also see our care home review for Milbury 694 Pinner Road for more information

This inspection was carried out on 18th June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The establishment felt homely and welcoming and the resident`s bedrooms are well decorated and personalised to each individual resident`s choice. Staff were putting much effort into ensuring that outings were taking place on the day of the unannounced inspection. Meals and food looked nutritious and well presented and flexibility was evident in the choice offered to residents.

What has improved since the last inspection?

A comprehensive set of actions has taken place to address the considerable requirements from the previous inspection. The home feels like it is being managed and led with a sense of purpose for the staff team in supporting residents, thus ensuring that the people living there are safe and well cared for.

What the care home could do better:

Whilst redecoration and improvements to the building have taken place, further work must be undertaken to ensure that the home is safe and more comfortable for the residents. Some specific risks concerning the input of challenging behaviour must be further reviewed to protect the safety of residents in the home.

CARE HOME ADULTS 18-65 694 Pinner Road 694 Pinner Road Harrow Middlesex HA5 5QY Lead Inspector Richard Adkin Unannounced 18 June 2005, 10:00am 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 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 Stationary 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. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 694 Pinner Road Address 694 Pinner Road, Harrow, Middlesex, HA5 5QY. Telephone number Fax number Email 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 8868 1894 020 8868 1894 Milbury Care Services Limited Miss Marisa Mwape CRH PC Care Home only 8 Category(ies) of LD Learning Disability registration, with number of places 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 5th & 18th August 2004 Brief Description of the Service: 694 Pinner Road is a care home providing personal care and accommodation for eight people who have learning disabilities. There were no vacancies at the time of the inspection. The home is owned by Milbury Care Services, which is a national, privately-run, care organisation operating in excess of 200 care services across the country. The London regional office, based in Henley, South London, provides senior management support to the staff and manager of the home. The home is located within a residential area of North Harrow. It is within walking distance of shops and rail links. It is on the main bus route between Pinner and Harrow. There is parking available at the front of the house. The home was opened in 1995. it is a spacious two-storey building that was not originally used for residential care but has been adapted. All the homes bedrooms are single rooms. They are all fully furnished. Most have built-in sinks. The home has two bathrooms, a shower room, and one other separate toilet. Access to the first floor is by stairs only. The home has a good-sized garden that is accessible and maintained. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a hot summers day on a Saturday in June. The purpose of the inspection was to look at the large number of requirements that arose from the last unannounced inspection that took place over two days (5th & 18th August 2004) to meet national minimum standards. Most residents at the home do not speak. Verbal and non-verbal feedback was used where clear. The inspector observed care practices of staff working with all the residents, and how residents use the home. Feedback was also received from staff members. The manager of the home kindly came in off-duty to support the inspection. The Inspector had the opportunity to look around the premises. The Inspector would like to thank all at the home for their help with the inspection. What the service does well: What has improved since the last inspection? A comprehensive set of actions has taken place to address the considerable requirements from the previous inspection. The home feels like it is being managed and led with a sense of purpose for the staff team in supporting residents, thus ensuring that the people living there are safe and well cared for. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 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. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 5 There is clarity for each resident about the terms and conditions of being a resident in the home. EVIDENCE: The inspector looked at the information held, where possible, by each resident in the room. The information was appropriate in content and format with clear statements of terms and conditions of being a resident living in the home. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 9 Progress has been made on the regular reviewing of residents health and social care needs. Further work that was undertaken needs to be taken forward to protect the safety of residents at the home. EVIDENCE: Person centred plans looked at by the inspector detail how residents’ needs in respect of their health and welfare are met. They are signed by the manager and whereby the resident, are updated and accessible for staff working at the home. One resident presents with challenging behaviour; a plan was in place to manage this behaviour and an extra member of staff was on duty during the course of the inspection to implement the care plan. A risk assessment needs to be undertaken of the resident group to help manage the impact of the challenging behaviour of a resident. An assessment of risk and guidance to staff which was in place for one resident who has previously left the home alone must be continuously considered by the staff group. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 15, 17 Progress has been made with providing outings and stimulation for people living in the home. Residents are provided with nutritious meals which offer a healthy and varied diet. EVIDENCE: Evidence was seen on the day of the inspection of outings being undertaken on the weekend. Extra staff including the manager of the home had come in to ensure that these outings took place. One group was attending a local “Summer Fayre”. Another resident as part of his care plan, was making a visit with his keyworker to the cinema. There were bowls of fruit available for residents, and several vases of fresh flowers around the home. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 11 The lunch that was provided was varied, substantial and healthy and positive indications were received from residents on how much they enjoyed the food. Contact files that residents have with their families are actively maintained and considered. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 Progress has been made on improving arrangements to ensure that the healthcare needs of residents are identified and met. An audit is needed on the chiropody and dental needs of residents. EVIDENCE: Weight records are now regularly taken depending on the resident’s need. Health records were looked at during the inspection and were up to date. However, an audit of the needs of residents with respect to dental and chiropody input is required in order that any shortfalls can be promptly addressed, as there was patchy information on the care notes about residents dental and chiropody treatment 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion. EVIDENCE: 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 30 Some improvements to the décor have been made. There are a number of repair matters outstanding that do not provide a satisfactory environment for residents. EVIDENCE: The indoor and outdoor living space was comfortable and homely. Bedrooms looked at were personalised to meet the needs and lifestyles of residents. One room was furnished with football related items of the team the resident supported. A number of areas required attention: The mattress and old wood at the side of the home must be removed. The staining from a leak in the wall needs renovating. The shower room toilet seat is chipped and needs to be replaced. Grouting is needed in the downstairs shower. The downstairs bathroom needs the bath panel and neighbouring parts renovated. Either the sealing between the floor and toilets needs to be made good or the flooring changed altogether. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 15 The upstairs bathroom needs some tiling work and the cupboard needs boarding up. The small toilet upstairs needs urgent remedial work in the u-bend behind the toilet. There is a need for all toilet areas to be kept free of offensive odours at all times and this would be addressed on the whole by the necessary remedial repair work. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 Staff are supported in promoting and safeguarding the health, safety and welfare of the people using the service. EVIDENCE: Supervision notes were looked at for 2 members of staff. Supervision had taken place fortnightly and was focussed. Appraisals are now part of the culture of the home. Some staff disciplinary issues that had arisen were being tackled through human resources procedures. There were a suitable number of staff on duty on the day of the inspection to effect the care plans. Staff members spoken to were positive about their work experience and wanted to provide a good service. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 42 The home is being managed properly and leadership and guidance and direction is being given to staff who are responding to promoting the welfare of residents. The manager has NVQ Level 4 and is working towards her RMA. EVIDENCE: The manager presented as providing leadership to the home. There was evidence that she undertook spot checks to ensure the quality of care. A number of health and safety issues arising from the previous inspection have been addressed such as maintaining suitable lighting throughout the home at all times, recording temperature of the fridge freezer. The professional check ups that were out of date have all taken place, i.e. water systems, gas systems check, fire checks 10/6/05. The staff meeting records were looked at and covered relevant areas of 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 18 practice. Staff meetings, though must be held for all staff members at least on a monthly basis as four meetings out of 6 had taken place this year. It would be helpful for the running of the home and enhancing record keeping etc. if a computer was provided in the home. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 1 x x 2 Standard No 11 12 13 14 15 16 17 x x 4 x 3 x 4 Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 694 Pinner Road Score x 2 x x Standard No 37 38 39 40 41 42 43 Score x 2 x x x 3 x G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 20 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 YA9 Regulation 12(1) 13(4) Requirement A risk assessment should be undertaken for all the residents in the home to consider the impact of one residents challenging behaviour. An assessment of risk and guidance to staff must be accessible to staff members and discussed as a team in respect of the user who had previously left the home alone. (Previous timscale not met) An audit of the needs of all residents with respect to dental and chiropody input is required, so that any shortfalls can be promptly addressed. (Previous timescale not met) The mattress and old wood at the side of the home must be removed. The staining from a leak in the hall needs renovating. The shower room toilet seat is chipped and needs to be replaced. Grouting is needed in the downstairs shower. Downstairs bathroom needs the G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Timescale for action 30 November 2005 30 November 2005 2. YA9 12(1) 13(4) 14(2) and 15(2) 3. YA19 12(1)(a) 13(1)(b) 30 November 2005 4. 5. 6. 7. 8. YA24 YA24 YA27 YA27 YA27 23(2)(b) 30 November 2005 30 November 2005 30 November 2005 30 November 2005 30 Page 21 694 Pinner Road Version 1.30 9. 10. 11. 12. YA27 YA27 YA30 YA38 16(2)(j) 23(2)(d) 18(2) bath panel and neighbouring parts renovated and the sealing between the floor and toilet made good or change the flooring. The upstairs bathroom needs some tiling work and the cupboard needs boarding up. The small toilet upstairs needs urgent remedial work in the ubend behind the toilet. All toilet areas must be kept free of offensive odours, at all times. Staff meetings must be held for all staff members at least on a monthly basis. (Previous timescale not met) November 2005 30 November 2005 30 November 2005 30 November 2005 30 November 2005 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 YA38 Good Practice Recommendations The registered provider is recommended to provide a computer for the home to support the management and administration of the home. 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlesex HA1 1BH 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 694 Pinner Road G62-G11 S17553 694 Pinner Road V233130 180605 Stage 4.doc Version 1.30 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!