CARE HOME ADULTS 18-65
9 Rosslyn Crescent 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ Lead Inspector
Julie Schofield Announced Inspection 10th November 2005 12:45 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service 9 Rosslyn Crescent Address 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ 020 8908 3410 020 8908 3410 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) Milbury Care Services Mrs Kesawarani Ravindran Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 21st April 2005 Brief Description of the Service: 9 Rosslyn Crescent is a detached house situated in a residential turning off the busy East Lane road. It is close to North Wembley station and about 10 minutes walk to the shops. The home accommodates 4 service users in 4 single bedrooms. The ground floor accommodation consists of an open plan lounge/dining room, laundry room, toilet, kitchen and a bedroom with en-suite facilities. The first floor accommodation consists of 3 single bedrooms and a separate bathroom and toilet. There is a garden at the rear of the property. There is off street parking for 3 cars at the front. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The registered manager was on maternity leave at the time of the inspection. The inspection began on a Thursday afternoon, the 10th of November, and started at 12.45pm. It finished at 3pm. During the inspection a site visit, examination of records and discussion with the deputy manager and a manager from another Milbury care home took place. The Inspector visited the home on Saturday morning, the 12th November and met residents and staff. This visit started at 9 am and finished at 11 am. The Inspector would like to thank the deputy manager, the manager from another Milbury care home and staff who gave their comments during the inspection. Residents were not able to communicate verbally with the Inspector. What the service does well: What has improved since the last inspection? 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 6 Since the last inspection a new music centre has been purchased for the lounge and some new furniture has been provided for one of the resident’s bedrooms. Person centred plans have been completed for each resident and the residents have had their second review meeting of 2005. The complaints procedure has been amended to include contact details for the CSCI. Staff have undertaken protection of vulnerable adults training. What they could do better:
Activities of interest to the resident need to be included in the programme for residents enjoying a “day off” from their day centre. Where activities outside the home involve the use of the company car both a driver and an escort are required and staffing levels need to reflect this. A letter of serious concern has been sent to the company regarding this. Individual risk assessments are needed for residents. Staff must have the means of quickly contacting the home in the event of an emergency i.e. having the use of a mobile telephone and there must be a policy for escorting residents in the community. The member of staff preparing a dish that meets the cultural, religious and dietary needs of residents must be the person who has the personal expertise and knowledge to do this. Medication records need to be complete and minutes of review meetings need to include the date of the review and the names of the people who were present. NVQ training must continue and staff also need to undertake training in infection control. Bedrooms must be odour free and carpets clean. Some making good and repainting of window frames etc is required both inside and outside the home. Some minor repairs are needed. It is recommended that the home encourage the placing authorities to attend review meetings and where this is not possible that copies of the minutes of the review meeting are provided. The home should request an initial review meeting if the placement has not been reviewed within 2 months of admission. When a resident is not able to communicate verbally the home should consider advocacy services for the resident. Communication systems should be reviewed to avoid duplication in recording information. New members of staff should undertake protection of vulnerable adults training during their induction period. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 7 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. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 8 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 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 9 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 the following standard(s): Standard 2 was inspected during the previous inspection in April 2005. EVIDENCE: 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 Reviewing care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed. The placing authority has a role to play in the review process so that the suitability of the placement can be monitored. The home should ensure that the placing authority is kept aware of the review process and the outcome of these. Residents exercise their right to make decisions within their day-to-day living although they may need the assistance of members of staff in presenting the alternatives from which to choose. EVIDENCE: The care plans for each of the residents was inspected. These were comprehensive and included a health action plan. Reviews had been carried out in February and in October 2005. The deputy manager said that a member of the placing authority had not attended these. The placing authority had not convened an initial placement review for the resident who was admitted to the home in April 2005. The minutes of review meetings did not always include the date on which the meeting had taken place or a list of persons who had attended the review meeting. A system of key working is in operation in the home.
9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 11 Residents do not communicate verbally and staff interpret wishes and choices by studying the facial expressions and body language of the residents. Staff said that residents might only use a few key Makaton signs as a means of communication. As residents do not communicate verbally they may benefit from the support of advocates. When asked how residents may be offered a choice the deputy manager said that in the morning the resident could be shown a few items of clothing and the resident may push away certain items or point at a particular item or by looking, show an interest in one item. Through these actions a choice is being demonstrated. When activities are offered, 2 or 3 different ones may be introduced. Residents may then show an interest in one particular activity, although how long the resident wishes to participate could be limited. When clothes or toiletries etc need to be purchased the resident and a member of staff go out shopping together. At the weekend the resident may wish to have a lie in and signifies this by closing their eyes and turning over in bed, after they have had their medication. They may choose the time they wish to go to bed by going to their room, when they are ready. Pictures of main dishes are used in menu planning to help the resident understand what is being offered. Assistance is given to all residents with managing their personal allowances. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 16, 17 Each resident has a day care programme, which provides an opportunity to develop his or her social and communication skills. The home needs to consider how to support the resident on their “day off” so that they have the opportunity to do something that interests them. While residents have the use of community facilities to provide opportunities for stimulation and enjoyment their safety is compromised when they are not provided with an escort while travelling in the car. A letter of serious concern has been sent to the company regarding this. The resident’s right of choice, privacy, dignity and independence are promoted and respected. Residents have a varied and balanced diet, with dishes to satisfy religious and cultural needs. EVIDENCE: Each resident has a day care programme and attends a day centre on 4 days a week. The day that is spent at home, during the week, is different for each resident. The individual residents’ daily diaries were inspected to see what residents did on their “day off”. Health care appointments, spending time in the home or going with the member of staff to collect residents from a day centre were the most common entries rather than time with a member of staff
9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 13 in an activity inside or outside the home. Comparing entries in the daily diaries and in the handover book etc identified some duplication of information. Residents have access to community facilities including restaurants, shops, hairdressers and religious places of worship. Where transport is required the residents either take a taxi or use the company car. It was noted that 2 of the residents use the car to travel to and from their day centres. An escort does not always accompany the driver and residents on these journeys. The driver is not provided with a mobile telephone so that they can contact the home in the event of an emergency. Staff said that they were not aware of a risk assessment for each resident in respect of using transport or of a policy on escorting residents in the community. A discussion took place with the managers about the rights of the residents and how these were respected by staff. Residents have their own private room where the door can be shut and where staff knock on the door and wait before calling out and entering. Assistance with personal care is given in the privacy of the resident’s room or in the bathroom. The dignity of the resident is maintained by helping the resident to maintain good standards of personal hygiene and a smart appearance. Examples of the resident’s right to make choices has been given in Standard 7. The staff team promotes the independence of residents and residents are expected to do as much as they can for themselves. When clothing is selected they are encouraged to dress themselves. When a meal is ready the residents are expected to help to lay the table and when they have finished they are encouraged to take the empty plates to the kitchen and to wipe the table. Residents help with their laundry, under supervision, and load the washing machine etc. Staff said that since the last inspection the system of menu planning on a weekly basis had been replaced by a five-week menu cycle. The new menus had been drawn up by taking dishes from previous menus. Staff confirmed that the residents liked the meals on the menu. However menus need to be flexible so that the expertise of the member of staff responsible for cooking the meal matches the meal on the menu. Some dishes rely on the personal knowledge of the member of staff to prepare and cook an authentic dish that meets the cultural, religious or dietary needs of the resident. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 20 Residents receive assistance with personal care in a manner, which respects their privacy and dignity. Residents are supported by staff to take their medication, at the times directed and in the doses prescribed by their GP, in order to promote their general health. However, incomplete medication records compromise the effectiveness of support given to residents with their medication. EVIDENCE: It was observed that assistance with personal care was offered in a discreet and sensitive manner. As the staff team is mainly female there is always a female member of staff on duty to provide assistance with personal care to female residents. Although during the week residents are encouraged to get up in the morning and go to bed in the evening at times that support day centre attendance the staff said that at the weekends residents wishes are respected and it was noted that on the Saturday morning the residents chose the time they were ready to get up. The deputy manager said that 2 of the residents had had a disturbed night and wanted to lie in. There are members of staff in the team who reflect the cultural and religious backgrounds of the residents and who share their knowledge with their colleagues.
9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 15 The storage of medication was safe and secure and medication had been appropriately administered from the blister packs, prior to the inspection. The procedure for the administration of medication to residents includes a record being kept of the person administering the medication and of the person who witnesses both the administration and the recording of this on each residents’ medication sheet. These were up to date at the start of the inspection. However the medication sheets had not been initialled on the evening prior to the inspection, the 9th November. The deputy manager confirmed that staff administering medication had undertaken medication training. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The welfare of residents is promoted and protected by having a complaints procedure in place. A format that is appropriate to the needs of the residents enables them to exercise their right to complain. Protection of vulnerable adults training for staff and familiarity with the home’s procedure contribute towards the safety of residents. EVIDENCE: Since the last inspection the complaints procedure has been amended to include details of how to contact the local CSCI office. The deputy manager said that complaints records will include details of the outcome of the investigation but since the last inspection no complaints have been recorded. There is a more user-friendly procedure for residents. Since the last inspection most of the staff have received training in adult protection issues and only the most recently recruited member of staff has still to attend. The manager of another Milbury care home who was present during the inspection said that in January 2006 the managers are to be trained to provide training to members of their staff team in adult protection procedures. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Although the overall appearance of the inside of the property is good some repairs are needed to ensure that residents enjoy a comfortable environment. Residents enjoy a home, which is clean and tidy, but the home must ensure that each of the bedrooms is free of any odours. EVIDENCE: A site inspection took place. Since the last inspection the home has filled in and made good where door handles have gouged a hole in the wall and doorstops have been attached to skirting boards, as necessary. The manager said that not all window restrictors have a working lock but the timescale for this to be remedied has not yet expired. There is peeling paintwork both inside and outside the home and panes of glass that are cracked but the timescale for this work to be carried has not expired. Bedrooms were attractively furnished and decorated although there were white marks on the carpet in one of the bedrooms. There was a rocking chair in one of the bedrooms and behind the chair there was scuffing on the wall. The home was clean and tidy although there was an odour of urine in one of the bedrooms. During the last inspection a requirement was made that all staff undertake infection control training. The timescale for this to happen has not expired.
9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 18 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 The home continues to support staff undertaking NVQ training. There were not always sufficient staff on duty to support the residents both inside and outside the home. EVIDENCE: The deputy manager is studying for a Registered Manager’s Award qualification. She said that 3 or 4 staff are currently undertaking NVQ level 2 training and 1 person confirmed that they have completed their LDAF induction and foundation training. The number of staff on duty varies and is not always sufficient for an escort to be provided when another member of staff drives the car used to transport residents. Staffing levels must be sufficient to meet the needs of residents and to facilitate a choice of activities, both inside and outside the home. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 The company has a quality assurance system to identify satisfaction with current services and changes in the needs and expectations of residents. This information is used to develop future services. EVIDENCE: A discussion took place about quality assurance systems. The managers said that the annual service review had taken place in September and the home was waiting for a copy of the report. As preparation for the review they said that the views of family members, professional visitors, members of staff etc were canvassed. In addition to the annual review the home also invites comments on the quality of the service provided from people attending the individual review meetings of residents. The home is also to introduce a record sheet for 1 to 1 sessions, held on a monthly basis, between the resident and their key worker. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 21 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 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30
STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 2 13 1 14 X 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 2 2 X X X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
9 Rosslyn Crescent Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X X X DS0000017488.V252086.R01.S.doc Version 5.0 Page 22 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 YA6 Regulation 15.2 Requirement That there is a record of the date on which review meetings are held and a list of persons attending the meeting. That the home reviews the support given to residents on their “day off”. That when residents use the company car there is an escort provided, who is not also the driver. That when staff accompany residents outside the home they have the use of a mobile telephone. That there are individual risk assessments for residents using transport. That the home has a policy on escorting residents in the community. That the expertise and knowledge required by staff preparing dishes to meet the cultural, religious and dietary needs of residents is reflected in the choice of member of staff for cooking duties. That medication records are complete and up to date.
DS0000017488.V252086.R01.S.doc Timescale for action 01/01/06 2 3 YA12 YA13 16.2 13.4 01/01/06 01/12/05 4 YA13 13.4 01/12/05 5 6 7 YA13 YA13 YA17 13.4 13.4 16.2 01/01/06 01/01/06 01/12/05 8 YA20 17.2S3.3 01/12/05 9 Rosslyn Crescent Version 5.0 Page 23 9 YA24 16 & 23 10 YA24 16.2 11 12 13 14 YA30 YA30 YA32 YA33 16.2 13.3 18.1 18.1 That the home provides a working lock for all window restrictors, makes good and repaints areas where paintwork is peeling and replaces glass that is cracked. That the carpet, which has white marks, is cleaned and that the scuffing on the bedroom wall, behind the rocking chair is made good. That all bedrooms are free from odours. That all staff undertake infection control training. That 50 of staff achieve an NVQ level 2 or 3 qualification. That there are sufficient staff on duty to support residents both inside and outside the home. 01/12/05 01/01/06 01/12/05 01/12/05 31/12/05 01/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 Refer to Standard YA6 YA6 YA6 YA7 YA12 YA23 Good Practice Recommendations That the home invites the placing authority to the review meeting and if the placing authority is unable to attend the home forwards a copy of the minutes of the meeting. That the home contacts the placing authority about an overdue initial review meeting for the resident who was admitted to the home in April 2005. That the care plan is reviewed at least every six months. That advocacy services are available to residents who are unable to communicate their needs verbally. That recording systems are reviewed so that duplication of information can be avoided, where possible. That the new member of staff completes their protection of vulnerable adults training within their induction period. 9 Rosslyn Crescent DS0000017488.V252086.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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