Inspection on 22/09/06 for Norwood 54 Old Church Lane

This inspection was carried out on 22nd September 2006.

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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Norwood 54 Old Church Lane 02/10/08

Norwood 54 Old Church Lane 01/02/06

Norwood 54 Old Church Lane 18/10/05

Norwood 54 Old Church Lane 02/03/05

Norwood 54 Old Church Lane 10/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Norwood 54 Old Church Lane 54 Old Church Lane Stanmore Middlesex HA7 2RP Lead Inspector Clive Heidrich Key Unannounced Inspection 22 September and 4th October 2006 8:30 nd Norwood 54 Old Church Lane DS0000017551.V313047.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 Norwood 54 Old Church Lane DS0000017551.V313047.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. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood 54 Old Church Lane Address 54 Old Church Lane Stanmore Middlesex HA7 2RP 020 8954 6498 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) Norwood Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Service User may have additional physical disabilities Date of last inspection 1st February 2006 Brief Description of the Service: 54 Old Church Lane is located in a residential area of Stanmore. It is a registered care home that offers personal care to a maximum of six service users who have learning disabilities. The organisation has voluntarily reduced this number to five so that the double-room need not be shared. The registered provider is Norwood, a national care organisation that specialises in providing services to people of a Jewish culture. The home is situated within a residential area of Stanmore. It is in keeping with other homes in the area. There is parking available in the forecourt for up to three cars, and on surrounding roads. Local transport links and shops are within 10 to 15 minutes walk. The building includes a lounge, a dining room, a ground-floor bedroom, a ground-floor shower room, four upstairs bedrooms, and a separate upstairs bathroom and shower room. Access to the first floor is by passenger lift or stairs. The home had a secluded and fair-sized garden. The manager noted that the fees depend on individual needs. The Service User Guide is available both on request and on the notice-board within the dining area. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the last inspection of this home, the registered manager has moved to another of the organisation’s care homes, and a new manager has begun working. This inspection took place across two days in early autumn. It lasted just over twelve hours in total. The focus was on inspecting all of the key standards, and with checking on compliance with requirements from the last inspection report. The inspection process included discussions with the three service users in the home who can provide verbal feedback. It also involved observations of how staff provided support to service users, discussions with staff about the work, checks of the environment, and the viewing of a number of records. The manager was present and available throughout the inspection. The inspector thanks all involved in the home for the patience and helpfulness before, during, and after the inspection. What the service does well: What has improved since the last inspection? The home now has three staff working at all times of day and evening. This improves on previous levels, and helps to provide the support necessary for the increasing dependency needs of some service users. There is now a driver working in the staff team at the weekend. Combined with increased staffing levels, service users are now able to access the community much more, for instance with going to the synagogue. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 6 There are now summaries of each service user’s care plan that are easily available to staff at all times. There are also records of progress on each service user’s goals from their formal review meetings. Service users are somewhat more involved in making decisions about their lives and the service. One service user attends a new organisational forum on improving the services for service users. The décor of the home has generally improved. Service users have had their rooms repainted. There is a new washing machine. A new bath, that will be easier to access, is being installed. There has been work undertaken in the garden to make it safer to use. 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. Norwood 54 Old Church Lane DS0000017551.V313047.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 Norwood 54 Old Church Lane DS0000017551.V313047.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Prospective service users can be supplied with good standards of information about this home and its services. There are suitable procedures for the assessment of prospective service users. EVIDENCE: The manager confirmed that there are no new service users and no planned admissions. The home has an admissions policy in place that was previously judged as suitable. Details about admissions can be found in the Service User Guide. The manager confirmed that this Guide and the home’s Statement of Purpose have been updated since her arrival earlier this year. The Statement of Purpose is now dated August 2006. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. There are excellent standards of care planning and providing support to service users with personal goals. There are also good standards of supporting service users with risk management, making decisions, and enabling consultation about the service in the home. EVIDENCE: Checks were made of the files of two service users. Care plans and risk assessments were found to be up-to-date. The documentation provided great detail, both with the range of needs to address and about how staff are to provide support. There are also monthly write-ups about each service user’s development, which now include about progression with the goals set at formal review meetings. The manager explained that she is setting up active files with each service user. These will include summaries of the care plans and risk assessments. This will support new care staff to quickly understand what the major support needs of each service user are. This is good practice. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 10 Formal review meetings were recorded as taking place for each service user within the appropriate 6-month timescale. Invites for these are sent to all involved people. The meetings record the service user being present and involved, as is appropriate. Those risk assessments seen were relative to the individual risks that each service user might present to themselves and others. For instance, around handling money, and having hot drinks. This is suitably person-centred. The manager noted that the local Health & Safety manager within the organisation has checked over all risk assessments, which is useful. Two service users spoke with the inspector about risk management around the home. They appeared to be very aware of possible dangers from such things as trips and fire hazards. Staff also provided support that minimised risks, such as for helping with mobilizing. Recent increases in staffing levels have helped to manage the risks associated with the increasing dependency of some service users. There was generally positive feedback about service users making decisions for themselves. The breakfast that the inspector observed involved staff asking service users about what each of them wanted for breakfast on arrival at the table. The manager and one service user noted that service users had chosen the colours for the recent redecoration of their rooms. Staff reported that service users are mostly quite assertive, and will refuse things such as meals and activities if they don’t like them. One staff member explained that they help service users to make decisions by knowing them and listening to them. Service users reported that they are usually able to make decisions for themselves. For instance, one service user said that they go to bed at a fixed time of their choice, and that they tell staff what they want to wear when being provided with support to get dressed in the morning. Records such as the minutes of service-user meeting showed that service users are asked their opinions and that these are recorded and actioned. For instance, meal preferences were found to have been included within consequent menus. Staff however noted that service users may then choose a different meal on the day. Records confirmed this. Service users confirmed that these meetings are useful. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 11 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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are provided with good support to engage in appropriate activities and occupations, including with respect to the Jewish faith. Recent improvements in staffing levels and car use have enabled excellent standards of community presence for service users. There is good support for service users to uphold personal and family relationships, and to have their rights and responsibilities addressed. Service users are provided with healthy diets with recognition of their preferences. EVIDENCE: One the first day of visiting, some service users spoke keenly about the celebratory meal being held later that evening in respect of Rosh Hashanah. One service user said that much shopping had been done in preparation for this. On the second day of visiting, there was an apparatus in the garden for use as part of Sukkot. Feedback and guidance records confirmed that Shabbat is observed every Friday. A volunteer from a local religious group comes into Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 12 the home on those days to lead prayers. The manager confirmed that all such people are familiar to the service users. There was also feedback that service users are supported to attend a local synagogue regularly. The service users also spoke with excitement about their upcoming holiday to Blackpool. The manager explained that specific transport was being arranged for this five-day trip. The service has now secured the use of a driver at the weekends, to complement the one driver already working within the care staff team. Service users reported being able to use the car more often at weekends. One service user said that they can manage to get into the house car but that it is not easy. The manager noted that she is in the process of acquiring quotes for a new car. All service users went out on the first day of inspection, for shopping and a meal out. The house car and a taxi were used for this. On the second day of visiting, most service users went out to a music session in the morning, whilst one other service user went to visit family. Staff provided support for all this. One service user spoke of going out to music sessions. Another service user said that they don’t go out much, which is fine with them, but that the meal out earlier in the morning was good. There was also feedback about individual service users going shopping, sailing, and taking photos. The home has a piano in the lounge, which one service user was heard to play during the visits. Each service user has an individualised occupation plan for a standard week. Day occupation options and employment training were recently discussed within service user meetings. Feedback from service users, staff, and the manager showed that service users are able to have visitors and visit people. For instance, one service user said that they regularly phone their brother from the home. Staff noted that one service user has a volunteer visit regularly. Records confirmed that arrangements for visits are carried out. The breakfast on the first day of visiting included porridge, rice crispies, toast, and orange segments. Each service user was asked about what they would like. One service user was given equipment to help them to drink easily. Another had a raised plate for their breakfast, to help them to scoop up the food. This all helps with service users’ independence. All service users were having breakfast by 9am. Feedback from service users about the food suggested that it is adequate. One service user said that the food is alright, and that they get their favourite meals sometimes. Another said that the food is ok. It sometimes does not taste nice, and alternatives are generally provided. Everyone confirmed that Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 13 they get enough, and there was particular praise for the desserts. It is recommended that the lack of strong positive feedback by service users about the food be explored, with a view to finding ways to improving service users’ enjoyment of meals. A copy of the proposed and actual menu was supplied to the inspector. A range of meals was provided. There were notes of when service users had something different, for instance pasta for one service user who does not like potatoes. The preferred food choices of service users are recorded about within their care files. Norwood 54 Old Church Lane DS0000017551.V313047.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users receive good standards of individualised personal support. There are generally very good standards of health and medication support. However, a few minor improvements must be addressed in these areas. EVIDENCE: Service users were seen to be suitably dressed in individual, well-fitting, and clean clothing from the start of the visit. This helps to show that staff provide appropriate support with personal care and grooming where needed. One service user in particular was seen to have pleasantly painted finger-nails, which they said that staff did for them. Staff said that there are now more staff working in the afternoon and early morning, to help to provide the personal care support that has recently become necessary due to the increasing dependency of some service users. They have had training relating to this. Staff spoke with knowledge about how they support service users with continence needs. Such support was offered with discretion during the inspection. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 15 Service users’ files contained communication profiles, which can assist staff particularly with those service users who do not speak. Staff and the manager showed good individual understanding of the communications of the service users who do not speak. Two service users were able to confirm that staff come with them for health appointments, and that this is supportive. One service user was seen to get clarification about an upcoming appointment from the manager. The handover between outgoing and incoming staff made appropriate reference to the runny nose of one service user. This is all appropriate. Records and feedback showed good health support for service users. Care plans generally provided suitable details about health issues of each service user. Health records showed input from dentists, opticians, and GPs, including for medication reviews. There were also good standards of supporting service users with dealing with individual health issues, such as for epilepsy and conditions relating to old age. The manager noted that one service user had recently received a private occupational therapy assessment due to deteriorating mobility needs. There were also records of wheelchair specialist input. One shortfall was identified within the records, about one service user not having received any chiropody input since May, and with no details about the outcome of such a visit since 2005. There are generally good standards of recording about how health appointments went. The manager agreed to ensure that chiropody needs for this service user are checked and addressed. Medication was seen to be given to service users with due respect. Staff minimised hand-contact with the medications, and provided water with the medications. One service user confirmed that this is standard practice. Two staff undertook the procedures together, to minimise risks of mistakes. Medications were generally all seen to be signed and up-to-date. The secure medication trolley was suitably clean and organised. There were daily records of temperature for the trolley. There was now a medications returns book. Feedback and records showed that issues relating to individual service users’ medications have been addressed with the GP and pharmacist where needed. For instance, the manager noted that they had recently acquired a liquid in place of the tablet that one service user had found too big to swallow. Records of changes to medications were signed by the GP. There was hence much evidence in support of good standards of medication. Some shortfalls were identified. There was no guidance on the circumstances in which to offer any service user a prescribed as-needed (PRN) medication. This could lead to inconsistency. Some medication bottles lacked dates of opening, which could allow the medication to continue to be used when the Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 16 medication is no longer fully effective. Two medications of variable doses lacked records of which dose was administered. This prevents suitable information from being available. The manager agreed to address all of these issues, as required, noting that some had been addressed straight away. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 17 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): Both of them. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service ensures that service users’ views are listened to and acted on, and that there are procedures to ensure that service users are protected from abuse. However some staff lack training in abuse-prevention, which must be addressed. EVIDENCE: The complaints book was seen to have no further entries since the last inspection. The documentation includes numbered complaint forms within a bound book, and space for follow-up actions and complainant’s comments, which shows good levels of transparency. The corresponding policy dates from 2004. One service user said that they are listened to, but have not needed to complain. Another said that they can speak to the manager and that they would be listened to, but they had no complaints. A third said that they could speak to staff and would be listened to. Staff noted that service users are asked within the service user meetings about whether they have any concerns with the service. Records confirmed this. This all suggests that should any service user have a complaint, it would be acted on. Feedback from service users generally indicated that they feel safe in this home. One staff member stated that they have had abuse-prevention training. They were able to give a good account of appropriate procedures should a concern about abuse arise. However there were gaps in the training records of Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 18 some staff in this respect. The manager has identified this, and it taking steps to address this requirement. Checks were made of two service users’ financial records and bank books as kept in the home. The cross-checking found no concerns and confirmed that there is a good standard of record-keeping in this respect. Appropriate purchases are made. Money is held securely in the home. The manager also explained that a member of Norwood undertakes regular independent audits of service users’ finances. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 19 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, 25, 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The environment and décor of the home is of a suitably homely, clean and comfortable standard overall. There is appropriate communal and bedroom space. Bathrooms and toilets will meet needs when the ongoing work to install a new bath is completed. Service users are provided with specialist equipment where needed. Improvements are particularly needed with the poor state of repair of the hallway carpet, the flat roof over one service user’s bedroom to prevent further leaks, and with ensuring that professional inspections of hoists are up-to-date. EVIDENCE: Service users fedback positively about the environment, noting that it is kept clean. A tour of the communal areas of the house was undertaken with one of the service users. They noted that there is now a new washing machine. Three bedrooms were also viewed separately, which the inspector received positive feedback from service users about. The general standard of décor and Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 20 cleanliness was good. There was feedback from service users that their bedrooms had been repainted this year and that they had chosen colour schemes for this. Walls throughout the home were generally clean and presentable. Actions from the last inspection report, in respect of décor, have generally been addressed, including levelling the stone-paving in the garden. The one outstanding requirement, about the hallway carpet, was noted by the manager and staff to be in hand. New garden railing was reported by one service user to have been recently put up. Whilst they preferred it without rails, they understood how this helped to prevent accidents. The railings do not significantly detract from the homeliness of the garden, and the reasons for them are suitable. A service user also said that there was new garden furniture, however it was now in storage, as was appropriate for the weather. The upstairs bathroom contained no bath at the time of the inspection. The manager explained that a more suitable bath was due shortly to be installed, and that the previous bath had been removed to facilitate this. Service users therefore currently only had showers available to them. This is reasonable as a short-term measure. The upstairs shower room itself was seen to have been retiled throughout. One service user’s room, to the far left upstairs, had clear water marks in the ceiling area. The manager explained that there had been a leak from the roof, and that she has applied for it to be rectified. There were records to confirm this. The issue needs to be addressed in terms of new roofing, else leaks may reoccur. The water from the shower room sink came out warm from the cold tap and cold from the hot tap. The manager agreed to ensure that taps are swapped around, to assist with service users’ independence. She noted that all mixer valves were changed after the last inspection, to ensure that hot water is suitably supplied. Records showed that minor maintenance issues such as blocked drains in the garden are quickly attended to. The manager noted that the radiator in one service user’s bedroom was being boxed, to minimise risks of scalding. She is ensuring that others are attended to. The manager established that there had been no recent professional inspection of the mobile hoists. This increases risks of accidents. A date for this to take place was fixed by the second day of visiting, as required. There were records to show that the passenger lift had been suitably inspected. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 21 The manager was not aware of a window handle being broken off in one service user’s room. She agreed that as staff assist to clean the room regularly, the issue should have been picked up on. She must ensure that staff are suitably vigilant. The inspector noted that the door at the top of the stairs bangs shut loudly. This could cause disturbance, which should be checked. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 22 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, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users are supported by a suitably qualified, supervised, and competent staff team. There have been recent improvements to staffing levels to address service users’ needs, which indicates an excellent standard of effectiveness of the staff team. Recruitment and training standards are generally appropriate, however shortfalls with acquiring suitable work references and with addressing training gaps must be addressed. EVIDENCE: Fedback from service users about the staff was positive. One service user said that staff seem to know what to do. Another said that they are all good. Staff were seen to interact appropriately and respectfully with service users. Checks were made of five staff members’ training records. Newer staff members have received a good range of formal courses, including on the principles of Jewish care and on epilepsy. All staff have had food hygiene training, and the majority have had training in fire safety and manual handling. There was some degree of gaps for established staff, either in getting refresher training in such areas as emergency 1st aid and adult Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 23 protection, or with not having attended certain courses. This can result in inconsistent or outdated care practices. The manager noted that she is addressing this, as is required. The manager stated that four of the ten staff have qualifications at NVQ level 2 or above. Three others are completing such courses or equivalent qualifications. This represents a suitable standard of team training. The manager stated that new staff work through a ‘Skills For Care’ national induction package, and attend intensive training during the first couple of months of work. There was written evidence of new workers undertaking shadowing roles and receiving core training from the start of their employment. The manager stated that she currently provides individual supervision to all staff. This includes a focus on staff development. Records and staff feedback confirmed a frequency of 4-6 weekly supervision meetings for most staff, as is appropriate. Checks were made of the recruitment files of three recently-appointed staff. These showed that suitable checks are made though application forms, employment histories, passports, and Criminal Record Bureau disclosures (CRBs). There was a shortfall with the written references obtained for one staff member in that they were not from their most recent care position. However, a large amount of previous references were supplied. The employer must attempt to gain references from the most recent care employer regardless of this being overseas, so as to minimise the risk of unsuitable people becoming employed. Staff and the manager noted that they now provide extra support to one service user due to their increasing needs. Funding for this has been acquired, and hence there is now three staff instead of two working from late afternoon and at the weekends. Additional support is also provided in the morning with the established third staff member starting an hour earlier. The manager noted that the additional staffing needs for another service user are currently being provided for from within the organisation. Liaison is taking place with the service user’s funding authority. An additional staff member is being recruited for. Rosters for the first two full weeks of September were inspected. These showed that three staff were usually working at all times of the day and evening. This represents a clear improvement on previous inspections. The manager noted that she also helps to provide cover. It would be helpful if this was clearly recorded on the roster. Some cover was needed to uphold these improved levels, which is usually though the use of peripatetic staff. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 24 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a new and experienced manager who demonstrates good leadership abilities. The manager is currently unregistered with the CSCI. The views of service users influence the running of the home, but improvements are needed with formalising policies on this and on quality assurance. There are also good standards of health & safety practices in the home. EVIDENCE: The people working as manager and deputy have changed since the last inspection. The new manager has been in post since the end of May 2006. She stated that she used to manage a 60-bedded dementia care home, and has been working in the care field for over twenty years. She has completed the Registered Managers’ Award, and has completed some units of the NVQ level 4 course in care. She is also an NVQ assessor and has a level 3 NVQ in promoting independence. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 25 The manager is aware of her responsibility under legislation to apply for registration as manager with the CSCI. She explained how this has been heldup. She was able to provide evidence of applying appropriate management skills in the home. One service user spoke positively of the new manager, explaining that the manager talks to them. There was also feedback from staff that the manager is supportive. Staff reported that staff meetings are held six-weekly, and that they contribute to them. The manager gave examples of how she is supporting staff with undertaking increased responsibilities and hence developing their abilities. For instance, team responsibilities have been set-up within a recent staff meeting. The manager stated that the organisation continues to work on a quality auditing policy, as previously required to help ensure that service users and their representatives can provide appropriate feedback about the service. She noted that the organisation is now providing a local, confidential forum for service users to attend. One service user from the home attends, which the service user themselves confirmed. Training on enabling staff to listen better to service users has been one outcome of this group, which is encouraging. Monthly service user meetings are being held in the home. Recent minutes of these showed discussions about a holiday, staff changes, and day occupation options. There was a good standard of involving service users with decisionmaking within this. It remains for the CSCI to be supplied with proprietor visit reports based on their monthly visits to the home as required under legislation. The reports would help to show that the home is being suitably monitored within the organisation. The manager noted that the home does also receive lay monitoring visits, and has received a recent external health & safety audit. There were records and certificates to confirm that suitable professional checks had recently been undertaken for the gas system, portable electrical appliances, the water system, and the fire systems. These included where faults or concerns arose, which had since been rectified. There were suitable internal checks of the fire systems, the fire doors, and the emergency lighting. There were also records of two fire drills in 2006, one false alarm, and a fire-safety risk-assessment. Monthly health & safety checks throughout the house are recorded about, as are suitable health & safety risk assessments in respect of such concerns as safe garden use and scalding. The manager noted that the organisation’s local health & safety manager has approved of these assessments. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 26 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 X 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 4 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 3 2 X X 3 X Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 1 YA19 13(1)(b) 2 YA20 13(2) 3 YA23 13(6), 18(1)(c) 4 YA24 23(2)(b, d) The manager must ensure that the professional chiropody needs of all service users are up-to01/12/06 date and suitably recorded about. The manager must ensure that: • There is always guidance available on the circumstances in which to offer any service user a prescribed as-needed (PRN) medication; 01/12/06 • All medication bottles have a date of opening; • Where a medication is prescribed as a variable does, that the actual dose is recorded about on each occasion of administration. The manager must ensure that all staff have received training in 01/03/07 abuse prevention. The hallway carpet has a number of small holes in it, and so must be replaced, to uphold a homely appearance. 01/02/07 Previous timescale of 1/7/06 not met. Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 28 5 YA24 23(2)(b, d) 6 YA24 23(2)(c, d) 7 YA24 18(1)(a) 8 YA29 23(2)(c) 19 schedule 2 part 3 18(1)(c) 10(1)(a) 9 YA34 10 11 YA35 YA37 12 YA39 26(5)(a) 13 YA39 24 The registered people must ensure that the leak into one bedroom upstairs is suitably fixed through repair work to the flat roof above it. The manager must ensure that the taps in the shower room sink are swapped over, so that they provide hot or cold water as appropriate. The manager must ensure that staff are suitably vigilant as to notice such breakages as the window handle in one bedroom that had come off. The manager must ensure that a professional inspection of the mobile hoists takes place. The registered people must always attempt to gain references from the most recent care employer, even when this involves an overseas position. The manager must ensure that gaps in staff training records are addressed. The manager must complete a CSCI application for registration as manager. Proprietor visit reports must be promptly supplied to the CSCI on a monthly basis. Previous timescale of 15/4/06 not met. A policy, in respect of establishing and maintaining a system of periodic review and improvement of the quality of care and support provided in the care home, is required. The policy must include about formal and proactive feedback channels for service users, their representatives, and involved professionals. Previous timescale of 1/7/06 not met. DS0000017551.V313047.R01.S.doc 01/03/07 01/12/06 15/12/06 01/12/06 15/12/06 01/04/07 15/12/06 01/12/06 01/03/07 Norwood 54 Old Church Lane Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA17 Good Practice Recommendations It is recommended that the lack of strong positive feedback by service users about the food be explored, with a view to finding ways to improving service users’ enjoyment of meals. The inspector noted that the door at the top of the stairs bangs shut loudly. This could cause disturbance, which should be checked. Consideration should be given to whether the carpet in the hallway upstairs is sufficiently easy to use for service users who use zimmer-frames. There should be records on the roster of the actual times that the manager worked. 1 2 3 4 YA24 YA29 YA33 Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 30 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 © 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 Norwood 54 Old Church Lane DS0000017551.V313047.R01.S.doc Version 5.2 Page 31 - 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. 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