Inspection on 27/09/06 for Norwood 60 Carlton Avenue

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Norwood 60 Carlton Avenue 27/09/07

Norwood 60 Carlton Avenue 03/01/06

Norwood 60 Carlton Avenue 05/09/05

Norwood 60 Carlton Avenue 25/01/05

Norwood 60 Carlton Avenue 13/07/04

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 60 Carlton Avenue 60 Carlton Avenue Kenton Middlesex HA3 8AY Lead Inspector Judith Brindle Key Unannounced Inspection 27th September 2006 08:30 Norwood 60 Carlton Avenue DS0000017520.V303199.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 60 Carlton Avenue DS0000017520.V303199.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 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Norwood 60 Carlton Avenue Address 60 Carlton Avenue Kenton Middlesex HA3 8AY 020 8907 0239 020 8907 3711 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 Ms Amy Vickers Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd January 2006 Brief Description of the Service: 60 Carlton Avenue is a care home providing personal care, and accommodation for up to 8 adults with learning disabilities. The care home is owned by Norwood, which is a Jewish organisation that provides care for children and adults with learning disabilities. The care home is located in a residential street in Kenton, close to Harrow. The home is situated very close to a park. There are local shops, a large supermarket, pubs, a post office, building societies, restaurants, and other amenities within a few minutes walk from the home. The home was opened in 1997, and consists of a purpose built detached building. There is a small garden area, and parking for 2-3 vehicles at the front of the house. The home includes a flat attached to the main house, where accommodation and support is provided for up to two service users, to enable them to have the opportunity to develop independent living skills. All the homes bedrooms are single; one bedroom has a shower facility. The home has a passenger lift. There is an enclosed, accessible, maintained garden at the rear of the property Documentation/information about the care home is accessible to residents and visitors. Fees, including additional charges vary according to the individual needs of residents, and are recorded in the resident’s written terms and conditions/contracts. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout seven hours during a day in September 2006. The inspector was pleased to meet all the residents, and a number of staff. Several residents communicate by sounds and gestures. The purpose of the inspection was to spend time with the residents to gain their views of the service, and to observe staff interaction with those with communication needs, also assess key standards, and to follow up and assess as to whether requirements and the recommendations from the previous inspection had been met. The inspection included a tour of the premises, and inspection of resident’s care plans, staff personnel records, medication storage and administration systems, meals and mealtimes, and inspection of a variety of other records. The inspector spent a significant part of the inspection talking with the two residents who live in the flat, which is connected to the main house. The inspector also spent time with the residents in the communal areas of the care home. Several staff including care staff also kindly spoke with the inspector. The registered manager was present during most of the inspection. Staff kindly provided all the information, and documentation requested by the inspector during the inspection. An up to date certificate of registration was displayed in the care home. 25 National Minimum Standards for younger adults were inspected. What the service does well: The home has continued to put particular thought into the environment in ensuring that there is a relaxed atmosphere within the home for the residents. The home is very welcoming. The environment is very homely with numerous attractive features that meet resident’s varied sensory needs. Staff work particularly hard to understand and meet the needs of residents with complex needs including those with significant communication needs who are unable to verbally communicate their needs. There is evidence that the staff work hard to ensure that residents are empowered to be as independent as possible. The home ensures that residents are fully involved (as far as they are able) in the development of their plan of care that meets their needs including Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 6 individual goals and objectives. Care plans focus on resident’s abilities, and in supporting resident’s independence. Arrangements are in place to ensure that risks are assessed, and that residents are supported to take risks as part of an independent (as far as they are able) lifestyle. Residents are supported in maintaining contact with friends and family. The home closely liaises with social and healthcare professionals. What has improved since the last inspection? 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 60 Carlton Avenue DS0000017520.V303199.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 60 Carlton Avenue DS0000017520.V303199.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): Standard 1 (partially) and 2 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to make an informed choice about where to live. Arrangements are in place to ensure that residents receive a comprehensive assessment of their needs prior their admission to the care home. EVIDENCE: The care home has a statement of purpose and a service user guide, which set out the objectives and describes the services and facilities provided by the care home. The format of these documents includes pictorial as well as written format. This documentation should be reviewed to include up to date information in regard to the environmental changes. The service user guide was accessible at the entrance of the care home’s office. The care home has an assessment policy. There have been no new admissions to the care home for approximately eighteen months. The inspector had been informed during previous inspections of the process of assessment of prospective service user’s needs, and admission to the care home. Prospective residents receive assessment from Norwood’s admissions coordinator, and the registered manager/deputy manager. Residents (generally with support from Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 9 relatives) participate in this process. The relevant Local Authority funding authority care manager also assesses their needs. There was evidence of comprehensive assessment of resident’s individual needs recorded in care plans inspected. The registered manager spoke of the importance of fully involving residents and their family/friends in the initial assessment and during the process of ongoing assessment. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 6,7,and 9 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all the residents have a plan of care that records their individual needs, and the action to be taken by staff to meet those identified care and support needs. Residents are supported to make decisions about their lives with assistance as needed. Arrangements are in place to ensure that risks are assessed, and that residents are supported to take risks as part of an independent lifestyle. EVIDENCE: All the residents have a care plan. Five care plans were inspected. These care plans recorded evidence of assessment of comprehensive needs (‘areas of development’) of each resident. Identified needs included communication, eating and drinking, activities, medical and health, mobility, sexuality and cultural needs. There was recorded comprehensive staff guidance to meet these assessed needs. This guidance was very detailed and informative. Care plans included very comprehensive night care plans, which included staff Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 11 guidance to meet resident’s assessed night care and support needs. This is positive. All the care plans inspected included recorded objectives and areas of development to meet residents assessed needs. Staff spoke of care plans as providing comprehensive information about resident’s needs and of staff guidance to meet those needs, which a staff member said was particularly useful during the staff induction programme, when getting to know the residents. The care plans and staff guidance indicated that they had been developed with residents (if able) and relative’s participation/involvement. All residents have a key worker. A service user who kindly spoke with the inspector spoke highly of his key worker and co-worker. There was recorded evidence in the care plans that confirmed that there was close liaison/communication with the Local Authority purchasing authorities, and that Care Managers/reviewing officers were invited to reviews of the residents needs. Records confirmed that care plans were regularly reviewed. A resident spoke very positively about his recent care plan review meeting. Each of the five care plans inspected recorded residents preferred morning, afternoon and evening routines. Staff guidance to meet residents assessed needs was clearly documented, including support from staff to assist residents in the development of their independence and general empowerment. Service users who kindly spoke with the inspector described examples of numerous day to day choices that they made. There are documented records of the amount and type of support that residents need for managing their finances. All the residents receive support from staff with the management of their monies. Records of incoming and outgoing payments are recorded. A senior informed the inspector that all monies including resident’s monies had been recently audited by an independent auditor. The registered person needs to ensure that all receipts of items bought by/for residents clearly records what each item is. This was not evident on two receipts inspected, which recorded a significant sum of money spent on clothes, but it was not clear from the receipt what these items were. Each item bought should be clearly recorded in the resident’s inventory. The care plans all recorded evidence of comprehensive risk assessment. These risks assessments were linked to the assessed needs of residents, and included mobility risk assessments, community activities, bathing risk assessments, and health and safety, and manual handling risk assessments. A resident kindly showed recorded guidance in regards to his safety when going out into the community. The care home has a missing persons policy/procedure. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13, 15,16 and 17 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that residents have access to a wide range of preferred leisure activities, including community participation. Residents are supported to maintain and develop their relationships with family and friends. Resident’s rights are respected and responsibilities recognised in their daily lives. Residents are provided with nutritious, wholesome and culturally appropriate meals. EVIDENCE: Residents individual activity programmes were displayed and also recorded in their individual care plans. These activity programmes indicated that residents participated in a variety of ‘in house’ and community based preferred activities. All the residents took part in activities during the inspection. Several residents Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 13 attended a community based ‘sing a long’ session during the morning of the inspection. Residents also had an aromatherapy session, watched television and one resident was observed to enjoy handling some colourful plastic bricks. Records informed the inspector that each resident has the opportunity to participate in a very varied activity programme throughout the day. Staff spoke of a resident who participated in regular cooking sessions. The religious and cultural festivals are celebrated. Residents spoke of recently enjoying Jewish New year celebrations. Cards celebrating this festival were displayed in the home. Two residents spoke of the numerous and varied activities that they enjoyed. Records and observation confirmed that residents were supported in participating in several activities during the day and evening. These include arts and crafts sessions, watching videos, baking, music sessions, and foot spa sessions. Residents spoke very positively of a recent holiday, that they had enjoyed, and of day trips that were planned. A staff member informed the inspector that trips to see several West End shows were being planned. The care home has recently acquired a fifteen-seated passenger vehicle, which staff spoke of as being a great asset to the home and ensures that the residents have access to community amenities and facilities. Staff and residents used the vehicle during the inspection. Since the last inspection residents living in the flat have obtained a pet cat. Both residents spoke positively of the process of choosing the cat and of caring for it, and they informed the inspector that the cat had settled in quickly. The care home has systems in place to ensure that the cat is well cared for and is of minimal risk to service users and staff. A resident kindly spoke of his close family contact and support. Records and staff informed the inspector that most residents have contact with family and significant others. A resident regularly spends the weekend with her mother. A staff member informed the inspector that resident’s relatives sometimes participate in religious celebrations that take place in the care home. Records confirmed that relatives/significant others generally attend residents care plan review meetings. The visitor’s book confirmed that there were visits to the care home by friends and relatives. Photographs of family members were displayed in resident’s rooms. Assessment of socialisation needs and sexuality needs of residents are recorded in their care plans. Staff were observed to respect residents privacy during the inspection, and to interact with residents in a positive and sensitive manner. This included knocking on bedroom doors. There was evidence that residents were assessed in regard to whether they wanted or were able to have a key to the home and/or their bedroom. Residents were observed to freely access communal areas of the care home and chose when to be alone or in company. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 14 The care home’s menu was available for in section. It is a four weekly menu and recorded varied and wholesome meals, which met the cultural needs of residents. Records confirmed that snacks are offered to residents. A staff member showed the inspector a menu board, which had the meals for the day in (photograph format) displayed on it. Residents have the opportunity to celebrate Shabbat every week, when a special meal is prepared. A resident spoke of enjoying this occasion. A resident who lives in the flat of the care home was having breakfast during the inspection. He was fully involved in choosing his breakfast, which included a significant portion of fruit. He was knowledgeable and positive in regard to healthy eating. There was evidence from the menu and other records that the care home emphasises the importance of healthy eating. There was fresh fruit that accessible in the care home. A variety of fresh, frozen and dried foods were accessible in the care home during the inspection. Records confirmed that staff receive food and hygiene training. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 15 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): Standard 18,19, and 20 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s personal and healthcare needs are met. Medication is stored and administered safely. EVIDENCE: The care plans inspected recorded evidence of comprehensive staff guidance to meet resident’s assessed needs. Resident’s preferences are recorded. These include morning, evening and night routines, which are particularly comprehensive with evidence of residents (and/or family/relatives) participation in developing these preferred routines. A new specialist bath has been purchased since the previous inspection. The registered manager spoke of several residents who enjoyed this facility. Residents spoke of the times for getting up and going to bed as being flexible. Another residents spoke of choosing their own clothes, and of shopping for personal items. Staff were respectful towards residents during the inspection. A resident spoke of ‘liking’ the staff. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 16 Records confirmed that residents have their health care needs are monitored and met. Appointments with the GP, chiropodist, optician, district nurse, psychologist, and dentist were recorded. Staff spoke of close liaison with healthcare professionals. On the day of the inspection a senior staff member contacted a Consultant Psychiatrist in regard to concerns about the change in behaviour of a resident. A staff member informed the inspector that a resident had had a ‘choking episode’ during the previous evening. Staff had taken appropriate action. It is recommended that the resident be re referred to a speech therapist and also community dietician. This was discussed with staff. Detailed staff guidance to meet resident’s particular assessed medical needs was recorded in their care plans. The care home has a medication policy/procedure. The pharmacist checked the medication storage and administration systems on the day of the inspection. Medication was administered safely by staff. Two staff participate in the medication administration procedure. Medication administration records were recorded fully. A staff member spoke of having received medication training during the induction programme. Individual certificates of staff medication training were available for inspection. A resident was observed to be fully involved in the administration of his medication and was knowledgeable about the medication that he received. Norwood 60 Carlton Avenue DS0000017520.V303199.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): Standard 22 and 23 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure. There have been no recorded complaints since 2004. A resident spoke of talking to the manager or key worker if he had a concern. Records indicated that residents were supported in communicating concerns/complaints. The care home has the Local Authority Protection of Vulnerable Adults procedure, and the adult protection guidance from the other funding local authorities. The registered manager should access the up to date Local Authority guidance in regard to safeguarding vulnerable adults. Staff who spoke with the inspector had knowledge and understanding of protection of vulnerable adults. Records confirmed that staff receive protection of vulnerable adults training. Records confirmed that there was recorded guidance and risk assessment in the care plans in regard to meeting the needs of residents that might challenge the service. A staff member was observed to have been hit on their arm by a resident during the inspection. There was no indication that this incident was recorded or reported during the inspection. The registered person needs to Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 18 ensure that all staff are aware of incident reporting and recording procedures, and that this is monitored closely. The care home has a policy/procedure in regard to the management of resident’s monies. A senior staff member confirmed that residents have their monies/finances audited regularly by an independent auditor. Risk assessments in regard to resident’s finances were recorded (see Standard 7). Norwood 60 Carlton Avenue DS0000017520.V303199.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): Standard 24, 25 and 30 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The environment of the home is safe, homely and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. The care home is very clean, and odour free. EVIDENCE: The home is located in a cul de sac close to a park. It is in keeping with other houses in the street, and close to a variety of amenities and facilities. The inspection included a tour of the premises. The premises includes the main house, with a flat attached to it. The home’s premises are suitable for it’s stated purpose. It is well maintained and safe. It is evident that the registered manager, and staff team have worked hard to develop the ‘homeliness’ of the care home. There are pictures throughout the home, and other colourful items. Furnishings and fittings within the home are of good quality. Residents were observed to move feely throughout the home. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 20 A resident who lives in the flat attached to the main house, kindly showed the inspector around his home. He and another resident spoke positively about their home. One resident informed the inspector that he had chosen the colour of the décor of his bedroom. He spoke of there having been a dining table and chairs recently purchased for the flat. The flat was homely and included evidence of personal items reflecting residents preferences. The inspector was informed that residents used the garden frequently. Various items including soft items of seating equipment were located in the garden for residents use. The garden areas at the rear of the property and on the forecourt of the care home are both in need of some attention. The manager spoke of plans to ‘tidy’ these areas up. An extractor fan located in the shower/wet room needs repair and cleaning. Since the previous inspection in January 2006 there has been significant development of two rooms in the care home. The care home now has a ‘quiet’ room for residents. It includes equipment such as a music system, soft lighting and very ‘calming’ and attractive furnishings. Staff informed the inspector that residents, with staff support, used the room frequently. Another room has been transformed into a sensory room. This room includes a variety of sensory equipment including specialist lighting, sound fittings, and soft furnishings. The inspector was informed by staff that this equipment had been chosen in regard to resident’s preferences and individual needs, and that this room had only recently been completed. The manager reported that the residents would soon be enjoying the use of this facility. The registered person should ensure that each resident who uses the sensory room has received a recorded assessment/risk assessment. The registered manager is commended for working hard to develop and improve the facilities within the care home for the residents. The previous inspection requirement in regard to improving the shower facility, which is located in a resident’s bedroom, has been met. Resident’s bedrooms were each particularly individually personalised, homely, attractive and comfortable. They included a variety of items including music systems, photographs and pictures. The home is very clean, and odour free. The laundry facilities are located away from food storage and food preparation areas. . The care home has two industrial washing machines and an industrial dryer. Staff spoke of supporting residents with the management of their laundry. A resident spoke of being fully involved in the laundering of his clothes. The home has policies and procedures in regard to infection control. Records confirmed that staff receive training in regard to health and safety, and that disposable protective clothing such as gloves is accessible to staff. A domestic staff member works in the home on a part time basis. Staff, visitors, and Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 21 residents have access to alcohol gel hand cleaner, which is located close to hand washing facilities within the care home. Norwood 60 Carlton Avenue DS0000017520.V303199.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): Standard 32, 34, 35, and 36 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. Staff receive training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. Staff receive supervision but this needs to take place more frequently for some staff. All staff should receive an annual appraisal. EVIDENCE: The staff rota was available for inspection. A board displayed in the sitting room recorded photos and the names of staff on duty during the day of the inspection. The staff on duty on the day of the inspection included the manager, deputy manager (A grade) and four care staff workers in the morning and three staff on duty (plus the manager for part of the pm shift) in the afternoon. Staff were observed to interact with residents in a positive and respectful manner. Staff who spoke with the inspector were judged to be motivated and were knowledgeable of residents varied and often complex needs. Two residents spoke positively of staff, and described them as being understanding and helpful. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 23 Staff have a verbal ‘handover’ session at the end of each shift, which includes reporting on residents’ progress. The inspector joined this meeting during the inspection. Records and staff confirmed that most staff have achieved NVQ level 2 and/or 3 in care. The deputy manager (A grade) has completed an NVQ level 4 course, NVQ assessor’s qualification. The home works hard to ensure that staff have the opportunity to complete NVQ care courses. The care home has a recruitment and selection policy/procedure. Three staff files were inspected. These included required documentation including enhanced Criminal Record Bureau checks. Records confirmed that staff receive varied and appropriate training. This includes a comprehensive induction programme, and additional statutory training including food and hygiene training, First Aid, health and safety training, COSHH (Control of Substances Hazardous to Health). There was recorded evidence that staff had received general manual handling training. There needs to be evidence that staff are competent to use the portable hoist that is located in the home, which includes the particular individual needs of the resident in regard to their use of this hoist. Staff should have an individual training plan. Staff who kindly spoke with the inspector confirmed that they received a comprehensive induction programme, which included gaining knowledge and understanding of individual resident’s needs by reading and discussing care plans and also included ‘shadowing’ staff to ensure that they had the skills to meet resident’s personal care needs. Certificates of induction training were available for inspection. Records and staff confirmed that staff receive supervision, but this needs to take place more frequently for some staff. Records informed the inspector that a staff member had not received formal recorded 1-1 supervision since August 2005, another staff member had received their last recorded supervision 19/02/06. The manager spoke of there having been recent staff shortages which had led to it being more difficult than usual to provide staff with more regular 1-1 staff supervision. It is recommended that the registered person review and possibly increase the number of competent trained senior staff who can carry out staff supervision. The registered manager spoke of plans for the employment of a second Grade A staff member, which would be able to carry out management duties. This would be positive for the care home. All staff should receive an annual appraisal. Norwood 60 Carlton Avenue DS0000017520.V303199.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): Standard 37,39, and 42 Quality in this outcome area is good. The judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the care home. Effective quality assurance and quality monitoring systems are in place to ensure that the quality of the service provision by the care home is monitored closely. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The registered manager has several years working with adults who have a learning disability. She has managed the care home for several years, and has completed an NVQ assessor’s course (D32/33) and Registered Managers Award, and completed a NVQ level 4 in care course. The manager spoke of completing training courses to ensure that she updates her knowledge and Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 25 skills. The manager regularly works evening shifts. The registered manager remains proactive in regard to improving the service, including ensuring that staff receive appropriate training, and she continues to work hard to meet the National Minimum Standards for adults, and inspection requirements. Records confirmed that the care home has effective quality assurance and quality monitoring systems in place, which include reviewing care plans, health and safety checks, staff training, and environmental maintenance issues. Following the unannounced inspection. The registered manager supplied the Commission for Social Care Inspection with a report/development plan in respect of monitoring and improving the quality of the service provided in the care home. The manager confirmed that questionnaires had been supplied to relatives and significant others, and that feed back had been positive. Residents (dependent on assessed needs) had also been supplied with questionnaires. Two residents spoke of ‘enjoying’ their regular resident meetings in which they could express their views and needs in regard to the service provided. A resident informed the inspector that a resident’s meeting was planned to take place during the weekend following the inspection. The registered manager informed the inspector that she had attended a ‘focus’ group in regard to quality assurance and development of a quality assurance policy/procedure. The care home should have a quality assurance policy. This was a previous recommendation. Certificates of worthiness confirmed that required health and safety checks are carried out in the care home. These included checks of the electrical systems/appliances and gas systems, hoist check, passenger lift, fire fighting appliances and weekly health and safety checks of the care home. Required fire alarm system checks are carried out. The care home has an up to date fire risk assessment. Fire drills are carried out. The last recorded fire drill was 26/05/06. Fire action guidelines are displayed in the care home. Systems are in place to ensure that accidents are reported, recorded and appropriate action taken by staff in response to incidents/accidents. The care home has accessible risk assessments in regard to safe working practices. The care home needs to have a recorded risk assessment in regard to the use of portable fans. Fridge and freezer temperatures are monitored, and food safety temperatures are recorded. A health and safety poster was displayed as required. Cleaning products were stored in a lockable cupboard. Accidents are recorded appropriately. The certificate of employers liability insurance was up to date and displayed. Norwood 60 Carlton Avenue DS0000017520.V303199.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 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 27 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 YA7 Regulation 13(6) 17 Requirement Timescale for action 01/02/07 2 YA23 3 4 YA24 YA35 5 YA36 6 YA42 The registered person needs to ensure that all items bought by/for residents is clearly record on the receipts. 12,13,17,18 The registered person needs to ensure that all staff are aware of incident reporting and recording procedures, and that this is closely monitored. 23(2) An extractor fan located in the shower/wet room needs repair and cleaning. 12,13(4), There needs to be evidence 18 that staff are competent to use the new portable hoist, which includes training in the particular individual needs of the resident who uses, or might possibly need to use the hoist. 18(2) The registered person needs to ensure that there is evidence that staff working in the home are regularly supervised. 13(4) The care home needs to have a recorded risk assessment in regard to the use of portable fans. 01/02/07 01/02/07 01/02/07 01/02/07 01/02/07 Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 28 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 7 8 9 Refer to Standard YA1 YA7 YA19 YA23 YA24 YA24 YA35 YA36 YA39 Good Practice Recommendations The statement of purpose and the service user guide documentation should be reviewed to include up to date information in regard to the environmental changes. Each item of clothing (or other item) bought should be clearly recorded on the resident’s inventory. It is recommended that the resident be re referred to a speech therapist and/or community dietician. The registered manager should access the up to date local authority protection of vulnerable adults procedure. The garden at the rear of the property and at the forecourt of the care home should receive some maintenance. The registered person should ensure that each resident who uses the sensory room has received a recorded assessment/risk assessment. Staff should have an individual training plan. It is recommended that the registered person review and possibly increase the number of competent trained senior staff who can carry out staff supervision. The care home should have a quality assurance policy. Norwood 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 29 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 60 Carlton Avenue DS0000017520.V303199.R01.S.doc Version 5.2 Page 30 - 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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