Inspection on 20/01/09 for Outlook Care 80 Doyle Gardens

This inspection was carried out on 20th January 2009.

CSCI found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Outlook Care 80 Doyle Gardens 18/01/07

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 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Outlook Care 80 Doyle Gardens 80 Doyle Gardens London NW10 3SR three star excellent service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Tony Lawrence Date: 2 0 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Outlook Care 80 Doyle Gardens 80 Doyle Gardens London NW10 3SR 02089619762 02089619762 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Outlook Care Name of registered manager (if applicable) Mr Richard Gaskill Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 3 0 care home 3 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home only - Code PC two service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 3 Date of last inspection 1 8 0 1 2 0 0 7 A bit about the care home 80 Doyle Gardens is registered to provide accommodation and care support to three adults with learning disabilities. At the time of this inspection, there were no vacancies. The home is a three-storey terraced house owned by New Era Housing Association. Outlook Care provides the care support. Service users’ accommodation is provided on the ground and first floors. All bedrooms are single occupancy. Office space and the staff quarter are on the top floor. The home is located opposite a large public park. It is close to public bus routes. It is within easy reach of Harlesden and Willesden town centres, shops, leisure, and health & social care services and facilities. There is parking space for one car at the front of the house, in addition to unrestricted street parking. There is also a wellmaintained garden to the back of the house. Care costs, and the Service User Guide, are available on request from the home. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This unannounced key inspection took place on Tuesday 20th January 2009, from 09:15 - 16:00. During this visit we reviewed outcomes for people living in the home against the National Minimum Standards for care homes for adults. We did this by spending time with residents and staff, checking care records, viewing all parts of the home and talking with care staff and the homes Manager. What the care home does well People who may want to live in the home will be given information that is easy for them to understand. Peoples care needs will be assessed when they move into the home and reviewed regularly. Care plans are person centred and focus on residents strengths and personal preferences. Plans are all different and highly individual and they include evidence that the service values improving outcomes for people. Plans also include comprehensive risk assessments. The service has a can do attitude and risks are managed positively to help people lead the lives they want. The service respects the human rights of people, with fairness, equality, dignity, respect and autonomy underpinning the care and support provided. People living in the home receive effective personal and healthcare support, using a person centred approach. Individual health action plans clearly record peoples personal and health care needs and detail how they will be met. Complaints and protection procedures reflect the needs of people under the six strands of diversity, including disability. People living in the home are provided with a complaints procedure they can understand and the procedure is available in a variety of formats. The home is clear when an incident needs to be referred to the Local Authority as part of the safeguarding adults procedures. There are consistently enough staff available to meet residents care needs, with more staff available at peak times of activity. The staffing structure is based around delivering outcome for residents. What has got better from the last inspection What the care home could do better Following this inspection we have made one recommendation to improve further the excellent standards of care and support provided in the home. The Manager should review the number and length of shifts worked by care staff in the home to make sure that they have sufficient breaks and days off to enable them to work effectively at all times. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Tony Lawrence Regional Contact Team Tel: 020 7239 0330 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People who may want to live in the home will be given information that is easy for them to understand. Potential residents and their representatives know that peoples care needs will be assessed when they move into the home and reviewed regularly. Evidence: During this visit we saw that the provider had produced a very good Service User Guide that described the services provided at Doyle Gardens. We saw that the Guide had been produced using excellent pictures and photos to make the information more accessible to some people with a learning disability. The Guide had been reviewed and updated in January 2009. The manager told us that the home had a block contract with Westminster Social Services Department to fund placements in the home. The manager also told us the provider was working with the local authority to introduce individual budgets to fund the services provided in the home. When we checked the residents care plan files we saw that all three people had lived in the home for between four and thirteen years. We saw evidence that peoples care needs were regularly assessed and recorded by staff working in the home and other professionals. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Care plans are person centred and focus on each persons strengths and personal preferences. Plans are all different and highly individual and they include evidence that the service values improving outcomes for people. Plans also include comprehensive risk assessments. The service has a can do attitude and risks are managed positively to help people lead the lives they want. Evidence: During this visit we checked the care plans and risk assessments for two people living in the home. One persons care plan had been reviewed and updated by staff in October 2008 and again in January 2009. The plan covered community activities, contact with relatives, communication, daily living skills and other personal and health care issues. The plan was written in a very person centred way and there was good evidence that the resident and other significant people had been involved. We also checked this persons daily care notes and these showed us that staff knew about agreed goals and how the person should be supported in each area. We also saw excellent risk assessments that covered behavioural and health issues, as well as activities planned by staff. The assessments clearly detailed the potential risks to the resident and other people and how these should be minimised. All of the risk assessments had been reviewed and updated within the last 6 months. We also saw that the care plan and risk assessments had been used to develop action plans and support guidelines for staff working with this resident. These guidelines had also been translated into Mandarin for members of the residents family. The manager told us that some of the goals identified in the actions plans had been met. The residents diet had improved, contact with his family had increased and he had been baptised. Evidence: The second persons care plan and risk assessments that we reviewed were also excellent and person centred. The care plan covered personal and health care issues and had been used to develop excellent, person centred guidance for staff on how to meet the persons identified care needs. In particular, we saw that staff had developed excellent guidance on supporting the person with intimate personal care. Good use had also been made of photographs to illustrate guidance for staff on supporting the person to help lay the table at meal times. The daily care notes that we saw showed us that staff supported this person to take part in a range of activities in the home and the local community. The daily care notes were linked well to goals identified in the persons care plan. Staff told us that one gaol, to reintroduce the person to day services, had been achieved recently. We also saw that a risk assessment screening form had been completed with this person in May 2007. The screening had been used to identify areas where a more detailed risk assessment and risk management plan were needed. Staff had then completed specific risk assessments covering challenging behaviour, epilepsy, use of the stairs in the home and fire safety. We saw that all of these assessments had been reviewed within the last 12 months. During the day we saw that staff frequently consulted residents and offered choices about aspects of their daily lives. Residents were given choices about food and drinks, whether or not they took part in activities and where they spent time during the day. All staff were familiar with the way that each person communicated their likes, dislikes and preferences and people were always given time by staff to make positive choices. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff promote peoples rights and choices, but also consider the protection of individuals in supporting them to make informed choices. The service respects the human rights of people, with fairness, equality, dignity, respect and autonomy underpinning the care and support provided. Evidence: When we arrived for this inspection, one person had already left for their day service and two other people were at home with three members of staff. Later in the day, both residents and all three staff went to a local supermarket to do the weekly house shop. The shift plan had been that only one resident went shopping but the second person also wanted to go and this was well managed by the staff to make sure that the residents choice was respected. During this visit we checked the daily care notes kept by staff. These showed that one person was supported to take part in regular activities of their choice in the home and the local community. This person also went to day services and had regular contact with family members. The persons care plan files included details of their family, friends and other significant people and the arrangements for seeing or contacting these people. The care plan also included excellent support guidelines that had been developed by staff in the home, working jointly with clinicians from the local multiagency Learning Disability Team. The guidelines were developed and agreed following a number of incidents and the manager told us that they had helped to reduce the number of challenges in recent months. Evidence: The second persons daily care notes gave us good evidence that they were supported to take part in a range of activities, including swimming, trampolining, massage and day services. This care plan also included contact details for significant people, although the person had no contact with their family. We saw that staff had made good use of photos to illustrate shopping lists and menus to involve residents in menu planning and shopping trips. During the morning, one resident showed us the photos that they would be using when they went to the local supermarket later in the day. The menus showed us that residents had a varied and nutritious diet, that they helped to plan at weekly house meetings. Staff told us that the residents agreed each evenings meal and then chose their own breakfasts and lunches. We saw that all meals provided for residents were well recorded. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home receive effective personal and healthcare support, using a person centred approach. Individual health action plans clearly record peoples personal and health care needs and detail how they will be met. Evidence: During this visit we checked the personal and health care records for two people living in the home. We saw that both people had a person centred Health Action Plan (HAP) that had been completed in June or July 2008. Both HAPs made excellent use of pictures and photos to make the information easier for the residents to understand. Where issues were highlighted in the HAP, we saw that good guidance had been developed for staff and appropriate actions plans were agreed. For example, where one persons parents raised concerns about his diet and weight gain, we saw that staff had developed a good healthy eating plan and a monthly weight check that showed a weight reduction. We saw good evidence that staff from the home worked well with health care professionals to meet individuals care needs. All health appointments were well recorded, with details of the outcomes for residents. The manager told us that, as a result of implementing the residents Health Action Plans and joint work with clinicians, one residents had not needed any prescribed medication for more than 12 months, a second person had had no epileptic seizures for 18 months and one person had not needed as required medication for more than 12 months. During this visit we checked the management of residents prescribed medication. We found that all medication was securely stored and staff kept a good record of any medication given to residents. The provider had also completed a medication audit in August 2008. All staff working in the home had completed a competency assessment Evidence: to show that they were able to manage peoples medication. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Complaints and protection procedures reflect the needs of people under the six strands of diversity, including disability. People living in the home are provided with a complaints procedure they can understand and the procedure is available in a variety of formats. The home is clear when an incident needs to be referred to the Local Authority as part of the safeguarding adults procedures. Evidence: During this visit we saw that the providers complaints and safeguarding adults procedures were displayed on the notice board in the homes kitchen / dining room for residents, staff and visitors information. The complaints procedure had been produced in an easy read format, using pictures to make the information easier for some residents to understand. We also saw that the procedure had been produced on a DVD, using clients from some of the providers other services to act out scenarios. This was an excellent way to make the procedure more accessible to some people living in the home. We also checked the homes record of complaints and saw that one formal complaint had been made by a residents family since our last inspection. The local authority Social Services Department had agreed that the homes manager should investigate the complaint. We saw from the homes records that the residents family and the local authority were satisfied with the outcome of the managers investigation. The manager confirmed that there had been one safeguarding adults investigation since our last visit. The Social Services Department asked the provider to investigate and a copy of the investigation report was sent to the Department and the Commission. We were satisfied that appropriate action was taken by the provider and they were aware of the importance of referring staff to the Protection of Vulnerable Adults register, if they were dismissed for gross misconduct. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home provides an environment that is appropriate to residents needs. The home is a very pleasant, safe place to live and bedrooms and communal areas meet the National Minimum Standards. The environment promotes the privacy, dignity and autonomy of residents. Evidence: 80 Doyle Gardens is a 3-storey, semi-detached house in a residential street, opposite a large park. The home was indistinguishable from neighbouring properties and was within walking distance of bus routes, an underground station, a leisure centre and shops. During this visit we saw all parts of the home, including the three bedrooms used by residents. We found that all parts of the home were well decorated and comfortably furnished. On the ground floor there was a large kitchen / dining room with access to the garden, a lounge and laundry room. There were three single bedrooms on the first floor. We saw that all three bedrooms were spacious, well decorated, comfortably furnished and very individual. There was an office / staff sleep in room and toilet on the second floor. There were enough bathrooms and toilets for residents use. There was off street parking for one car at the front of the house and meter parking on the street. During this unannounced visit we saw that all parts of the home were clean and hygienic. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are consistently enough staff available to meet residents care needs, with more staff available at peak times of activity. The staffing structure is based around delivering outcome for residents. There was a need to review the rota to make sure that staff were able to work effectively at all times. Evidence: I really like the teamwork, we have a good team here. Comment from a member of staff. I have done all of the core training I need to do my job. Comment from a member of staff. I have regular supervision with the manager and its very helpful. Comment from a member of staff. When we arrived for this unannounced inspection, the Deputy Manager was on duty with three members of the homes care staff team. The homes Manager was at a meeting and returned to the home later in the day. When we arrived, two residents were at home and one resident had already left for their day service. This level of staffing was sufficient to meet the residents care needs and staff worked very well together throughout the day to support both people who were at home. During this visit we spoke to staff on duty and checked the homes rota. Staff were very positive and knowledgeable about their jobs and the care needs of people living in the home. All staff were able to tell us about each residents preferences and routines and significant people in their lives. Staff were also very positive about the training provided by their employer. They told us that they had regular supervision with the homes Manager and discussed their Evidence: training needs as part of their supervision. We also saw that very good information about training organised by the provider was displayed in the homes office / staff sleep in room. When we checked the homes staff rota we saw that some staff were working long shifts, on some occasions 12-hour days followed by a sleep in shift. Two staff were also working 24 days out of 28 in January 2008. We discussed this issue with the homes Manager. While we understand the importance of continuity of care and the need for staff who know residents and understand their care needs, it is important that staff have sufficient breaks and days off to enable them to work effectively at all times. The Manager agreed to review the rota and the number and length of shifts worked by staff. The Manager confirmed that staff records were kept at the providers Head Office. He told us that he saw all application forms and references and received email confirmation of Criminal Records Bureau (CRB) clearances for all staff. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager has the required experience and is competent to run the home. The manager has a clear understanding of the key principles and focus of the service and provides an increased quality of life for residents. There is a focus on person centred thinking, equality and diversity and promoting residents human rights. Evidence: The Manager told us that he had been appointed by the provider in March 2008. He had more than 15 years experience of working in social care and we registered him as a suitable person to manage a care home in September 2008. The manager demonstrated a clear understanding of current best practice and developments in the field of learning disability. Staff told us that he was a good leader with clear ideas about how the home should improve outcomes for each resident. The Manager also told us that staff supported residents to take part in the providers regular Service User Forums where the quality of services was discussed. Residents views of the services they received were also included as part of the quarterly contract monitoring by Westminster City Council, the local authority responsible for funding places in the home. During this visit we checked a selection of care records kept by staff, including residents care plans, risk assessments and medication records. All of the records we saw were well completed by staff, were up to date and regularly reviewed. The home had very good standards of person centred care planning and risk management. We saw no evidence of health and safety concerns during this unannounced visit. Evidence: We saw that a representative of the provider made unannounced monthly monitoring visits to the home. A written report was sent to the home after each visit that included action points to improve outcomes for residents. The report also concentrated on best practice issues. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 33 The Manager should review the number and length of shifts worked by care staff in the home to make sure that they have sufficient breaks and days off to enable them to work effectively at all times. 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