Inspection on 30/09/05 for Pear Tree Lodge

This inspection was carried out on 30th September 2005.

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 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

Pear Tree Lodge 26/01/09

Pear Tree Lodge 01/02/07

Pear Tree Lodge 12/01/06

Pear Tree Lodge 28/02/05

Pear Tree Lodge 23/11/04

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 HOMES FOR OLDER PEOPLE 340 Preston Road Shaw healthcare (Homes) Limited Pear Tree Lodge 340 Preston Road Kenton Middlesex HA3 0QH Lead Inspector Mr Ram Sooriah Unannounced Inspection 30th September 2005 13:40 X10015.doc Version 1.40 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 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 340 Preston Road Address Shaw healthcare (Homes) Limited Pear Tree Lodge 340 Preston Road Kenton Middlesex HA3 0QH 020 8385 1640 020 8385 1642 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) Shaw healthcare Limited Mr Manny Tagulinao Care Home 10 Category(ies) of Learning disability (10), Learning disability over registration, with number 65 years of age (0) of places 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 28th February 2005 Brief Description of the Service: Pear Tree Lodge belongs to Shaw Homes, a national provider of care services. It is registered to provide personal care to ten elderly service users of mixed gender with learning difficulties. It is about two minutes walk from local shops and facilities; and is easily accessible by public transport. There is a good bus service down the Preston Road and the Underground station is about five minutes walk away. There is limited parking on the grounds of the home, but additional parking can be found on the nearby roads. There is a maintained garden at the back and some lawn areas in the front and on the side of the building. The home is a converted big house on the Preston Road. Service users are accommodated in single bedrooms on 2 floors. Each floor has 5 bedrooms and a lounge/dinning area. The 1st floor has a small kitchenette; the main kitchen and the laundry are on the ground floor. At the time of the inspection there were nine service users in the home. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the first of the two statutory inspections for the period 2005-2006. It started at about 13:40 and lasted for about four hours. During the course of the inspection, the inspector spoke to service users, the manager and her staff. He also toured some of the premises, look at a sample of records and checked for compliance with previous requirements. The inspector would like to thank the service users, the manager and his staff for a kind welcome to the home and for their cooperation and support during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans of service users must be more specific to clarify the actions that need to be taken by staff to meet the needs of service users. In cases where service users are unable to take part in drawing up or in the review of care plans or when they do not have a representative, a note should be made about the above in the care records. The home must consider providing the records, which are accessible to service users in easy to read format. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 6 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. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 Service users are admitted to the home after a comprehensive needs assessment to ensure that the home will be able to meet the needs of the service users. EVIDENCE: The inspector looked at three care records. Two of them were for service users recently admitted to the home. They both had pre-admission assessments, which were fairly detailed. The manager stated that every effort is made to obtain the care needs assessment of the placing authority. The pre-admission assessments are normally carried out by the manager or by the deputy manager. The needs assessments of service users, once admitted to the home, were generally completed appropriately. The information was available in the care records, but it is not always that easily accessible because of the format that is used to record this information. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 9 Members of staff in the home were familiar with the service users and with their needs. The range of training that staff have had, also suggests that staff have the right experience and competencies to care for the service users in the home. Service users were also satisfied that their needs were being met. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 The individual care plan was not always very clear as to the actions to take the meet the identified needs of service users. The healthcare needs of service users are being met in the home. The management of medicines in the home is carried out safely. Service users are treated with respect and dignity and are given the opportunity to make choices. Care plans were not always clear with regard to the wishes and instructions of service users with regard to end of life care. EVIDENCE: Each service user had two care files, one a general care file and the other a Health Action Plan. The Health Action Plan is per the guidance of the Department of Health, that all service users with a learning disability should have a Health Action Plan with a view to ensure good health and the Promotion of Health. The inspector noted that the needs of service users were in the main, addressed in these files. There were care plans in cases where particular needs of service users have been identified. In the case of a service user with diabetes, there was no care plan in place, but there was a risk assessment. It was however not very clear with regard to the signs and symptoms to observe 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 11 in cases where the blood sugar may rise or fall. It also did not clarify the actions to take in these circumstances. In the case of another service user the care plan for incontinence and the incontinence assessment had not been updated when the needs of the service user changed. There was evidence that care plans were reviewed at least monthly. The inspector was shown paperwork to show that the home was keen on introducing a ‘person-centred care’ format to care plans. This would be desirable, as currently care records seem to be repetitive. Introduction of the new format may lead to the combination of all the care records into one, adopting a holistic approach. Care records were not yet in a format, such as signs and symbols, which might be easier for some service users to read and understand. There was some evidence of the involvement of some service users in the drawing up and review of care plans. The manager stated that not all service users have representatives and some are not always able to take part in drawing up or in the review of care plans. In these cases the manager must ensure that a note is made in the care records to this effect. The home uses a range of risk assessments such as manual handling, falls, nutritional and pressure sore risk assessments. There were also records of visits/checks by various healthcare professionals. All service users are registered with a GP and the manager stated that service users are always accompanied and supported when attending their appointments with the various healthcare professionals. The management of medicines in the home was checked. All appropriate records were up to date. There were records of receipt, administration and disposal of medicines. Medicines were stored securely and tidily in a small clinical room. Medicines were administered by senior staff/team leaders, all of whom have had training in medicines administration. There was also yearly assessment of all staff who administer medicines by the deputy manager. This is good practice and the home is commended. The inspector noted that all service users were dressed appropriately. They all presented as well groomed and clean. The clothing of service users were all ironed and stored tidily in their respective wardrobes/drawers. There was a clear interest in staff to ensure that service users present themselves in a dignified manner. The home has a portable phone, which allowed service users to make and to receive phone calls from the privacy of their bedrooms. The home reviews the needs of service users and when these change appropriate actions are taken to ensure that the needs of service users are continuously being met. Some service users have in the past been transferred to care homes with nursing as and when their needs changed. The care plans of some service users contained information about the funeral arrangement of service users, but others contained little information with regard to the wishes and instructions of service users with regard to end of life care and death. The inspector acknowledged that a few service users do not 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 12 have representatives and that some of the service users are unable to express their wishes, but every effort should be made to ensure that these are known and recorded. If this is not possible, a note should be made to this effect. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 Service users in the home have access to leisure and recreational activities. Outings including holidays are arranged for service users. The home provides a range of meals to service users according to their choices. EVIDENCE: The home has an activities programme. The recreational and leisure needs of service users were identified in the care records and care plans were in place to meet these needs. Activities are normally provided by members of staff, but once a week, there is an ‘exercise to music’ session which is conducted by an external person. This session was taking place on the day of the inspection and it was noted that service users were enjoying that session. The home has a mini-bus and the inspector was informed that trips are organised in the van and that service users normally go for holidays in the van. There were records that four service users have been for holidays. The inspector was informed that outings also take place in the local community. Service users tend to use the local shops and amenities, which they attend with members of staff. One service user in the home also attends a day centre five days a week. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 14 The home has an open visiting policy and the manager confirmed that visitors are welcome to see the service users. There were no visitors at the time of the inspection, but in the past the inspector has noted that visitors were received appropriately in the home. The inspector was informed that the meals which are cooked in the home are chosen by service users. They choose the meals in a meeting with the chef on a weekly basis and a menu is made with the choices of the service users. Ordering of the ingredients is made on line and these are then available to prepare the meals. The chef stated that this arrangement seems to be working well and he always exercises some flexibility with regard to choices of service users, but that in essence he is cooking what service users want to eat. Records about what each service user had for her/his meals were kept appropriately. All other records with regard to fridge/freezer temperatures were being kept appropriately. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home takes complaints seriously. It has systems in place to ensure that suspicions and allegations of abuse are dealt with appropriately. EVIDENCE: The home has not received any complaints since the last inspection. The complaint procedure in the past has been judged suitable. A copy was available in the foyer of the home and in the service users’ guide. Once a facility is available to provide documents in easy to read format, the complaint procedure must also be provided in that format according to the needs of the service users. The manager stated that all new staff have abuse training as part of the induction training. Staff knew that all suspicions and allegations of abuse has to be reported to the person in charge for appropriate action to be taken. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 The home in the main provides a safe and comfortable environment to meet the needs of service users. However the communal areas are starting to look dated and would benefit from being redecorated and refurbished. EVIDENCE: The grounds in the front of the home were laid with lawns and bushes, which were maintained. There are also lawns, shrubs and flowerbeds at the back of the home. This area looked pleasant and maintained. The exterior of the building was generally in good condition. There has been some maintenance in the home. The corridors have been painted and the carpet in the main staircases has been changed. There were pictures, plants and mirrors in the corridors, which contributed to making the environment homely and pleasant. The home has identified some areas for redecoration and refurbishment in the budget. The decoration in the lounges are starting to look dated as well as the carpet, particularly around the area leading from the kitchen to the dining room. Furniture in the communal areas has also started to look worn and scruffy. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 17 Since the last inspection some bedrooms have been repainted. All of them were clean, tidy and pleasantly personalised. There were no odours in the home. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 and 30 The home provides staff in appropriate numbers and with the appropriate skills to meet the needs of the service users. The manager ensures that a high standard of training is provided to his staff. EVIDENCE: Both the manager and the deputy manager were on duty at the time of the inspection. They are supernumerary most of the time. There were also a team leader and three carers on duty. The home normally has four care staff during the day and two at night. The inspector was informed that despite some vacancy hours, the home uses its own bank staff to cover the shifts. The staffing was judged to be appropriate to meet the needs of the service users. The home also employs a chef and weekend chef for the kitchen and a domestic for cleaning. The inspector was informed that most staff have done NVQ level 2 except for the new members of staff. A few members of staff have also done NVQ level 3 in care. Some senior carers have also done NVQ level 4 in management. The home has a training and development plan and apart from all staff being up to date with statutory training, staff have also done a range of other courses. These included 3 members of staff who have completed the Learning Disability Award Framework. Staff have also been booked to attend infection control training and training on Person-Centred care. The inspector concluded that the home provides an excellent standard of training for care staff and judged that this standard is exceeded. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 38 The management approach in the home is open and inclusive. The finances of service users are being managed appropriately. No Health and Safety issues, which could put service users at risk were identified during the course of the inspection EVIDENCE: The manager and his deputy have been in post since the inception of the home and are familiar with the needs and requirements of the service users. They both are trained nurses and have the NVQ level 4 in management. The manager has set up a clear line of delegation and each senior member of staff is given clear responsibilities. There is evidence of service users meetings and of staff meetings. There was also evidence of appraisal and supervision meetings with staff. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 20 The inspector looked at the management of service users money in the home. The manager is the appointee and manages the moneys of most of the service users in the home. Service users had bank accounts in their names and all monies paid to service users go straight into the bank accounts. A ‘float’ was kept in the home for daily expenditures. Records checked for one service user, chosen at random, showed that correct procedures were being adhered to. There were records for all transactions and receipts were kept for all expenditures. The inspector was informed that the monies of service users are regularly audited by head office and once a year by the financial auditor. The manager added that monies of service users are also checked during review meetings by the relevant placement authorities. The inspector however recommends that enquiries should be made with regard to deciding whether the service users who have no relatives/representatives should be under Court of Protection. The inspector did not note any health and safety issues during the inspection. All staff in the home have had the necessary statutory training. There was an identified person for First Aid on each shift. 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 2 x x x 3 x 3 STAFFING Standard No Score 27 3 28 4 29 x 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 3 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15(1) Requirement The registered person must ensure that care plans set out in detail the actions that need to be taken to meet the needs of service users and must ensure that the care plans/assessments are updated when the needs of service users change. In cases where service users are not able to take part in the care planning process or when they do not have a representative a note must be made in the care records to this effect. The registered person must consider the use of easy to read formats such as signs and symbols in all records, which are available to service users, such as the care records, the complaints procedure and the service users’ guide, to enable service users to read and to understand these records, as per an assessment of the abilities of the service user. Timescale for action 31/12/05 2 OP7 15(2)(c) 31/12/05 3 OP7 15(2)(b) 31/12/05 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP11 Good Practice Recommendations Every effort should be made to ensure that the wishes and the instructions of service users with regard to end of life care and death are identified and recorded as appropriate in the care records. The inspector recommends that enquiries should be made with regard to deciding whether the service users who have no relatives/representatives should be under Court of Protection. 2 OP35 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 340 Preston Road DS0000017483.V256307.R01.S.doc Version 5.0 Page 25 - 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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