Inspection on 13/02/07 for Real Life Options 2-4 Bethecar Road

This inspection was carried out on 13th February 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Real Life Options 2-4 Bethecar... 04/09/07

Real Life Options 2-4 Bethecar... 08/12/05

Real Life Options 2-4 Bethecar... 22/02/05

Real Life Options 2-4 Bethecar... 06/07/04

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

CARE HOME ADULTS 18-65 Real Life Options 2-4 Bethecar Road 2-4 Bethecar Road Harrow Middlesex HA1 1SF Lead Inspector Ms Margaret Flaws Key Unannounced Inspection 13th February 2007 16:30 Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.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 Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.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. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Real Life Options 2-4 Bethecar Road Address 2-4 Bethecar Road Harrow Middlesex HA1 1SF 020 8248 5867 020 8248 5867 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) www.reallifeoptions.org Real Life Options Mr Michael Piekarczyk Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Some of whom also have a physical handicap. Date of last inspection 8th December 2005 Brief Description of the Service: 2-4 Bethecar Road is a registered care home providing care and accommodation for up to six adult service users who have a learning disability, some of whom have a physical disability. The registered provider is Real Life Options. 2-4 Bethecar Road is one of several care homes owned by Real Life Options. The home is located in a residential area close to central Harrow and Harrow Wealdstone. The house is in keeping with other houses in the area. The home consists of two semidetached houses that have been converted into one house. There is parking for up to three cars at the front of the property. The care home is close to a variety of amenities that include shops, a library, a cinema, banks, a post office and restaurants. Public transport facilities are within a few minutes walk of the home. These include bus and train services. The home also has its own passenger vehicle. The home has six single bedrooms, one of which has en-suite facilities. There is a large accessible well-maintained enclosed garden. Fees for the home are £1202. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over an afternoon and evening. The Inspector met and spoke to service users and two care staff on duty. Service user files, general home records and policies and procedures were inspected. A tour of the premise completed the inspection. What the service does well: What has improved since the last inspection? What they could do better: Five new requirements were made at this inspection; one previous requirement is restated and strengthened. Cat bowls must be washed and kept completely separate from other dishes. All medication received must be properly recorded when received into the home and medication given must be recorded appropriately in the MAR chart. Three requirements relate to adult protection: all staff be trained in adult protection; staff understanding of the external adult protection reporting procedure must be checked by the Registered Manager (who is an adult protection trainer) and all staff must know where to locate the local authority’s reporting procedures and understand how to follow them. A recommendation is restated – that the Provider should review the Registered Manager’s hours to ensure there is time for all the management tasks in the home. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 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. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.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 Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.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): 2 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Prospective service users aspirations and needs are assessed and acted upon to the benefit of service users. EVIDENCE: There are currently four service users at the home. One service user died in April 2006 and another service user moved out because he needed a higher level of care. The home has two vacancies. Assessments for two prospective service users were checked and found to be very thorough. There was evidence of extensive multi-disciplinary input into assessing the needs of the prospective service users. Flexibility and determination have been shown by the staff at Bethecar Road to ensure that the individual needs and aspirations are understood and addressed. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The changing needs and goals of service users are captured, recorded and addressed. Care plans are excellent and risks are appropriately handled. EVIDENCE: Two care plans and service user’ files were inspected. Care plans and risk assessments are reviewed at least every six months and on an as and when basis. Good outcome driven action plans are produced and followed up in consultation with the service users. Comprehensive healthcare reports and treatment plans are done at each review. Changing needs are constantly reassessed and documented. Copies of the Person Centred Plan are distributed to key agencies. Decisions are made with service users about their lives. Goals are detailed in the Personal Care Plans and appropriate support was on file about taking forward the goals. Staff were observed treating the service users with respect and encouraging their choices. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 10 The home has a ‘taking risks policy’ for service users in an accessible format. Risk assessments were on file, relevant and up to date; these risk assessments are discussed in team meetings and signed by staff members to demonstrate that they have read and understood them. Risks are also documented on flowchart which helps the staff evaluate the degree of risk. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users have an active daily programme and take part in the local community. Their personal development is paramount. They are provided with a healthy diet and wholesome meals. EVIDENCE: All four service users came home during the inspection, which covered the late afternoon and evening period. Each service user attends day centre four days a week and they can choose to have a day off once a week. On days spent at home, service users contribute to the running of the home, for example, doing chores. Family members are encouraged to visit. Local activities take place with trips to the cinema, football matches, and the pub. These trips reflect service users’ identified interests. The inspector shared a meal with the service users and staff. It was wholesome and nutritious and service users demonstrated their choices throughout the meal. Although only one of the service users was predominantly verbal, communication between staff and service users was Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 12 very clear. There was a positive, supportive and relaxed family feeling around the table. There is a separate dining area that seats six people and also a separate dining table in the sitting room that service users can sit and eat at if they wish. There was a bowl of fruit on the table. Service users accompany staff to buy food from the local supermarket for mealtimes at the home and choose what they want to eat. The menus are fully determined by what the service users choose. Packed lunches are also provided when service users attend day services. The fridges and cupboards were very well stocked with fresh and nutritious foods. A requirement is made to improve kitchen hygiene under Standard Thirty. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home’s administration and procedures for medication protects the well being of service users but improvements are needed in the practice. Very good ongoing health assessment in service users’ interests. EVIDENCE: Medication is provided in blister packs from Lloyds Chemist and they take away unused medication. A medication returns form is completed and countersigned by the pharmacist; a copy of the form goes to the GP. The medication policy is in an accessible pictorial format for service users. Medication signatories sheet is detailed and initialled. Audits are done three monthly. The medication records were checked. All MAR charts were in good order, except where an antibiotic for a service user with flu was not checked in or signed for when given. Requirements are made to cover this. Healthcare records are thorough and regular multidisciplinary health checks are in place. The care plans inspected covers guidance for staff on identified service users personal care needs and the service users own preferences. One service user died in 2006. Staff followed good procedures to support him with his admission to and during his stay in hospital. Staff spoken to and observed Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 14 had a very good understanding of the service users’ emotional and physical needs. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users views are listened to and their views taken seriously. Local policies on protecting vulnerable adults must be in place to protect residents at the home and understood by the staff so that they can protect the service users. EVIDENCE: The home has a complaints policy that was reviewed April 2004, along with a complaints leaflet. The complaints procedure is also now available to the service users both in their files and on the wall in the living room. The Registered Manager has completed a Train the Trainer course on the Protection of Vulnerable Adults. The home now has a copy of the London Borough of Harrow’s guidelines on Protecting Vulnerable Adults. However, staff on duty could not locate these guidelines at the time of the inspection. Staff could describe the nature of abuse but could not describe how they would report abuse externally (outside their organisation). About half of the staff have been trained in adult protection. Requirements are made that all staff be trained in adult protection; that staff understanding of the adult protection reporting procedure is checked and that all staff know where to locate the local authority’s reporting procedures and understand how to follow them. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Refurbishment work has been done to improve the environment for the service users. Some improvements are needed in kitchen hygiene. EVIDENCE: The home is very comfortable and homely. The communal areas have plenty of materials (music, DVDs, games) for the service users. There were also lovely photos on the walls of service users on holidays or relaxing at home. Further significant building upgrades have been completed. The ground floor bathroom has been considerably upgraded and accessibility improved. The handrails by the front door have been painted. A sluice facility has been installed in the utility room. The home was free from offensive odours and was clean on inspection. Fridge and freezer temperatures were regularly checked. Staff mentioned that cat bowls are washed with the other kitchen items. This practice should be discontinued. A requirement are given. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34, 35, 36 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staff are appropriately recruited, supported and trained to undertake their responsibilities. EVIDENCE: Two staff members were on duty on the afternoon and evening of the inspection. Because the Registered Manager was not there, staff files could not be inspected. There is a good recruitment and selection policy in place. New staff undertake a full Skills for Care Induction, which is signed off on completion. Staff meetings are now more regular. The home has a well established staff team and a low staff turnover. Staffing levels seemed reasonable at the moment but the service is under occupied and nom one presents with significant challenging behaviour. One staff member did mention that the staffing level can seem low when the Registered Manager is on shift because of the need to do management tasks. A requirement about the use of the Registered Manager on the rota is made under Standard Thirty Seven. The staff training profile was up to date and included certificates and statutory training records. Staff training regularly covers all key statutory areas of Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 18 practice and issues affecting the service users. Three staff have completed and six are working towards NVQ qualifications. There were gaps in adult protection training and knowledge. This is addressed under Standard Twenty Three. Staff supervisions takes place monthly and are recorded on a matrix to make it easy to see if someone has not received supervision. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 19 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): 37,39 and 42 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is well managed and run in the service users’ interests. EVIDENCE: The Registered Manager has extensive experience in learning disability. He has completed the Registered Manager Award. Staff were positive about the management of the home and the support they receive. Each shift has a plan in place, which is discussed at each handover. This covers the core tasks of the service. The Inspector looked at the rota duties and observed that the manager was still on the duty rota; capacity should be preserved to ensure that there is capacity for core management tasks. A recommendation from the inspection on December 2005 is restated. The home should review the staffing levels and the pressure of shift work on the Registered Manager’s time. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 20 Three monthly health and safety audits are done and are very good. The home has a current contract for waste disposal. The Legionella test has been done, meeting a previous requirement. The portable appliance testing and electrical wiring certification are up to date. Gas safety is certified and the home has purchased a new gas cooker. The home has current public liability insurance. Quality Assurance systems are in place. The registered manager undertakes a monthly quality report and there is a response of action plans by the regional manager. Each year a sample of two service users from the home are reviewed through the company process, as part of a multi-perspective evaluation of quality in the home life. The home has initiated Monthly Reports, which clearly set out issues. Service users’ financial records were sampled and were all in order. Staff said they are audited weekly and checked and signed off by the service users. Fire protection systems are good. The home has regular fire drills; a fire evacuation plan (also in pictorial form which the service users understood). Fire records inspected were all in order. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA23 Regulation 13(6) Requirement The Registered Persons must ensure that the POVA guidelines for the London Borough of Harrow should be available and understood by all staff. Previous timescale of 01/02/06 not met. The Registered Persons must ensure that cat bowls are washed and kept completely separately from other washing up. The Registered Persons must ensure that all medication received into the home is properly recorded. The Registered Persons must ensure that all medication given to service users is systematically recorded in the MAR chart and signed for. The Registered Persons must ensure that all staff receive POVA training and understand how to follow the POVA guidelines for reporting allegations of abuse. The Registered Person must ensure that the Registered Manager checks staff DS0000017518.V303277.R02.S.doc Timescale for action 15/04/07 2. YA30 12(1) 15/04/07 3. YA23 13(2) 15/04/07 4. YA20 13(2) 15/04/07 5. YA23 YA35 18(1) 15/04/07 6. YA23 YA35 18(1) 15/04/07 Real Life Options 2-4 Bethecar Road Version 5.2 Page 23 understanding of adult protection reporting procedures. 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 YA37 Good Practice Recommendations The Registered Person should ensure that the Registered Manager’s hours are reviewed. Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 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 Real Life Options 2-4 Bethecar Road DS0000017518.V303277.R02.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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