Inspection on 08/12/05 for Real Life Options 2-4 Bethecar Road

This inspection was carried out on 8th December 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 found no outstanding requirements from the previous inspection report, but made 5 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... 13/02/07

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

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

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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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 2-4 Bethecar Road 2-4 Bethecar Road Harrow Middlesex HA1 1SF Lead Inspector Richard Adkin Unannounced Inspection 9th December 2005 09:00 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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 2-4 Bethecar Road DS0000017518.V266715.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 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. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 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) Real Life Options Mr Michael Piekarczyk Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Some of whom also have a physical handicap. Date of last inspection 24th August 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. Currently there are six male residents, who originate from Harrow. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a weekday morning in December. The Inspector had the opportunity to meet five of the six residents, care staff, a carer and the registered manager, who kindly made himself available. Service user files, policies and procedures were looked at as part of the process. The Inspector would like to thank staff and service users for their contribution to the inspection. What the service does well: What has improved since the last inspection? What they could do better: Some decoration and refurbishment needs to take place that includes adapting a bathroom to meet the physical needs of service users. A sluice facility is needed in the utility room. The Protection of Vulnerable Adults policy for the local authority should be accessible to compliment the home’s own policy. 2-4 Bethecar Road DS0000017518.V266715.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. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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 Prospective service users aspirations and needs are assessed and acted upon to the benefit of service users. EVIDENCE: The last service user to moved into Bethecar Road 14 months ago. Information was limited given the unique circumstances of the service user. There was evidence of a multi-disciplinary contribution to assessing the needs of the service user; a person centred plan was undertaken within three months of the service user arriving. The plan compensates for the lack of original information and established a baseline around a number of key areas such as health, communication, what is important, dreams, hopes and wishes and risk assessment. Flexibility and determination have been shown by the staff at Bethecar Road to ensure that the individual needs and aspirations are understood and addressed. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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, 9 The changing needs and goals of service users are captured and addressed. Risks are appropriately handled. EVIDENCE: The Inspector had the opportunity to look at the Personal Care Plan for two residents. The package is reviewed at least every six months. Action plans are scrutinised to ensure that these have been followed up and are outcome driven. A comprehensive health care report is completed for the review of the Personal Care Plan. Treatment plans for relevant specialists are integral to the health care reports. Capturing changing needs of service users through a range of means such as outpatients, handover, daily records was shown to be a dynamic live process. This information is accessible in summary, through the PCP package that gives details of how to support the service users making choices and other areas of needs and aspirations. Copies of the PCP are distributed to key agencies. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 10 Decisions are made with service users about their lives. Goals are detailed in the Personal Care Plans and appropriate support was seen on files about taking forward the goals. Seven goals were detailed on one plan and were shown to be subsequently acted upon. There is a ‘taking risks policy’ for service users that is 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 that they have read and understood them. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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 Service users have an active daily programme and take part in the local community. EVIDENCE: All six service users attend the in-house vocational day service at Lowther Road in Stanmore. Each service user attends four days a week; one service user was going horse riding as part of the day service on the day of the inspection. On days spent at home, service users contribute to the running of the home, in terms of 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. 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. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 12 Service users take part in accompanying staff in buying food from the local supermarket for mealtimes at the home. Packed lunches are provided if service users are attending day services. One service user helps make his own packed lunch and made his own lunch during the course of the inspection. A family member visiting the home was positive about the care her relative received and how she was made welcome. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 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 The home’s administration and procedures for medication protects the well being of service users. EVIDENCE: Medication is provided in blister packs from Lloyds Chemist and they provide a service that takes 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. Real Life Options medication policy that is substantial is currently being revised. Medication signatories sheet is detailed and initialled. One resident has diabetes. There is a separate locked cupboard for needles and medication; there is a fridge with a locked unit for medication that needs to be stored. During the course of the inspection two service users were taking part in reviews with their responsible specialist medical officers to look at medication, physical health and management issues. Healthcare records are thorough. The care plans inspected covers guidance for staff on identified service users personal care needs and the service users own preferences. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 14 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, 23 Service users views are listened to and given importance. Local policies on protecting vulnerable adults must be in place to protect residents at the home. EVIDENCE: The home has a complaints policy that was reviewed April 2004 and a complaints leaflet. There is a collection of service user friendly policies kept in the office and downstairs. It would be helpful if a broader policy on complaints were accessible in that form. The registered manager has been on a one day training course on Protection of Vulnerable Adults. There was no copy of the London Borough of Harrow’s guidelines on Protecting Vulnerable Adults. These should be in place particularly given that all the service users are originating from the London Borough of Harrow. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 15 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, 30 Some refurbishment work is needed to provide a safe environment. Sluicing facilities are needed to provide a hygienic environment. EVIDENCE: The bathroom facilities that needed reviewing have been recently decorated and the loose handrail has been repaired. New flooring was put down. A new sofa and table were due to be delivered for one of the living areas. Radiators have all been replaced in the last six months and have been covered; this has left some minor decoration needed where radiators have had to be moved. New sinks and vanity units have been put in the bedrooms. A bath that is worn and stained on the first floor needs replacing. The handrails by the front door leading to the gate both need decorating as the paint has flaked off. The bathroom on the ground floor needs to be adapted to meet the physical needs of one of the service users. The home was clean and free from offensive odour at the time of the inspection. Three of the service users have incontinence issues. A sluice facility is needed in the utility room. The toilet seat lids have now been replaced since the last inspection. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 16 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 Staff are appropriately recruited, supported and trained to undertake their responsibilities. EVIDENCE: The staff rota was inspected. There were two members of staff on duty and the manager on the day of inspection. One member of staff was sick, as usually there are three members of staff on duty. There is a home recruitment and selection policy in place. Two staff files were looked at by the Inspector that had the required information. The records looked at confirmed that all staff had received CRB checks. No staff meeting had place since September 05. A minimum of six regular staff meetings should take place each year. There is a folder with the staff training profile that was up to date and included certificates and statutory training records. The staff personnel information in regard to a transferred staff member has now been transferred from the day service to the care home as was required. Currently, there are two staff vacancies; these have been interviewed for and filled. There is also a 10-hour night vacancy. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 17 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, 42 The home is well managed and lead; monitoring is in place. A health and safety matter must be addressed. EVIDENCE: The registered manager is a registered nurse with extensive experience in learning disability and is currently undertaking the Registered Manager Award. Statutory training on records were viewed and discussions with staff is undertaken for all staff around fire safety, food and hygiene training, manual handling and health and safety training. There is a shift plan in place that the manager has developed and this is discussed at handover. This covers the core tasks of the service. Appropriate action has been taken to ensure that all the radiators within the care home are of low risk to service users. This is a significant piece of work that has been undertaken since the last inspection. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 18 The fridge containing some medication has an external lock and an internal locked unit. The Inspector looked at the rota duties and observed that the manager was on the duty rota; capacity should be preserved to ensure that there is capacity for core management tasks. The Legionella test was two months overdue and needs to take place. The portable appliance test was up to date. Gas safety check for the boilers and cookers took place on 2nd June 2005. Quality Assurance systems are in place. A monthly quality report is undertaken by the registered manager 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 that is a multi-perspective evaluation of quality in the home life. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 2-4 Bethecar Road Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 2 X DS0000017518.V266715.R01.S.doc Version 5.0 Page 20 NO 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 2 4 5 6 Standard YA23 YA24 YA24 YA30 YA42 Regulation 13(6) 23(2) 23(2) 23(2)(k) 13(4) Requirement The POVA guidelines for Harrow should be available. The handrails by the front door need decorating. The bathroom on the ground floor must be adapted for service user needs. A sluice facility is needed in the utility room. The Legionella test needs to take place. Timescale for action 01/02/06 01/03/06 01/07/06 01/03/06 01/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA22 YA37 Good Practice Recommendations An accessible format about making complaints should be further developed for service users. The registered providers should undertake a review of the Managers’ hours to ensure that there is capacity for management tasks. 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 21 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 2-4 Bethecar Road DS0000017518.V266715.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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