Inspection on 17/08/05 for Real Life Options 90 Capel Gardens

This inspection was carried out on 17th August 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Real Life Options 90 Capel... 05/07/07

Real Life Options 90 Capel... 16/12/05

Real Life Options 90 Capel... 22/02/05

Real Life Options 90 Capel... 25/09/04

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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 90 Capel Gardens 90 Capel Gardens Pinner Middlesex HA5 5RD Lead Inspector Virginia Allen Unannounced 17 August 2005 2.00pm 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 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 Stationary 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. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 90 Capel Gardens Address 90 Capel Gardens Pinner Middlesex HA5 5RD 020 8868 7149 020 8868 7149 Telephone number Fax number Email 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 Pankaj Bhalla Care Home 6 Category(ies) of LD 6 registration, with number of places 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22/2/2005 Brief Description of the Service: 90 Capel Gardens is a registered care home providing personal care and accommodation for a maximum of 6 adults aged 18-65 who have learning disabilities. At the time of inspection there were no vacancies. The registered provider is the Real Life Options, a national care organisation. The responsible individual is Mr David Wandless and the registered manager is Mr Pankaj Bhalla. The home is a detached two storey building in a quiet cul-de-sac in a residential area. It is in keeping with the surrounding neighbourhood. It is close to Pinner and North Harrow where shops, pubs and other community amenities can be found. There is a bus stop at the bottom of the street and the home has its own people carrier to transport service users to community facilities. The home was first registered in 1994. All bedrooms are single, and none have en-suite facilities. There is a bathroom on each floor and an additional toilet. There are separate lounge and dining areas and a well maintained garden that can be accessed through the rear of the home. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a sunny August afternoon in 2005. The key inspection standards were assessed during the unannounced inspection. During most of the inspection 4 of the 6 service users were attending a day centre. They returned to the home one hour before the inspection was completed. During the inspection the inspector was able to talk with each of the morning staff and the afternoon staff concerning their views of the home and it’s management. The staff are long term and all involved in on going educational projects. They talked of having changed both their attitudes and approaches towards the service users since the current management became involved. They were finding this rewarding. None of the service users were able to verbalise their views, but interaction between staff and service users was comfortable, individual and calm. The inspection involved observing the entire home inside and outside. The inspector thanks all at the home for their help with the inspection. What the service does well: What has improved since the last inspection? What they could do better: Care at 90 Capel Gardens is of a high standard. However, documentation showing service user involvement in care planning could be improved. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 6 Although it is obvious that the home focuses on and provides good practice, improved documentation would be best practice. 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. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 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 standard(s) 1,2,3,4,5 Prospective service users and their families are given information concerning the home to allow an informed choice to be made about where they live. Individual needs are assessed and steps taken to meet these needs. Service users are able to spend time at the home before making a final decision about where they live. Each service user has an individual written contract. EVIDENCE: Six male service users with severe learning disabilities live at 90 Capel Gardens. Communication with service users is non-verbal. Hence, decisions concerning accommodation are made in consultation with the family and/or guardian of the service user. The management are able to supply full information concerning the nature of the home, a statement of purpose, daily activity programmes offered and the degree of support and personal care available. The decision-making process takes about 6 weeks and the policy is that the service user is able to trial the home. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 9 Documentation supports the work done by management and staff to understand the individual needs of the service user and the way in which these needs are met. A copy of the Statement of Purpose has been forwarded to the Commission for Social Care Inspection. Each service user has an individual service agreement and there is a licence agreement. No new service users have moved into the home in the last three to four years. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8, 9 Service users are involved in care planning changes. Service users make decisions about their lives with assistance. They are consulted about their participation in aspects of home life. EVIDENCE: To portray their needs and wishes, service users use non-verbal communications. Hence, staff needs to be attentive and skilful in their interpretation of non verbal communication. Management and the documented evidence support this approach. During the inspection two assessment and care plans were reviewed. Assessments were comprehensive and accurately informed the care plans. Care plans were detailed but clear and simple. Changes in individual needs of the service user and how these needs were met were documented. Documentation also reflected the service user’s satisfaction with changes. Despite non-verbal communication, service users make known their wishes with regard to home routines. The aim of the staff is to make sure each service user is happy with their routine. These routines are documented. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 11 Meetings are held twice a year to review care plans. The service user and his key worker are present at the meeting. However, documentation needs to reflect service user input. Documentation of service user information is well organised. The daily handover sheet is useful and daily records for each service user have good personalised detail. Training has contributed to the way in which staff interpret service users wishes and to the way in which their consequent needs are met. Staff report that this is a rewarding experience and that they are able to observe satisfied service users. Service users are encouraged to be independent, commensurate with their intellectual needs. Service users are free to attend to their own personal care or make snacks during the day. Some service users take a support worker by the hand and lead them to what they want. These methods are encouraged. Confidential information is stored securely. It is recommended that a copy of all protocols and letters to staff be placed in folder with a signature sheet for staff to document when they have read these. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,16,17 Service users have opportunities for personal development. Service users take part in appropriate leisure activities. They have appropriate personal and family relationships. Service users rights and responsibilities are recognised in the daily lives. A healthy diet is offered. EVIDENCE: Good daily records are kept for each service user that reflected skill development and progressive care planning. However, better documentation needs to be kept of service user involvement in their care planning. During the day four service users attend a day centre for activities, one service user attends the day centre for sessions of his choosing and one service user does not wish to attend the centre. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 13 The management is endeavouring to develop the individual skills and strengths of each service user. They are working with the day care centre that is introducing new activities. There is a programme of community activities and outings, which are accessed in the evenings. Such events as going to the library, the pub, or the shopping centres. One service user attends church each Sunday with the support of a carer. Where possible service users are encouraged to have contact with their families. Each service user has a key worker who supports them in this encounter. The key worker corresponds with the family to facilitate visits. One service user is transported regularly with two support workers, to visit family out of London. The evening menu for the home showed variety of selection and was balanced over the period of a week. The lunch menu has been individualised according to each service user’s wishes. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 14 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 standard(s) 18,19,20,21 Service users receive appropriate personal support. Their physical and emotional needs are met. Family wishes upon death of a service user are recorded. EVIDENCE: During the inspection it was observed that each service user required different interaction. This was respected by staff and appropriate responses made by service user. Daily records are kept of service user patterns of behaviour and staff use these to assist them in determining the service user’s physical and emotional needs and wishes. An example of this was the changing pattern of behaviour of a service user who did not enjoy some of the day centre activities. Analysis of the pattern of behaviour allowed staff to understand what sessions the service user enjoyed and what sessions he preferred not to attend. On the day of inspection this service user came back to the home at lunch time. The manager reported that the service user was much happier since he had commenced choosing which sessions he would attend. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 15 Family requirements in the event of the death of a service user are documented. No service user administers their own medications. All staff have had recent medication training and medication protocols are in place and adhered to. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 16 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 standard(s) 22,23 Service users feel their views are listened to and acted on. They are protected from abuse, neglect and self-harm. EVIDENCE: Service user wishes are listened to and acted on. This is documented and the service user is aware in that they are satisfied with the response to their non verbal requests. All staff has attended Protection of Vulnerable Adult training and have an annual update. There have been no complaints received by the home since the last inspection. The inspector talked with staff who reported that management was supportive and encouraged person centred communication between staff and service user. This had reduced the amount of behaviours and the service users appeared more content. Communication was centred on what the service user wanted. The staff believe that this is also rewarding for them. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 17 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 standard(s) 24,25,26,27,28,30. The home is homely, comfortable, safe and clean. Service users bedrooms suit their needs and promote their independence. Toilet and bathroom areas provide privacy. EVIDENCE: During the inspection the home was judged to be homely and suitable for the needs of the service user. Personal photos were on the sitting room walls and each service user had their own lounge chair. Music is played throughout the day and there is a TV in the sitting room. The sitting room leads out onto a large and well maintained back garden. There is a garden setting for service users to access. During the summer months service users often eat outside. The inspector viewed a sample of bedrooms. Rooms were individual with no en-suit. These rooms were appropriately designed and decorated with the service users personal items. Each service user has a key and their bedrooms 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 18 kept locked. As most of the service users do not have the dexterity to be able to use a key in the lock, staff do this with the service user present. Toilets and bathrooms provide privacy but one of the upstairs bathrooms had a lock that tended to stick. This needs to be attended to straightaway. Staff attends to the cleaning of the home. They have a roster of tasks, which spreads the cleaning over a period of a week. The home was clean and tidy at this unannounced inspection. The fireguard on the kitchen door was not working. This needs immediate action. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 Staff has clarity of roles and responsibilities. Service users are supported by competent staff who are undergoing appropriate training. Service users individual and joint needs are being met by staff that are well supported and supervised. EVIDENCE: The home benefits from appropriately trained and competent management and a commitment towards staff training. Staff ratios are adequate for the needs of the service users. There are six service users with three staff in the morning plus one driver. In the afternoon there are three staff, a driver until 5 pm and the manager. The evening shift has one waking night staff and one sleep over. Staff have defined duties. The kitchen roster, activities roster and the cleaning roster name those responsible for each individual daily task. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 20 The home has a clear training programme with an Induction and Foundation course. After completing these, staff is supported to take on NVQ training. Ongoing ‘in house’ training includes fire safety, epilepsy management, medication training, health and safety and Protection of Vulnerable Adult training. The home employs a trainer. Each service user has a named key worker who supervises their care. Agency staff is employed when necessary. However, the agency supplies support workers who have worked at the home before and know the service users. Currently the home is fully staffed. Staff works to a minimum standard policy. They have current CRB checks. Staff reported to the inspector that they enjoy working for the new manager. They felt that the home was calmer and the focus was clearly on satisfying the wishes of the service user. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,40,41,43 The service user benefits from a well run home that has strong leadership and management. The home is person centred and the service user’s needs and wishes underpin all policy and practice. This is well documented. The service users benefit from competent and accountable management of the service. EVIDENCE: The inspector was confident that the manager and staff were committed to providing appropriate personalised care for all service users. Over the last 2 years programmes and policies for the home have been reviewed and re written to reflect the person centred ethos of the home. All practice is directed towards the rights, wishes and best interests of the service user. There is good documentation to reflect this. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 22 All of the staff present at the time of inspection were interviewed by the inspector. Staff attitudes to person centred care supported the documentation. 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 23 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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 90 Capel Gardens Score 3 3 x 3 Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 3 x 3 G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 24 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 27.6 Regulation 23 2(b) Requirement A door closing mechanism must be repaired on the first floor bathroom door so that service users can close the door. The fireguard on kitchen door must be repaired in keeping with fire safety regulations. The cleaning of ventaxias must be included in the cleaning schedules for the care home Ongoing plans for upgrading of the laundry room have been sighted by the inspector. Council Health and safety have approved project. Need advice on fire protection and structural elements of project. Also need date work to be completed. Ensure that certain evidence of the staff recruitment process (e.g. references) are available for inspection in the care home. Ensure that certain evidence of the staff recruitment process (eg references) is available for inspection in the care home. Timescale for action October 2005 October 2005 October 2005 October 2005 2. 3. 4. 24.11 24 30 23 2(b) 23 4 (c) (i) 23 2(d) 16 2(e) & (j) & 23 (2) (a) & (k) & 39 (h) 5. 34 17 (2) Schedule 4,6 16 (2) Schedule 4,6 October 2005 October 2005 6. 34 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 25 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 7 Good Practice Recommendations It is clear from observation and interviews that service users are involved in their own care planning. However, it is recommended that their involvement is documented for best practice. It is recommended that a copy of protocols and policies be kept in a folder with a signature sheet as evidence of staff having read each policy and procedure. 2. 36 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection 4th 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 90 Capel Gardens G62-G11 S17523 90 Capel Gdns v212204 170805 Stage 4.doc Version 1.40 Page 27 - 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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