Inspection on 05/07/07 for Real Life Options 90 Capel Gardens

This inspection was carried out on 5th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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

Real Life Options 90 Capel... 17/08/05

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 Real Life Options 90 Capel Gardens 90 Capel Gardens Pinner Middlesex HA5 5RD Lead Inspector Andreas Schwarz Key Unannounced Inspection 5th July 2007 09:30 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 90 Capel Gardens DS0000017523.V340812.R01.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 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Real Life Options 90 Capel Gardens Address 90 Capel Gardens Pinner Middlesex HA5 5RD 020 8868 7149 F/P 020 8868 7149 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 Pankaj Bhalla Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2007 Brief Description of the Service: 90 Capel Gardens is a registered care home providing personal care and accommodation for 6 men aged 18-65 who have learning disabilities. The home had one vacancy during this inspection. The registered provider is 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 close to shops and transport links in Pinner and North Harrow. 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. Each person living in the home has his own bedroom. There is a bathroom on each floor and an additional toilet. There are separate lounge and dining areas and a well-maintained garden. Fees and charges can be obtained from the registered manager on request. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place during a day in July 2007 and lasted over six hours. The registered manager Mr Bhalla was not on shift but came for a couple of hours to discuss issues with the inspector. A senior support worker Mrs Halima Audu was available throughout this inspection to support the inspector. The inspector case tracked two people using the service and viewed care plans and other records relevant to the care provided. The inspector observed a handover and spoke to four members of staff during this visit. All people using the service are non-verbal and the inspector observed interactions by staff. The inspector would like to thank the people using the service, senior support worker, care staff and registered manager for making the inspector welcoming during this unannounced key inspection. What the service does well: What has improved since the last inspection? Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 6 The home has met all three requirements made during the last key inspection. The home has reviewed the procedure of people using the service paying for staff meals when supported in the community and all residents have been reimbursed by the organisation. What they could do better: 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. The summary of this inspection report can be made available in other formats on request. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.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 90 Capel Gardens DS0000017523.V340812.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is conducted professionally and sensitively and involves the individual, and their family or representative, where appropriate. EVIDENCE: This has been assessed previously as met, this group of residents have been living together for a number of years and no new service users have moved in since the last inspection. Care plan files demonstrated that people using the service have been assessed prior to moving in. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The care plan is written in plain language, is easy to understand and looks at all areas of the individual’s life. A key worker system allows staff to work on a one to one basis and contribute to the care plan for the individual. The care plan is a working document reviewed regularly involving the person and their representatives if agreed. Each care plan includes a comprehensive risk assessment, which is reviewed regularly. EVIDENCE: The inspector viewed and assessed two care plans during this key inspection, both care plans were of very good standard and it was evident that care plans are working documents and updated when needs change. Care plans provide carers, service users and significant others with valuable and relevant information about people using the service needs and preferences. Care plans are person centred and the home makes very good use of pictures, symbols, etc. Care plans have been reviewed regularly, the inspector noted however Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 10 that one of the care plans is due a review and monthly reviews were outstanding. The registered manager explained that the home went through great difficulties for the past four months with one person dying and another person breaking his leg and being therefore transferred to more suitable accommodation, this may have lead to the care plan not being reviewed and key worker reports not being updated. Information provided by the home is in written and pictorial format and residents have been assessed by Speech and Language Therapy to support the staff team around communication. The home is managing service users finances and records assessed by the inspector where correct and of good standard. The inspector would however recommend reducing the amount of coins in service users cash tins to make financial audits easier. The responsible individual is the appointee for all but one person living in the home. The inspector viewed a range of very detailed risk assessments on areas such as travel, challenging behaviour, in the car, in the home, etc. Risk assessments have been reviewed and updated if risks have changed. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are supported to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. The meals are balanced and nutritional and cater for the varying cultural and dietary needs of the individuals using the service. EVIDENCE: Three service users living in the home use a day service in Stanmore, which is provided by Real Life Option. The home is providing tailor-made activities to one service user, i.e. food preparation class, and weekly drama and movement classes. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 12 One resident was relaxing in the lounge during this visit following having a lay in after visiting his brother outside London the day before. The manager informed the inspector that the home has good relationships with their next-door neighbours. People using the service can use a people carrier provided by the organisation, when going for appointments or activities. Service users families have been involved in both care plans assessed and people using the service regularly access the community for meals, café’s, pub, etc. Staff observed interacted with service users sensitively to their needs and residents are asked to take part in household activities. All residents are provided with a key if they wish to lock their room. The inspector viewed a well-balanced and nutritious menu, staff went shopping during this inspection and the fridge was well stocked with fresh food. The inspector joined one person during lunch, which was prepared nicely. The home is discussing the menu, by using pictures for the people to choose from. Staff is also aware of the likes and dislikes which are recorded in the care plan. Menus viewed by the inspector reflect peoples cultural background. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal healthcare needs including specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. The service listens and responds to individuals’ choices and decisions about who delivers their personal care. People who use services are given the support they need to manage their medication. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of medication. EVIDENCE: Residents are registered with their own General Practitioner. The local Learning Disabilities Team is available for support. Care plans have clear guidance of how service users prefer to be supported. Residents were dressed appropriately for the time of the year. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 14 Health records viewed by the inspector were detailed and of very good standard. Residents are supported to access clinical appointments such as dentist, chiropodist, community nurse, etc. The General Practitioner is reviewing medication every six months and records have been viewed by the inspector. The home has a detailed medication policy in place and the Medication Administration Sheet had no omissions. Medication is stored safely and the shift leader keeps the key. The home is using the NOMAD system, some medication is administered in liquid form, and the inspector noted that bottles have not been signed and dated after opening, this is required. Staff has received medication training. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an open culture that allows residents to express their views, and concerns in a safe and understanding environment. The service has a complaints procedure that is clearly written and easy to understand. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them, there is however a lack of regular staff training. EVIDENCE: The home has a detailed complaints policy in place, which is made available in the service users guide and on the notice board in the hallway. The complaints policy is available in pictorial form. The home did not receive any complaints since the last inspection. Previous complaints have been recorded and investigated appropriately. The manager is auditing complaints every three months to assess if there is a pattern. The home has an adult protection policy in place and local Protection of Vulnerable Adults guidelines are available. Not all staff has received Protection of Vulnerable Adults training, which is required. Staff demonstrated good understanding of how to report abuse. Previous issues with the misuse of service users monies have been reviewed and all people using the service have been reimbursed. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 16 Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. People who use services are encouraged to personalise their bedrooms. The home is well lit, clean and tidy and smells fresh. The home however must ensure repairs are dealt with and cleaning materials are stored safely. EVIDENCE: The registered manager showed the inspector around the home. 90 Capel Gardens is a spacious detached property, with two bedrooms on the ground floor and a further four bedroom on the first floor. There is a shower room, large lounge, kitchen, and dining room on the ground floor. The spacious well maintained garden can be accessed through the lounge or dining room. On the first floor is the office and bathroom. The home is nicely decorated and comfortable. Service users rooms are spacious and nicely decorated. The home Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 18 has a keypad system on the main door due to people using the service having a history of absconding. The registered manager informed the inspector that quotes to re-carpet the whole house have been obtained and work is planned to start in the near future. The inspector noted damp patches on the ceiling in the hallway and was informed that one of the sinks upstairs was leaking, the leak has been repaired and the damp patch must be redecorated. The utility room is located in the garage, which can currently only being accessed from outside the property, the registered manager informed the inspector that he is planning to build a door, which would allow access through the hallway. The utility room is of good standard and a professional washing machine and clothes dryer is available. The home has a sluice room, which is not in use. The sluice room is used to store cleaning materials, but the door was found to be unlocked. The home was free of offensive odour during the visit and staff was observed using air fresheners regularly. The home has a range of Health and Safety policies in place. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services have confidence in the staff that cares for them. The staffing structure is based around delivering outcomes for the people using the service, and is not led by staff requirements. The service has a good recruitment procedure that clearly defines the process to be followed. EVIDENCE: Staff informed the inspector that the home is staffed appropriately and people using the service are supported by a qualified and enthusiastic staff team. The home has altogether 14 staff employed, four staff have their National Vocational Qualification in Care and 3 staff currently work towards it. The home has introduced a new National Vocational Qualification in Care process, which will enable more staff to attend this training. The figures however show that 50 of care staff is currently National Vocational Qualification in Care trained and National Minimum Standards are met. The home does not employ staff under the age 18. New staff will have to do their Learning Disabilities Award Framework Induction before being able to attend their National Vocational Qualification in Care training. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 20 The home did not employ any new staff since the last inspection; staffing records that have been assessed previously demonstrated that the home is completing the required checks on all staff. Staff spoke very positive about the training provided. The home is providing an eight-day induction and foundation training for new staff based on the Learning Disabilities Award Framework principles. Staff has received Person Centred Planning, Fire Safety, Team Teach, Autism, Health and Safety, Moving and Handling Training. Staff said that sometimes there is too much training. The home has training records available for inspection. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager has the necessary experience to run the home. The manager has a good understanding of the organisation’s strategic direction and an awareness of its financial planning systems and how the business plan for the running of the home fits into the organisational structure. Health and Safety records are up to date EVIDENCE: The manager is experienced to manage the care home a deputy manager with eight years experience is supporting the registered manager. Staff spoke very positive about the support provided by the management team. The registered manager does not have the relevant qualifications to manage a care home, which is required. Staff informed the inspector that they feel well supported by Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 22 the manager in particular regarding the recent death of one of the people using the service. The manager introduced a remembrance book, which is used by staff. Staff suggested group therapy, which could be explored. The home has a quality assurance policy in place and regular recorded providers visits are undertaken. The manager provided an annual service review, which included people using the service and families input for 05/06. The organisation is currently undertaken service users and family surveys to produce an annual service review for the current year, it is required to forward a copy to the Commission for Social Care Inspection once completed. Staff has regular staff meetings, but due to level of disabilities it was found that residents meetings are not suitable. The inspector viewed fire records and a detailed fire risk assessment is in place. The fire system has been serviced during this visit. Fire equipment is checked weekly and the last fire drill was undertaken on the 20/06/07. The home had a visit from the Environmental Health Officer on 22/09/06, with a satisfactory outcome. Landlords Gas Safety Certificate, Portable Appliances Test Certificate, Electrical Installation Certificate and Legionella Test are all up to date. Fridge and freezer temperatures are taken daily. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 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 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 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 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 3 X 2 X 3 X X 3 X Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 24 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. Standard YA20 Regulation 13(2) Requirement The registered manager must ensure that liquid medication bottles are signed and dated after opening. The registered manager must ensure that all staff receive Protection of Vulnerable Adults training within the first six months of employment and every two years a refresher course. The damp patches on the hallway ceiling must be repaired. The registered manager must ensure that cleaning materials are locked away at all times. The registered manager must obtain the relevant qualifications in care and management. Timescale for action 01/08/07 2. YA23 13(6) 01/09/07 3. YA24 23(2)(b) 01/09/07 4. YA30 13(4)(c) 01/08/07 5. YA37 9(2)(b)(i) 01/04/08 6. YA39 24(1)(a)&(2) The registered manager must send a copy of the annual development plan to the Commission for Social Care DS0000017523.V340812.R01.S.doc 15/08/07 Real Life Options 90 Capel Gardens Version 5.2 Page 25 Inspection once completed. 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. 1. Refer to Standard YA7 YA37 Good Practice Recommendations The registered manager should reduce the amount of coins in service users money tin. The registered manager should explore if staff could receive group therapy to deal with the death of one of the people using the service. Real Life Options 90 Capel Gardens DS0000017523.V340812.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area Office 4th Floor, Aspect Gate 166 College Road Harrow London HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 - 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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