Inspection on 03/09/07 for Real Life Options 96 Harrowdene Road

This inspection was carried out on 3rd September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Real Life Options 96 Harrowdene... 23/03/07

Real Life Options 96 Harrowdene... 18/11/05

Real Life Options 96 Harrowdene... 20/05/05

Real Life Options 96 Harrowdene... 08/12/04

Real Life Options 96 Harrowdene... 09/09/04

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Edenvale

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Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Real Life Options 96 Harrowdene Road 96 Harrowdene Road Wembley Middlesex HA0 2JF Lead Inspector Judith Brindle Key Unannounced Inspection 3rd September 2007 08:25 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.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 96 Harrowdene Road DS0000017454.V344007.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 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Real Life Options 96 Harrowdene Road Address 96 Harrowdene Road Wembley Middlesex HA0 2JF 020 8904 3543 F/P 020 8904 3543 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 Ms Kylie Miles Care Home 6 Category(ies) of Learning disability (4), Physical disability (2) registration, with number of places Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd March 2007 Brief Description of the Service: 96 Harrowdene Road is a care home providing personal care for 6 adults with learning disabilities, including up to two service users who may also have physical disabilities and who are accommodated on the ground floor. The home has no vacancies. The home is situated on a busy road that links East Lane with the Harrow Road. The nearest underground tube station is North Wembley. There are also bus routes along the two main roads. The property has off street parking for three vehicles. However there is also parking available in the street outside the house. The house consists of two floors. There is a seating area in the very large entrance hall, a lounge, conservatory, dining room, kitchen, laundry, and two service users bedrooms on the ground floor. Two bedrooms have an en-suite shower and toilet. There is a bathroom, separate toilet, office and 4 service users bedrooms on the first floor. Information about the service including the statement of purpose and service user guide are accessible within the home. Fees are recorded in the service agreements of people using the service, and extra charges are recorded in these documents. Details of fees can be obtained from the registered provider, Real Life Options. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout a day in September 2007. There were no vacancies at the time of the inspection. The people living in the care home have limited vocal communication abilities, and were able to respond to questions to a limited degree. Therefore observation was an important tool used during the process of inspection. Two people using the service have a physical disability. All residents receive funding from the Local Authority, there are no people living in the care home who are privately funded. The registered manager is presently taking maternity leave, and is due to return to work in July 2008. Temporary acting managers have managed the home since the commencement of her leave, and presently an experienced deputy manager from another Real Life Options home is managing the care home on a ‘short term’ basis. I was informed that another temporary manager has been recruited and would commence employment in the care home in the near future. The acting manager supplied the Commission for Social Care Inspection with a completed Annual Quality Assurance Assessment (AQAA) document following the inspection. This had been comprehensively recorded, and included required information about the service and future plans for improving, and developing the service provided by the care home. Staff were also spoken with during the inspection, and were very helpful in supplying all documentation, and information requested by the inspector. The acting manager was present during the inspection. The care home’s Divisional Manager was present during a significant part of the inspection. The inspection focussed on spending time with people living in the care home, and observing interaction between residents and staff. Documentation inspected included, resident’s care plans, residents’ financial records, risk assessments, staff training records, and some policies and procedures. The inspection also included a tour of the premises. Assessment as to whether the requirements from the previous inspection had been met also took place during the inspection. Staff and inspection of records confirmed that not all of these had been met by the service. 29 National Minimum Standards (including Key Standards) for adults were inspected during this inspection. The inspector thanks all the people living in the care home, and the staff for their assistance during the inspection process. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The care plans of people using the service, and risk assessments could be significantly improved and developed. I was informed that this was an issue that had been identified and was in the process of being undertaken. The financial recording and monitoring systems of the monies of people using the service needs to be improved and more closely monitored. There needs to be evidence that cultural and religious needs of residents are fully understood and met by staff. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 7 There could be more evidence that staff receive up to date ‘refresher’ training and specialist training for example in supporting people using the service in regard to meeting their epilepsy needs. The frequency of staff supervision could be better. Some assessment information needs to be developed for example in regard to the use of bedrails. There needs to be better monitoring of the weight of people using the service. All staff need to have knowledge and understanding of the procedure for notifying the Commission for Social Care Inspection of significant events. Some documentation could be better recorded, and out of date records should be archived. There needs to be an experienced and competent manager appointed to manage the care home on a ‘long term basis’, whilst the present registered manager is not working in the care home. This manager needs to be registered with the Commission for Social Care Inspection. 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 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 8 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 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 9 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): Standard 1 and 2 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for prospective service users to have the information that they need to make an informed choice about where to live. Arrangements are in place to ensure that prospective resident’s needs are assessed, but these needs could be more comprehensively documented. EVIDENCE: The care home has a service user guide and a statement of purpose. The service user guide included written and pictorial format (photographs of the care home and location), and includes a record of the fees and of costs are not included in the fees , such as toiletries, and hairdressing. There were several copies of the service user guide documentation accessible in the office of the care home. Each person living in the care home should be given a copy of the service user guide. Following the unannounced inspection a copy of the statement of purpose was supplied to the Commission for Social Care Inspection. This had been recently reviewed. The care home has an assessment procedure. This is documented in the statement of purpose, and is recorded in written and pictorial format. Staff confirmed that an initial assessment of a prospective resident, with their (and/or a relative/significant other if applicable) is carried out by a competent person prior to their admission to the care home. From this the home aims to Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 10 determine if it can meet the needs of the prospective resident and that it suits their needs and preferences. I was informed that the referring Local Authority would also carry out a care assessment of the person’s needs. Records and staff confirmed that visits to the care home by prospective residents were supported and encouraged, to ensure that the prospective resident has the opportunity to meet all the people using the service and that they have the opportunity to meet the prospective resident. A care plan of the most recently admitted resident included evidence of some assessment information, but some documentation such as ‘Assessment Plan’ was not fully completed. There was evidence that placement reviews of the resident’s needs had taken place, with involvement of the Local authority Care Manager, previous placement staff, and others. Emergency admissions are not generally admitted to the care home. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 11 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): Standard 6,7, 8and 9 People who use this service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that all residents have a plan of care, but these plans could be improved and developed. The management of residents’ personal monies could be significantly improved and better monitored. Residents are supported and encouraged to make decisions and choices, but risk assessments could be improved to ensure that people using the service are supported to take risks as part of an independent lifestyle. EVIDENCE: Three residents care plan files were inspected. The care plan documentation consisted of individual large files with a mixture of information in them (including health records, and assessment information) and much old documentation, which should be archived. It was very difficult to access clear succinct information, including staff guidance for meeting resident’s individual Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 12 needs. It was also not clear how each resident participated in their plan of care and its review. Much of the documentation was not dated and there was very little evidence of it having been reviewed, one care plan recorded reviews in May 2006 and November 2006. The care plans should be at least monthly reviewed with a more comprehensive review every six months. Individual resident goals were developed from reviews but it was not clear that these goals had timescales for aiming to achieve the goal, and they were not generally referred to in the following review, nor evaluated. Requirements from the previous inspection (that took place in March 2007) in regard to care plans being reviewed, and care plan files needing to be restructured and re-organised were judged not to have been met. I was informed that comprehensive reviews of each residents’ needs are planned to take place in September 2007. This is positive. There was little evidence that residents (apart from the person most recently admitted) had had a review of their needs from a representative of their funding authority within the last twelve months. There was some evidence of some care plans being in the process of being developed and improved, with some appropriate staff guidance, but this was not comprehensive, and was not consistent. The care plans could be more ‘person centred’ (show evidence that the resident is central to their own care plan and that they participate fully in its development, and in its review). There could be more assessment information in regard to individual cultural, social and religious needs, and the care plans should be ‘working’ documents in which there is evidence of them being constantly updated in response to the changing needs, and the views of residents. The Divisional Manager informed me that a person had been employed to develop individual care plans with risk assessments for all the residents and was in the process of completing this work, and that this person had with them some care plan documentation in regard to the residents. This care plan information needs to be accessible in the care home at all times. Copies of documents need to be completed if the information is needed outside of the care home. Annual Quality Assurance Assessment (AQAA) document information received by the Commission from the care home recorded that there were plans to reorganise the residents’ files. Amongst the large file of one resident there was some information that this resident had had a seizure last year. There was no accessible assessment information or staff guidance for staff to support the resident if they had a further seizure. The acting manager reported that he would develop this guidance as soon as possible. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 13 There was evidence that a resident had received speech and language therapy, but guidance from the speech and language therapist was not easily accessible in the care plan inspected. A resident with particular cultural religious needs had had these briefly assessed regards of dietary needs (by identifying only one food type that this resident did not eat), but nothing else was recorded in the care plan. It was evident that these cultural dietary needs had not been fully understood by all staff, as records confirmed that this person had been provided with a packed lunch containing foods that did not meet their religious needs. Also there was no indication in the menu about these needs or clarity whether meat eaten should be Halal. Though the resident had the opportunity to watch Asian Hindi DVDs, it was not evident in the care plan that these met the person’s particular religious needs or preferences. There was only an indication that a relative had been spoken too about this resident’s religious and cultural need. Daily’ records of resident’s progress were varied in the content and comprehensiveness. There were some gaps in recording. There should be evidence that these are closely monitored. Four residents monies were inspected. All of these balanced as recorded. Staff reported that they check the balance of each resident’s money on a daily basis. Resident’s expenditure records were inspected. These records included receipts with petty cash slips attached to them. It was not evident that staff always signed petty cash slips. Receipts were not numbered, and were ‘jumbled’ up, and difficult to match with the record of expenditure. Several of the receipts were not clear in regard to what items were bought. For example a petty cash slip recorded ‘pub’ but it was not clear what item was bought in the pub, another petty cash slip recorded the names of two shops where items were bought, but there was not a description of the items on the petty cash slip nor on the receipt. Two receipts recorded that a resident bought an alcoholic drink, but it was not documented in the care plan that this resident drank alcohol, particularly in regard to his/her particular religious needs. This needs to be investigated, by the registered person. There were receipts for significant expenditure by residents in regard to purchases for the care home’s fish tank. It was not clear whether the fish tank belonged to a resident or several residents or whether it was the homes’ fish tank. There was nothing recorded in the care plans or other records about who was to fund items for the fish tank. There needs to be a clear recorded protocol, and guidance in regard to this, and recorded in individual residents financial risk assessments if relevant, and appropriate. However a requirement from the previous inspection in regards to residents not paying for staff lunches when out, was judged to have been met. Staff confirmed that staff do not have their lunch paid for by residents. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 14 Two receipts recorded that residents had contributed to a ‘voucher’ for a staff ‘leaving’ present. There was no record that these residents could make this informed choice about this expenditure (particularly in regard to their significant communication needs, and their learning disability needs), nor was it recorded in the resident terms and conditions documentation nor the service user guide that this was part of a resident’s ‘extra’ expenditure. This issue needs to be investigated by the registered person. The Divisional Manager and acting manager were not clear, when asked as to whether there was a gifts policy. Records confirmed that there is a gifts policy, and that this is covered during the basic staff induction. I did not access the full policy during the inspection. Real Life Options needs to ensure that all staff are aware of this policy, and that it is monitored closely that staff follow this procedure. Two receipts of items bought by residents, were inspected and recorded that a supermarket point’s card was used. Staff reported that they thought that there was a house card or that one resident had a loyalty card, but these cards were not available for inspection. The registered person should examine whether there should be policy in regard to the use of supermarket loyalty. Also residents should have the opportunity to own their personal loyalty supermarket card. The acting manager agreed and has recorded in the AQAA documentation this is a goal to be achieved by the home. The home has a ‘service user privacy’ procedure. This is recorded in written and pictorial format. Staff were observed to respect resident’s privacy during the inspection. Examples of this was staff knocking on resident’s bedroom doors. The AQAA information informed me that an objective for the care home is to find advocates /befrienders for the residents to support residents in making choices. There were some generic general health and safety risk assessments but many of these were out of date and in need of review. There were few accessible risk assessments in regard to the residents. There needs to be a variety of individual risk assessments including bathing risk assessments (particularly as it was documented that a resident had fallen in the bath and injured their toes), kitchen safety, finance, etc. Resident’s risk assessments need to be improved and developed to ensure that there are strategies in place to support residents to take risks safely. AQAA information supplied to the Commission confirmed that this issue was recognised as an objective by the home. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 15 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): Standards 12,13, 14, 15, 16 and 17 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Central to the home’s aims and objectives is the promotion of the individual’s right to live an ordinary and meaningful life, both in the home and in the community. People living in the care home have the opportunity to take part in a variety of activities including those promoting personal development, independence, and being community based. Arrangements are in place to enable people living in the care home to maintain contact with family/significant others, as they wish. Meals provided to people using the service are varied and wholesome, but there could be development in improving meal choice, cultural dietary needs for residents and better recording of food eaten by people using the service. EVIDENCE: All the residents attend the Real Life Options day resource centre, where they participate in a variety of activities. I was informed that each resident spends Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 16 one day at home during the week to enable him/her to participate in 1-1 activities with staff, which often includes accessing community facilities, such as going shopping. A resident was spending the day at home during the inspection. There was evidence that residents participated in a variety of activities/ leisure pursuits including accessing community facilities. A resident had recently had her hair cut at a well renowned hairdresser, and indicated that she was happy with her hair; another resident had recently attended a swimming session at a specialist activity centre. Records informed me and staff that residents have the opportunity to have aromatherapy sessions. Staff reported that residents and staff usually go out shopping, or out to lunch or go out on day trips during the weekend, and that a karaoke session, and a music session take place regularly in the home. Each resident has a ‘time plan’, which is linked with activities that are carried out at the day resource centre, attended by the residents. There should be an activity plan, which includes day, evening and weekend home activities, and evidence that these are linked to preferred activities documented in the individual care plans. The AQAA information supplied to the Commission recorded that there are plans to have a personalised display board for each resident, using photographs and pictures, and that a goal for the home is to improve the reporting and recording of activities. The care home has a passenger vehicle for residents use. All residents should have the opportunity to apply for taxi cards, and also the opportunity to obtain public transport travel passes that enable them to access public transport without cost. A requirement from the previous key inspection in regard to the home ensuring that residents have access to the community regularly was judged to have been met. Records of activities undertaken by residents were recorded but not comprehensively and this recording could be improved. I was informed that no people using the service had had a holiday this year but that there were plans to ensure that residents have the opportunity to have a holiday. The home has a visitors policy, which confirms that residents choose who they see and when, and that they have the opportunity to meet visitors in their own room or another private area of the home. Staff, records, and a resident confirmed that relationships with family and friends are supported and encouraged. The amount, and the kind of contact that people using the service have with family/significant others is varied. A previous inspection requirement that all residents must be registered on the Local Authority electoral register was judged to have been met. The acting manager reported that an application to ensure that all residents were on the electoral register had been recently sent to the Local Authority. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 17 There was a written menu displayed on the wall. Staff reported that there is a four week menu developed by staff. Staff spoke of ways of how they gained knowledge of residents (particularly in regard to the people using the service who have verbal communication needs) food preferences, and had incorporated these preferences into the menu. Though the menu seemed varied and wholesome it was not clear that residents are offered choice or that cultural needs are included in the menu or that relatives/significant others are involved in the development of the menu (if residents are unable to communicate their preferences). This was discussed with staff. The menu should be more accessible to residents, i.e. in pictorial or photographic format. The AQAA information supplied to the Commission recorded that there are plans to improve the format of the menu, and to make it more accessible to the people using the service, and that 90 of staff have received training in safe food handling. Unless they do not have contact with any food in the home, the registered person should ensure that all staff have received training in safe food handling. Food eaten by residents was partially recorded, but there was little evidence of records of what individual residents had chosen to eat. For example staff reported that one resident disliked pasta, but a meal recorded did not have any documentary evidence that this resident had received another meal. Also records informed me that a resident with particular dietary/cultural needs had had an inappropriate sandwich filling in his/her packed lunch sandwich on more than one occasion, when attending the day centre (see Standard 7). Staff must behave knowledge and understanding of the cultural dietary needs of residents. A variety of frozen, fresh, dried and tinned foods were stored in the care home. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 18 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): Standard 18,19 and 20 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that resident’s individual personal and healthcare needs are generally met, but there needs to be evident that all individual residents health needs are assessed and systems are in place to meet these needs. Medication is generally stored and administered safely, but there needs to be improvement in regard to aspects of medication recording. EVIDENCE: Records and staff informed me that all the residents need help from staff with some or all of their personal care needs. Care plans inspected recorded some staff guidance to meet individual assessed needs. There was some evidence of recorded health care action plans. A previous requirement in regard to this was judged to have been met. AQAA information recorded that there were plans to develop and improve personal support plans and health care action plans, and to ensure that all residents receive regular health checks. Records, and staff confirmed that residents have access to advice and treatment from healthcare professionals. This includes dental, chiropody and optician care and treatment. Appointments with the GP, Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 19 hospital and physiotherapists were documented. A physiotherapist visited a resident during the inspection. Records confirmed that a resident needed dental extractions, it was not clear from records whether this had been carried out. This was discussed with the acting manager. A record in the communication book recorded that a resident had got ‘some bedsores on his back, please apply sudocrem’. The manager reported that this person did not have bedsores, and that this record was not correct. Staff need to have training in appropriate recording, and particularly in regard to confidentiality. Records informed me that there was not clarity in regards to the use of bedrails for a resident. A record in the communication book recorded an incident when a resident had climbed over bedrails that were attached to his/her bed. It was recorded to keep the bedrails down. Another later message recorded that the bedrails should be up. There was no accessible bedrail assessment. This was discussed with the acting manager. There needs to be evidence that the use of bedrails in the care of residents must be agreed by the resident (and/or relative/significant other) and individually assessed/risk assessed, with advice and guidance from a healthcare professional. A record in the communication book recorded that indicated that there were concerns in regard to a resident having lost weight. There was not accessible information as to whether residents are regularly weighed monitored in the home. There were some records of residents being weighed at the GP surgery. There needs to be evidence that residents have their weight monitored closely, and if there are issues with residents not wishing to be weighed or that particular scales have to be used in regard to residents particular needs, this needs to be documented in the care plan and appropriate action taken to meet this need. The home does have access to portable weighing scales. The care home has a medication policy. Records confirmed that this was signed as being understood by staff. The medication in the home is stored as required. Medication administration records that were inspected were fully recorded. The shift leader administers medication to people using the service. No record was seen in regard to medication being returned to the pharmacist. There should be a list of staff signatures of what is written on the medication administration record sheets. I was informed that staff receive training from the pharmacist, and some refresher ‘in house’ medication video/questionnaire training. The AQAA information supplied to the Commission recorded that there were plans for all staff to have ‘medication competency checks’. This should take place. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 20 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): Standard 22 and 23 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place for ensuring that complaints are taken seriously and handled objectively. The complaints record book needs to be accessible at all times. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm, but there needs to be evidence that residents monies are managed appropriately at all times. EVIDENCE: The care home has a complaints policy/procedure, which has been recently reviewed. It records that comments, complaints and compliments are welcomed. It included timescales for responding to complaints/concerns, and recording procedures. The acting manager reported that copies of the complaints procedure had been supplied to relatives/significant others. I was informed that there have been no complaints since the last inspection but staff could not access the complaints book for inspection. This complaints record book needs to be available for inspection. The home has a ‘ Complaining about bullying or harassment’ procedure, which is in pictorial and written format. The AQAA documentation supplied to the Commission recorded that a goal for the home was to improve and develop communication (such as staff receiving Makaton training) with residents (particularly those who have significant verbal communication needs), to enable staff to identify when residents have a concern/complaint. This action should take place. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 21 Records informed me that protection of vulnerable adults training has been completed by staff, and that guidelines in regard to the adult protection procedure have been drawn up and made accessible. Staff who spoke with me were aware of the reporting and recording procedures in response to an allegation or suspicion of abuse, and confirmed that they had received protection of vulnerable adults training. Inventories of residents’ individual possessions are in place. Staff need to have knowledge and understanding of procedures in regard to the management of resident’s monies, and individual comprehensive risk assessments of each resident’s finances needs to be drawn up, to ensure that residents are not at risk of financial abuse. (See Standard 7). I was informed that the financial situation of two residents was still in the process of being resolved. A previous inspection requirement in regard to this issue was therefore judged as not being met. The registered person should seek advice from appropriate bodies to ensure that these residents have their finances sorted out. Senior staff informed me that there was only one staff member that could sign for the withdrawals from resident’s bank accounts. This is not good practice. There needs to be a system in place to ensure that more than one staff member has responsibility for withdrawing residents monies, particularly in regard to practical issues such as when this staff member is taking annual leave or is off sick. It needs to be evident that resident’s ‘monies’ are audited on a regular basis by a competent person not employed within the home, and that there are clear robust systems in place to minimise any risk of financial abuse. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 22 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): Standards 24, 25 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The environment of the home is safe, clean, homely and comfortable. The premises are suitable for the care home’s stated purpose; there are some maintenance issues that could be resolved. Resident’s bedrooms are individually personalised, and meet their individual needs. EVIDENCE: The care home is located in North Wembley, within a few minutes walk from a variety of amenities that include shops, restaurants, cafes and banks, and local transport facilities that include train and bus services. The home is in keeping with the other houses in the area. The inspection included a tour of the premises. The home is generally well maintained and clean. The home has an attractive enclosed garden. The acting manager spoke of plans to develop and improve the garden, (such as putting in raised beds for plants, and to make the garden more wheelchair Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 23 friendly) and to fully involve people using the service in these plans. These plans are positive and should be put in place. The home has a programme of maintenance, and building worked. Most of the environmental maintenance requirements from the previous inspection including kitchen maintenance issues were judged to have been met by the home. There were some maintenance issues, which should be addressed. The damp patches on the wall in one of the residents’ bedrooms, and in the lounge were in the process of being repaired. This was a previous inspection requirement. The registered person should replace the flooring in the downstairs bathroom and the utility room and the cracked freezer drawers should be replaced, and the paintwork in the kitchen could be repainted. The fly screen in the kitchen should be replaced. The carpet in a ground floor bedroom was stained in some areas and needs cleaning or replacing. The kitchen floor is stained in some areas and could be replaced. There are several radiators that are not covered. The registered person needs to complete a risk assessment of the radiators and take in account of the needs particularly behaviour needs of all the residents More ramps could be in place (such as from the conservatory to the garden) to ensure that residents who use a wheelchair, can access as much of the garden as possible. Rendering of some areas of the outside walls should be carried out. The leak in the shower of a ground floor bedroom needs to be repaired. Two residents kindly showed the inspector their bedrooms. They included several personal items, and the residents indicated that they were happy with their bedrooms. The home has an infection control procedure. Records confirmed that staff had received infection control training. The home was clean, bright and airy during the unannounced inspection. Laundry facilities are located away from food storage and food preparation areas. Staff have access to protective clothing including disposable gloves and aprons. The laundry room should be redecorated. The door of the COSHH cupboard (cupboard for storing chemical cleaners and other items) is loose at the hinge, and needs repair. . Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 24 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): Standards 32,33,34, 35 and 36 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff receive some training but it needs to be evident that they receive appropriate ‘refresher’ training, and specialist training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities in meeting the needs of people using the service. Arrangements are in place to ensure that residents are supported and protected by the care home’s recruitment policy and procedures. It needs to be evident that supervision needs to take place regularly for all staff. EVIDENCE: The staff rota was available for inspection. There are 3 to 4 staff on duty during the day and one waking night staff and a staff member who completes a ‘sleep in’ duty at night. Four care staff were on duty during the inspection. Staff spoke of there being flexibility in regards to staff numbers on duty depending on the needs of the people using the service. The AQAA information supplied to the Commission recorded that there are plans to have a notice board displaying information, including photographs of Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 25 which staff are on duty. The acting manager has recently introduced a shift planner, which records the duties and responsibilities of staff during their shift. Staff spoke of their role as key worker to residents, which included key worker/resident meetings. These key worker/resident meetings should be documented. Some residents have two key workers. I was informed by records and from speaking to staff that all staff receive induction training during the first six weeks of employment and that this leads to foundation training, which is linked to the Learning Disability Awards Framework (LDAF) requirements, which is accredited training to ensure that staff have the knowledge and understanding to be able to carry out their responsibilities in regard to supporting adults who have a learning disability. Records from the AQAA documentation recorded that the majority of staff have completed the Learning Disability Award Framework award, but that this training is not always completed within the probation period. AQAA records confirmed that the home was aware of this issue and aimed to improve this, so that all staff complete their induction and foundation training within their six months probation. Staff receive an induction handbook. Staff then go on to complete NVQ (National Vocational Qualification) level 2 or 3 in care, depending on their job role. The AQAA information supplied by the acting manager informed me that five staff have achieved a NVQ level 2 or above and that there are five staff working towards this qualification, and that out of two ‘bank’/agency staff one person is in the process of achieving NVQ level 2 qualification, which according to AQAA records is 75 of the staff. Staff training records need updating, and from the available records it was evident that significant ‘refresher’ staff training needs to take place particularly in regard to statutory training such as manual handling, health and safety etc. Training particularly relevant to the needs of the residents needs to be in place an example of this is epilepsy training (see standard 6), and Makaton training (in regard to residents communication needs), and staff need to receive training in regard to diversity and equality and include religious and cultural needs (See Standard 6). I was informed by senior staff that Real Life Options had recruited a Learning and Development Officer, who is due to take up their post shortly. This I was told would be positive in ensuring that staff have their training needs assessed and that action is then taken to meet those needs. AQAA information recorded that a new database of staff training that has taken place, and training planned for each staff member is to be put place. The AQAA information recorded that staff had received equal opportunities training, recruitment and retention training, and training in regard to the Mental Capacity Act within the last twelve months. The home has a volunteer policy in which it records that an appropriate Criminal Record Bureau disclosure and references will be obtained prior to commencement of the volunteer role. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 26 The home has a comprehensive recruitment and selection policy/procedure, which includes the need for an enhanced Criminal Record Bureau check, which includes a protection of vulnerable adults (POVA) check (to ensure that the POVA list is checked to gain knowledge whether a person is banned from working with vulnerable adults). Staff records inspected recorded evidence that appropriate recruitment procedures are followed. Records confirmed that staff had received recent appraisals. Records confirmed that some staff had received recent staff supervision, but that it was evident that staff have not had the opportunity of participating in 1-1 staff supervision regularly to ensure that there is evidence that staff are supported in their role and have the opportunity to develop goals in regard to carrying out their duties. This was discussed with the Acting Manager, who is aware of this issue and has worked hard to put systems in place to ensure that staff have the opportunity to have 1-1 staff supervision, which is fully recorded. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 27 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): Standards 37,39 41,and 42 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The care home has been managed for some months by temporary acting managers, whilst the registered manager is on maternity leave. There needs to be a competent acting manager in post until the registered manager returns back to work in the care home. Arrangements are in place to ensure that effective quality assurance and quality monitoring systems are in place to monitor and improve the quality of the service provision by the care home. Arrangements are in place to ensure that so far as reasonably practicable the health, safety and welfare of residents and staff is promoted and protected. EVIDENCE: The registered manager is currently taking maternity leave. Several acting managers have managed the care home since she commenced her leave. I Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 28 was informed that she is not due back from her leave until the middle of 2008. The deputy manager of another Real Life Options home was managing the home at the time of the inspection. He has several experience in a management role and of working with adults with a learning disability. It was evident that during the short time that he has been managing the home he has been aware of the need for some changes in the care home and has been proactive improving the quality of the service for residents. I was informed that he would be in post only for a short time, and that another temporary manager would be shortly taking up the post of acting manager. There needs to be a competent and experienced manager (who is closely supervised and well supported by Real Life Options), employed in the care home whilst the registered manager is taking maternity leave, so that there is a quality service of care and support provided to people using the service. This manager must be registered with the Commission for Social Care Inspection, There is an ‘on call’ managers rota. It was evident from talking to staff that there are clear lines of accountability within the care home, and within Real Life Options. The requirement in regard to the registered manager achieving a Registered Managers Award qualification has been temporarily removed, as the manager is not at present working in the home so it is not achievable within the recorded timescales. Policies and procedures that were inspected recorded evidence of having been regularly reviewed, and staff sign when they have read policies. A representative of the owner carries out monthly visits to the care home, and completes a report following carrying out checks of a variety of systems within the home, to assess and monitor the service provided to residents. Following the inspection, the acting manager supplied the Commission for Social Care Inspection with a business plan for 2007-8 for the service. This document included a number of goals for the home, to improve and develop the quality of the service provided to people using the service. Records confirmed that a staff team meeting had taken place recently. I was informed that questionnaires about the service have been supplied to relative /significant others in 2007. Some records were generally up to date, but others such as some health records, and some records in care plans were not dated nor comprehensively completed. The registered person should consider archiving some records, particularly in regard to the care plan information. This was discussed with the acting manager. AQAA information supplied to the Commission confirmed that this was planned, and that the care home’s office files and folders would be reorganised as well. Policies and procedures are comprehensive, and record evidence of being regularly reviewed. Records naming residents need to be in their own individual file not a staff communication book. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 29 Recent gas safety and electrical checks had been carried out. Health and safety checks of the environment take place regularly. Safety checks of equipment, wheelchairs and aids were available for inspection. Therefore a previous inspection requirement in regard to these checks was judged to have been met. A fire risk assessment was available for inspection. It was dated 2006. The fire risk assessment should be further developed so that each room in the care home is individually assessed in regards to fire risk. There was some guidance in regard to individual fire risk assessment for each resident. A door leading into the was propped open to enable access for residents who use wheelchairs to meet their mobility needs. If doors are needing to be left open during the day the registered person needs to ensure that there is an appropriate safe mechanism in place to enable doors to be left open safely during the day. Advice should be accessed from the local fire service, and the fire risk assessment needs to be updated to include the issue of doors needing to be left open during the day, but closed at night. The home has a disaster/emergency plan in the event that the building becomes unsafe/unfit for habitation due i.e. to flooding, fire etc. Records informed me that a resident had had an accident in April 2007 in which they received treatment at hospital. There is no indication the Commission for Social Care Inspection was informed of this significant event as is required. All staff need to ensure that they have knowledge and understanding of reporting procedures. The employer’s liability certificate of insurance was displayed and up to date. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 30 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 3 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 2 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 2 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 2 X 3 X 2 2 X Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 31 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 YA6 Regulation 15(2)(b) Requirement All care plans must be reviewed six monthly as per Real Life Option’s care plan policy. Timescales 30/04/07 not met • Care plan files must be restructured and re-organised. Timescales 30/04/07 not met All care plan information needs to be accessible in the care home at all times There needs to be accessible assessment information and staff guidance for staff to care and support a resident if they had a further seizure. It must be recorded in residents care plans if they wish to drink alcohol particularly if this is not usual practice in regard to their religious needs. • All receipts must clearly document the items bought with Version 5.2 Page 32 Timescale for action 01/12/07 2 YA6 17(3)(a) 01/12/07 3 YA6 12 (1) 13(4) 14(1)(2) 01/11/07 4 YA6 14(1) 15(1)(2) 01/11/07 5 YA7 13(4) 17, 20(3) 01/12/07 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc 6 YA7 13(6) 7 YA7 13(6) 14 8 YA7 12(1) 13(6) 15(1) (2) 20 9 YA8 20(1) resident’s money. • The registered person needs to investigate whether an alcoholic drink purchased by a resident was for that person. There needs to be a clear protocol, and guidance in regard to expenditure for the fish tank, and residents reimbursed if appropriate. All people using the service need to have individual recorded financial risk assessments. • Real Life Options needs to ensure that all staff are aware of the gift policy, and that it is monitored closely that staff follow this procedure. • It needs to be documented in the residents’ plan of care if they can or cannot make an informed choice as to whether to pay for a gift for a staff member. • Residents concerned need to be reimbursed if found to be appropriate. • Financial situation of one of the residents living in the home must be addressed and resolved. The inspector must be kept informed of the progress. Previous timescales 30/04/07 not met • A second person using the service 01/11/07 01/11/07 01/11/07 01/01/08 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 33 10 YA9 13(4) 11 YA17 14(1), 15(1)(2) 16(2)(i) 12 YA19 12, 13(4) 14(1) 13 YA19 12(1) 13(4) 14 15 YA22 YA23 17(3) 22 13(6) 17(2) needs to have their financial situation resolved. Resident’s risk assessments need to be improved and developed to ensure that there are strategies in place to support residents take risks safely. • Staff must behave knowledge and understanding of the cultural dietary needs of residents. • There needs to be evidence that the menu offers choice to residents. • Food eaten by residents must be recorded fully. There needs to be evidence that the use of bedrails for the care of residents must be agreed by the resident (and/or relative/significant other) and individually assessed/risk assessed, with advice and guidance from a healthcare professional. There needs to be evidence that residents have their weight monitored closely, and if there are issues with residents not wishing to be weighed or that particular scales have to be used in regard to residents particular needs this needs to be documented in the care plans and appropriate action taken to meet this need. This complaints record book needs to be available for inspection. • There needs to be a 01/11/07 01/11/07 01/11/07 01/11/07 01/11/07 01/11/07 Page 34 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 16 YA24 23(2) 17 YA24 13(6) 23(2) 18 YA24 23(2) 19 YA35 13(4) 18(1)(c) system in place to ensure that more than one staff member has responsibility for withdrawing residents monies. • It needs to be evident that resident’s ‘monies’ are audited on a regular basis by a competent person not employed within the home. • And that there are clear robust systems in place to minimise any risk of financial abuse. The damp patches in one of the residents’ rooms and the lounge must be repaired. Timescales 31/05/07 not met. The registered person needs to complete a risk assessment of the radiators and take in account of the needs particularly behaviour needs of all the residents • The door of the cupboard used for storing cleaning chemicals etc needs to be repaired so that the cupboard is secure. • The leak in the shower of a ground floor bedroom needs to be repaired. • Refresher’ staff training needs to take place particularly in regard to statutory training such as 01/11/07 01/11/07 01/11/07 01/02/08 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 35 20 YA36 18(2) 21 YA37 8(2) CSA 11(1) 22 YA41 17(1)(2)(3) 18(1)(c) 23 YA42 37(1) manual handling, health and safety etc. • Training particularly relevant to the needs of the residents needs to be in place an example of this is epilepsy training (see standard 6), • and training in regard to diversity and equality and include religious and cultural needs of residents (See Standard 6). Staff must have the opportunity of participating in 1-1 staff supervision regularly to ensure that there is evidence that staff are supported in their role and have the opportunity to develop goals in regard to carrying out their duties. The care home needs to ensure that there is a competent and experienced manager managing the care home (whilst the present registered manager is on maternity leave) who is registered with the Commission for Social Care Inspection. Staff need to receive training in regard to record writing, and in the issue of confidentiality linked to this. • The Commission for Social Care Inspection needs to be informed of all significant event that effect the welfare of people using the service. • All staff (including 01/12/07 30/01/08 01/12/07 01/10/07 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 36 24 YA42 12(1) 13(4) 23(4) • • temporary managers) need to ensure that they have knowledge and understanding of reporting procedures. If doors need to be left open during the day the registered person needs to ensure that there is an appropriate safe mechanism in place to enable doors to be left open safely during the day. the fire risk assessment needs to be updated to include the issue of doors needing to be left open during the day, but closed at night. 01/11/07 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 3 Refer to Standard YA1 YA2 YA6 Good Practice Recommendations Each person living in the care home should be given a copy of the service user guide. The registered person should ensure that all assessment information is fully recorded. The care plans could be more ‘person centred’ (show evidence that the resident is central to their own care plan and participate fully in its development and its review) and include more information in regard to individual cultural, social and religious needs, and be a ‘working’ document in which there is evidence of them being constantly updated in response to the changing needs and the views of residents. • Daily records of resident’s progress could be improved and should be closely monitored. • Key worker/resident meetings should be DS0000017454.V344007.R01.S.doc Version 5.2 Page 37 4 YA6 Real Life Options 96 Harrowdene Road 5 YA7 6 YA12 7 YA13 8 YA20 9 YA24 9 YA35 10 YA41 11 YA42 documented. • Receipts and petty cash slips should be in good order and be possibly numbered to be more accessible. • The registered person should examine whether there should be policy in regard to the use of supermarket loyalty cards. • Also residents should have the opportunity to own their personal loyalty supermarket card. There should be an activity plan, which includes day, evening and weekend home activities, and evidence that these are linked to preferred activities documented in individual care plans. All residents should have the opportunity to apply for taxi cards, and also the opportunity to obtain public transport travel passes that enable them to access public transport without cost and/or minimal cost. • There should be a list of staff signatures of what is written on the medication administration record sheets. • Records should be accessible in regard to medication being returned to the pharmacist. The registered person should • redecorate the washing/laundry room. • Replace the flooring in the downstairs bathroom and utility room • The sealant surrounding the shower unit in a ground floor bedroom ensuite facility should be repaired. • The cracked freezer drawers should be replaced. • The paintwork in the kitchen could be repainted. • More ramps could be in place (such as from the conservatory to the garden) to ensure that wheelchair users can access as much of the garden as possible. • Rendering of some areas of the outside walls should be carried out • The registered person should ensure that all staff have received training in safe food handling, unless they do not have contact with any food in the home. • All training records should be regularly updated. • Old documentation, such as information in the care plans, should be archived. • Records naming residents need to be in their own individual file not a communication book. • The fire risk assessment should be further developed so that each room in the care home is individually assessed in regards to fire risk. • Advice should be sought from the fire service in regard to suitable safe mechanisms for keeping DS0000017454.V344007.R01.S.doc Version 5.2 Page 38 Real Life Options 96 Harrowdene Road doors open safely. Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow 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 Real Life Options 96 Harrowdene Road DS0000017454.V344007.R01.S.doc Version 5.2 Page 40 - 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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