Inspection on 29/07/05 for St Joseph`s Care Home

This inspection was carried out on 29th July 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

St Joseph`s Care Home 12/01/09

St Joseph`s Care Home 19/01/08

St Joseph`s Care Home 26/01/07

St Joseph`s Care Home 18/01/06

St Joseph`s Care Home 23/02/05

St Joseph`s Care Home 20/07/04

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

CARE HOMES FOR OLDER PEOPLE St Josephs Care Home 38 - 40 Hindes Road Harrow Middlesex HA1 1SL Lead Inspector Clive Heidrich Unannounced 29 July 2005, 08:10h00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service St Josephs Care Home Address 38-40 Hindes Road Harrow middlesex HA1 1SL 020 8863 2868 020 8427 2146 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Hazelwood Care Ltd Wayne H. Hughes CRH PC Care Home only 19 Category(ies) of DE Dementia 65 Years and over registration, with number of places St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23/2/05 Brief Description of the Service: St Joseph’s is a privately owned care home for up to 19 older people most of whom have dementia or related conditions. There were no vacancies at the time of this inspection. The home is part of the Hazelwood Care Organization. The home is a conversion of two semi-detached houses that interlink on the ground and first floor. Service user accommodation is on the ground and first floor, with seven bedrooms downstairs including two double rooms. There is accommodation provided on the second floor for three live-in staff. Access to the first floor is by stairs, or chair-lift on the house #40 side. The large lounge and dining area is split into two distinct sections. There is a private garden of a reasonable size to the back of the home. The home is situated close to local shops and transport facilities. There is a small, open forecourt at the front that has some parking facilities. Parking restrictions apply on the road outside the home. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a warm July morning. It lasted seven hours. The inspector met with a number of service users during the visit. Issues were also discussed with staff and the manager, some records were checked, care practices were observed, and much of the home environment was inspected. The home’s manager and service manager were both present throughout most of the inspection. The inspector thanks all at the home for their patience and helpfulness throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: It remains for refresher training to be provided to staff in a number of areas. The manager has however audited staff needs in this respect and made good plans for such training. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 6 Health care records and care plans are both in need of updating and being easily available, so that service users can be appropriately supported by both staff and health care professionals. There needs to be proper availability of staff-call alarm systems and doorlocking systems to those service users who can capably use them. 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. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Prospective service users are not necessarily provided with written information about the home. This prevents them having a fully-informed choice about moving in. The service user guide would also serve as a useful reminder document once moved-in. EVIDENCE: It was previously required for the manager to update the statement of purpose and service user guide. Copies of suitable updates were supplied to the CSCI following the last inspection. They were seen to be available in the entrance hall of the home during this visit. The inspector asked a sample of service users as to whether they have a service user guide or anything else in writing about the home. No-one was able to say that they had. The manager must ensure that these are distributed to service users when moving into the home, and that current service users are provided with a copy if they want one. It is suggested that a record of distribution of such documents is included within each service users’ inventory. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Service users needs are set out in a plan of care. The plans need to be kept more up-to-date, and available for care staff, to ensure that appropriate care continues to be offered to individual service users. The home provides good support to service users in terms of their health and medication needs, acquiring outside professional input where necessary. Service users are generally treated with respect. There was however scope for improvement. EVIDENCE: One service user commented that clothing is looked after very well. This was observed to be the case, with service users wearing well-fitting and individual clothing that is labelled to ensure that it is returned to the owner after washing. The inspector additionally observed no concerns with nail and hair care. It is recommended that the clothing needs and wishes of dependant service users be established and recorded, so that there is clarity about what each service user likes, and can expect, to wear. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 10 The interaction between staff and service users varied. The inspector positively observed staff working in a friendly manner with service users, paying service users attention, and addressing their needs. The inspector also observed staff working in a functional manner with service users that devalued the service user. Specific incidents were discussed with the manager. He and the service manager noted that staff have improved on their interactions with service users and that the atmosphere is generally livelier these days. Management must consider how improvements can be made to how staff interact with service users. The manager explained the actions taken recently to try to address the care needs of some of the more dependent service users. Feedback and records showed that there has been good consultation with external health and social care professionals. There was for instance evidence of pressure care equipment, and of district nurse support, on this visit. Records in support of staff following district nursing advice were also seen. The manager explained that records of external visitors are within each service user’s daily write-ups and within the staff handover book. A summary sheet of health professional input and outcomes is however also required for each service user, for ease of access and monitoring purposes, as the files do not otherwise clearly show what health input across recent months each service user had. The manager consequently forwarded a suitable format to address this issue a couple of weeks after the inspection. The care plans about each service user, which are available to staff within each service user’s daily write-up file, were in many cases out-of-date. Consequently, the accessible information for staff either did not reflect many service users’ current needs, or there were updated plans within lessaccessible files or on the manager’s computer. Individual risk assessments, for such things as falls management and general safety, were similarly out-ofdate. The manager agreed to address this. The plans also need to include appropriate reference to health care and communication (including pain communication and management where applicable). The requirements of the CSCI pharmacy inspector’s last visit were seen to have been generally addressed. These were mainly issues of ensuring sufficient recording and monitoring. The checks of the medication systems on this occasion found the systems to be more secure. The only improvement needed is around the completion of the homely remedy system. It was positively noted that there had been a recent internal audit of medication, from which necessary actions were being taken. This includes refresher training for staff. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Service users receive sufficiently nutritious meals and snacks in a comfortable environment. The routines of the home reasonably allow service users to choose the lifestyle that they wish to have. EVIDENCE: Service users commented that they are free to get up and go to bed when they want. At the start of the inspection, two service users were dressed and in the lounge. The home’s morning routine focussed around helping service users to arise, have breakfast, and in most cases come into the lounge. Some service users read the day’s newspapers. Warm drinks and a biscuit selection were offered to all mid-morning. Following a lunch of fish fingers, chips, and spaghetti in sauce, plus dessert, a large bingo session was held in the dining area. Around half of the service users took part, and the atmosphere for this was involving. One service user commented that the food in the home is wonderful. All service users spoken with commented positively about the food. The menu for the previous week showed that there was a reasonable variety of nutritious meals provided. Sufficient records of the food eaten by service users were being kept. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Service users and their representatives can be confident that any complaints made will be acted on appropriately. EVIDENCE: The manager showed the folder in the entrance hall for receiving complaints. There had been none since the last inspection. One service user reported a complaint to the inspector that they stated had been dealt with by the manager. The manager was however not aware of the complaint, so agreed to look into it following the inspection. He reported an outcome to the inspector a few days later, including key actions that would be taken to prevent a further scenario happening again. The actions are judged as empowering to the service user. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 22, 24 and 26. The environment has been significantly improved since the last inspection, as the lounge and kitchen have had major refurbishment work undertaken. Service users have equipment to maximise their independence, but in some cases care needs to be taken to ensure that it is fully accessible. Service users rooms are otherwise suitably comfortable and appropriate. The home is kept clean and hygienic. EVIDENCE: The kitchen has been almost fully refurbished since the last inspection. It is now pleasant and easier to work in. Health and safety issues due to the poor quality of the old kitchen have been addressed, to everyone’s benefit. The lounge and dining areas have been redecorated, and have had new flooring installed, since the last inspection. This greatly improves on the homeliness and comfort of the service users’ main living area. There was also new garden furniture available for warm days. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 14 There were no concerns about cleanliness during this visit. The laundry area around the side of the house was on this occasion being kept reasonably clean. The room has also been repainted and has new lino flooring. A couple of service users kindly showed the inspector their rooms. Both had reasonable facilities. Both service users spoke positively about their rooms. One of these people however noted that they would benefit from a bolt to their door so as to stop other service users wandering into their room. The manager agreed to attend to this, and a couple of weeks later confirmed that it had been addressed. A review of current service users’ wishes and abilities, about having locks and keys to their doors (overridable by staff in emergencies) and having a locking space (e.g. drawer) in their room, is required. Wire radiator covers remained in place around most radiators of the home. These should be replaced with more homely versions. The staff call-alarm system was heard to work during the visit. It was not available to one service user through being under their bed. The manager noted that a number of these bells need some sort of hook on the wall, so as to hold them in place and make them easily accessible. Such a system was seen to be in place in some bedrooms. The manager must ensure that this is fully addressed. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. Staffing levels at the home are sufficient. The overall skills mix and experience of staff allow service users’ needs to be met. Minor improvements are needed to ensure that staff are appropriately trained for their jobs. EVIDENCE: Service users’ comments about the staff were generally very positive. A couple of service users noted independently that staff will do anything asked of them. The rosters checked indicated that there are four staff on duty in the morning, three in the afternoon, two in the evening, and one between 9pm and 7am. A live-in staff member helps from 5am most nights. This meets the general staffing level requirements agreed for this home. No agency staff were used within the rosters checked on. The manager noted that he has analysed the staff training needs as a whole since the last inspection. He has found that there are gaps in refresher training for some staff. Consequently training courses have been booked, initially for mid-August and again later in the year, in the areas of fire safety, 1st Aid, and moving & handling. This training will include night staff, as is appropriate. The manager noted that almost 50 of the staff team are qualified at NVQ level-2 in care or equivalent. Some of these people have NVQ level-3 or are qualified nurses. Plans showed that the 50 minimum level should soon be reached. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 16 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 35, and 38. Service users benefit from suitable and concerned management approaches. Where the home is involved in their financial interests, these are appropriately looked after. The health and safety of service users and staff is in generally upheld. EVIDENCE: One service user commented that their money is being looked after fine. Another had concerns about its whereabouts. Checks of the money being kept by the home on behalf of service users found that money is being looked after securely for four service users. Records of spending, and receipts thereof, were being suitably kept for each person. The money being held for two people balanced with that recorded. It is recommended that the home acquire a safe for the storage of the money. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 17 One service user commented that management bend over backwards for you. Management processes within the home were generally judged as beneficial overall to service users. Minor health and safety requirements from the last inspection were sent to have been addressed at this visit. The inspector was shown detailed and thorough food hazard analysis assessments. There were a number of health and safety checks being kept with respect to food storage and cooking procedures, which is positive for service users’ health. Fire extinguishers, the fire system, and the emergency lighting were seen to have been professionally checked within the last year. Necessary remedial work was recorded as having been undertaken. The home needs to have a check for portable electrical appliances, to ensure that they remain safe to use. Suitable internal fire tests and drills were recorded as taking place. St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 3 x 2 x 2 x 3 STAFFING Standard No Score 27 3 28 3 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x 3 x x 3 x x 2 St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 19 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 1 Regulation 5 Requirement Timescale for action 15/9/05 2. 7 15 3. 7 15 4. 8 5. 9 17(1)(a) schedule 3 part 3(m) 13(2) The manager must ensure that service user guides are distributed to service users when moving into the home, and that current service users are provided with a copy if they want one. Individial care plans must be 1/9/05 kept up-to-date and easily available to staff and service users. Individual care plans must 1/10/05 include appropriate reference to health care and communication (including pain communication and management where applicable). A summary sheet of health 15/9/05 professional input and outcomes is required for each service user. The manager must complete the process of acquiring GP approval for each homely remedy used in the home. The medication policy must clarify how the homely remedy system in the home is to work. Management must consider how improvements can be made to 1/10/05 6. 10 10(1), 12 15/9/05 Page 20 St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 7. 22 23(2)(n) 8. 24 23(2)(n) 9. 30 18(1)(c) how staff interact with service users. The manager must ensure that 1/10/05 the staff-call alarm system is easily available in all service users bedrooms. A review of current service users’ 1/11/05 wishes and abilities, about having locks and keys to their doors (overridable by staff in emergencies) and having a locking space (e.g. drawer) in their room, is required. Completion of the process of 1/7/05 ensuring that all staff have undertaken statutory training courses is required. (timescales of 1/2/05 and 1/7/05 not met) The home needs to have a 1/11/05 professional check of portable electrical appliances. 10. 38 23(2)(c) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 1 7 Good Practice Recommendations It is suggested that a record of distribution of a service user guide be included within each service users’ inventory. It is recommended that the clothing needs and wishes of dependant service users be established and recorded, so that there is clarity about what each service user likes, and can expect, to wear. Wire radiator covers should be replaced with more homely versions. It is recommended that the home acquire a safe for the storage of service users money. 3. 4. 19 35 St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 4th Floor, Aspect Gate 166 College Road Harrow, Middlessex HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI St Josephs Care Home G62-G11 S38579 St Josephs V241658 290705 Stage 4.doc Version 1.40 Page 22 - 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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