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Inspection on 18/01/06 for Stanmore Residential Home

Also see our care home review for Stanmore Residential Home for more information

This inspection was carried out on 18th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The care home has a very welcoming atmosphere. Residents live in a homely environment. Residents and a visitor were very positive about the service provided by the care home. Residents are supported in maintaining relationships with their families and friends. Residents are supported by staff to make life choices and to develop their independence. Residents are supported by a well trained and competent staff team who demonstrated knowledge, and understanding of the resident`s needs, and who were judged to have a particularly caring manner. Several residents confirmed this. The care home is active in regard to understanding and meeting the cultural needs of the residents.

What has improved since the last inspection?

There has been a consistent quality service provided since the previous inspection. All requirements except for one have been met since the last inspection.

CARE HOMES FOR OLDER PEOPLE Stanmore Residential Home 2-4 Jersey Avenue Stanmore Middlesex HA7 2JQ Lead Inspector Judith Brindle Unannounced Inspection 18th January 2006 09:00 X10015.doc Version 1.40 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 Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 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 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. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Stanmore Residential Home Address 2-4 Jersey Avenue Stanmore Middlesex HA7 2JQ 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) 020 8907 4636 020 8933 2051 Mr Nalin Joshi Mrs Anila Joshi Ms Carol Sweeney Care Home 18 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (17) of places Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Temporary variation agreed for one named individual DT aged 73 years to receive Dementia care for the duration of her stay. 19th October 2004 Date of last inspection Brief Description of the Service: Stanmore Residential Home is a care home providing care, and accommodation for 18 older persons. Mr and Mrs Joshi own the care home. The home is located in a quiet residential road, a few minutes drive from Stanmore, within the residential area of Belmont. The home is close to a variety of local shops, restaurants, banks, and parks. Local public transport includes bus services. Stanmore and Harrow Wealdstone underground train stations are located within a short drive from the home. The home was opened in 1988, and consists of a detached two-story building. There is parking for several cars on the forecourt. There are four rooms that are shared, and ten bedrooms that are single. There are no bedrooms with en-suite facilities. There is a passenger lift. The home has a large enclosed, and well-maintained garden to the rear that is easily accessible Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place throughout 4.5 hours during a day in January 2006. There were no vacancies at the time of the inspection. The inspector was pleased to meet and talk with several residents, also spoke with four care staff, and a visitor. Staff were very helpful during the inspection, and supplied all documentation, and information requested by the inspector. The registered manager was on duty during the inspection, and a provider was present for part of the inspection. During the inspection the registered manager informed the inspector that a condition of registration in regard to a named resident was no longer applicable, as this resident was now resident in another care home. Following the unannounced inspection the Commission for Social Care Inspection removed this condition from the registration, and supplied a new registration certificate to the care home. The inspection focussed on spending time talking with residents, and observing interaction between residents and staff, and with other residents. Assessment as to whether the requirements from the previous inspection had been met also took place during the inspection. Documentation inspected included, resident’s care plans, residents’ financial records, and some policies and procedures. A partial tour of the premises took place. 14 National Minimum Standards for adults were inspected during this inspection. Commission for Social Care Inspection feedback/comment cards for residents, relatives and significant others in regard to their views of the service were given to the staff member for distribution during the unannounced inspection. Three feedback cards from relatives, and one from a resident were received by the Commission following the unannounced inspection. All were positive about the service provided. What the service does well: The care home has a very welcoming atmosphere. Residents live in a homely environment. Residents and a visitor were very positive about the service provided by the care home. Residents are supported in maintaining relationships with their families and friends. Residents are supported by staff to make life choices and to develop their independence. Residents are supported by a well trained and competent staff team who demonstrated knowledge, and understanding of the resident’s needs, and who were judged to have a particularly caring manner. Several residents confirmed this. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 6 The care home is active in regard to understanding and meeting the cultural needs of the residents. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 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 the following standard(s): Standard 1 and 3 Arrangements are in place to ensure that prospective residents (and their relatives/significant others) can access information about the service provided. Arrangements are in place to ensure that residents receive an assessment of their needs prior to moving into the care home. EVIDENCE: The statement of purpose, and service user guide documentation were available for inspection. There was evidence that the statement of purpose had recently been reviewed, and that up to date information in regard to the service provided by the care home, was included in this text. The statement of purpose should be dated following being reviewed. The service user guide contained required information about the service. This document should show evidence of having been recently reviewed. The inspection report attached to the service user guide was dated 2003. There needs to be a recent inspection report included in the service user guide documentation. The registered manager reported that both documents were accessible to prospective residents, residents, and others. Two comment cards received following the inspection confirmed this. One feedback form left the Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 9 question relating to this blank. The registered person should ensure that all relatives/significant others are aware of how to access a copy of inspection reports. The admission procedure is recorded in the statement of purpose documentation. The manager confirmed that all prospective residents are assessed by her and/or the provider, and that assessment of prospective resident’s (who are not self funding) needs are also completed by the purchasing authority during the referral process. The registered manager informed the inspector of several examples of her having assessed prospective residents needs, and demonstrated the importance of this assessment. The four care plans inspected recorded evidence of comprehensive assessment of individual residents needs. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 10 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 the following standard(s): Standard 7 and 10 Arrangements are in place to ensure that all residents have a recorded plan of care. Residents are treated with respect, and their right to privacy upheld. EVIDENCE: Four care plans were inspected. These included recorded evidence of assessment of each resident’s needs, and of the staff action to meet those needs. The registered person should further develop some of this staff guidance to ensure that there is clarity, and consistency in regard to meeting resident’s varied needs, which include behaviours from resident’s that might challenge the service. This was discussed with the registered manager. The care plans included evidence of risk assessment in regard to risk of pressure sores, and of risk of residents falling. Records confirmed that care plans were reviewed monthly. Staff were observed to respect resident’s dignity, and privacy during the unannounced inspection. There is a telephone that is accessible to residents. The registered manager informed the inspector that residents receive mail unopened, but that some residents do need support from staff to open their post. It is recommended Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 11 that if residents require support in regard to opening mail, that this is agreed by the resident, and is recorded in their care plan. A resident who kindly spoke to the inspector confirmed that she wore her own clothes at all times. Resident’s preferred name should be recorded in their care plans. It was evident during the inspection that medical assessment/consultation takes place in the individual resident’s bedrooms. Appropriate screening was observed to be provided in shared bedrooms. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 12 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 the following standard(s): Standard 13, 14 and 15 Arrangements are in place to ensure that residents are able to have unrestricted contact with family and friends. Resident’s are supported, and encouraged to make choices. Meals provided are varied and wholesome. EVIDENCE: The home has a visitor’s policy. The registered manager reported that there was times of visiting residents were not restricted. A visitor confirmed that there was open visiting within the care home. The registered manager, residents, and observation during a previous inspection confirmed that residents could receive visitors in private. A visitor and recorded comment/feedback cards from three visitors confirmed that they were kept informed of important matters affecting their relative/friend. The registered manager confirmed that residents could bring personal possessions with them when moving into the care home. There was evidence that in bedrooms inspected that residents had a variety of personal possessions. The inspector was informed that all residents have their finances managed by their relatives/significant others. A menu was displayed. This recorded varied, and wholesome meals. The lunch provided on the day of the inspection was different to the meal recorded Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 13 on the menu. The registered provider informed the inspector that some meals are chosen with the residents on a daily basis, and that this is recorded on the notice board in the communal area. It should be recorded on the menu that meals are sometimes chosen on a daily basis. The lunch on the day of the unannounced inspection was recorded on the communal notice board. A resident was provided with a lunch of her particular choice, during the inspection. Several hot and cold drinks and biscuits were provided throughout the inspection to the residents. The specific cultural dietary needs of residents are met by the service. This was demonstrated during the inspection. The provider reported that she brings food in for the Asian residents on a daily basis. These residents kindly spoke with the inspector and confirmed that they enjoyed these meals. Staff were observed to assist some residents with their meal. This assistance was provided in a sensitive manner. Lunch during the inspection was unhurried. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 14 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 the following standard(s): Standard 18 Arrangements are in place to ensure that residents are protected from abuse. EVIDENCE: The care home has an adult protection policy. The whistle blowing policy was displayed. The care home had the some local authority protection of vulnerable adults guidance available for inspection. The registered manager was unable to access the more comprehensive Harrow Local Authority protection of vulnerable adults guidance. The registered person should obtain this documentation. The registered provider confirmed that all staff receive abuse awareness training during their induction programme. Two staff that spoke with the inspector confirmed that they had knowledge, and understanding of the reporting procedures in regard to allegations of abuse. The inspector discussed staff training in regard to abuse awareness, and supplied information to the registered manager in regard to accessing appropriate training for staff. The home has a policy in regard to gifts, gratuities, and bequests to staff by service users. The home also has a handling of service users monies policy. Resident’s monies were kept securely. A sample of records, and balances (of three resident’s monies) were inspected and were accurate (see Standard 35). Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 15 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 the following standard(s): Standard 19 and 26 Arrangements are in place to ensure that residents live in a safe, wellmaintained environment. The care home is clean. EVIDENCE: The inspection included a partial tour of the premises. The care home is generally well maintained, and there are ‘homely’ features. The registered manager informed the inspector of some minor maintenance issues that were being attended too. The garden is accessible, and maintained. The premises was clean, warm and odour free during the inspection. The home employs a domestic staff member part time. She was on duty during the unannounced inspection. Laundry facilities are located away from food storage and food preparation areas. The registered manager reported that all the staff had recently completed an infection control course. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 16 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27 Arrangements are in place to ensure that staffing numbers and skills meet the needs of the residents in the care home. EVIDENCE: The staff rota was available for inspection. There were four care staff and the registered manager on duty during the inspection. The manager provided practical support and assistance to residents in regard to meeting their personal care (and other needs) needs during the inspection. Staff who kindly spoke with the inspector had knowledge and understanding of their role in meeting the varied needs of residents living within the care home. All the staff spoke of having worked in the care home several years and of knowing each resident well. Staff were observed to be very respectful and kind to residents during the inspection. Staff informed the inspector of their key working role. Several residents spoke very positively of the staff. Staff who kindly spoke with the inspector reported that they spoke a variety of Asian languages as well as English so were able to meet all the residents language/communication needs. Comment/feedback cards received from three relatives confirmed that they thought that there was sufficient numbers of staff on duty. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 17 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 33, 35, and 38 (partially) There need to be arrangements are in place to ensure that there is comprehensive monitoring, and review of the quality of the service provided by the care home Arrangements are in place to ensure that resident’s financial interests, which are managed by the care home, are safeguarded. EVIDENCE: There needs to be further development in regard to ensuring that the care home has effective quality assurance, and quality monitoring systems in place. This should include an annual development plan in regard to the service provided. The registered person needs to supply to the Commission for Social Care Inspection a report in respect of any review of the service conducted by her. This was a previous requirement. There was evidence that records including care plans, some policies, and environmental maintenance issues are regularly reviewed. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 18 The care home has a policy/procedure in regard to the handling of resident’s money. The registered manager reported that resident’s relatives (significant others) support residents in the management of their finances. The home handles generally small amounts of resident’s cash, for the purchase of toiletries, clothes, and hairdressing. Three residents financial records and balances were inspected. These were up to date and correct. Receipts were available for inspection. There was evidence that a previous requirement had been met in regard to the installation of an appropriate door closure for a resident to enable her to keep her bedroom door open during the day. The registered person should ensure that she continues to regularly review the issue of doors possibly being ‘propped’ open within the care home, and that advice is sought from the local fire service in regard to appropriate and safe methods/mechanisms, which allow doors to be open without risk to individuals. Fire safety equipment had recently been serviced. Required fire safety checks had been recorded as having been carried out. There was one recorded fire drill/training session carried out in 2005. There needs to be evidence that fire drills take place more frequently (at least twice a year) to ensure that all staff, and so far as practicable residents are aware of the fire procedure to be followed in case of fire. The certificate of employers liability insurance was displayed and up to date. Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 19 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5 Requirement Timescale for action 01/04/06 2. OP33 24(1)(2)( 3) 3 OP38 23(4) There needs to be a recent inspection report included in the service user guide documentation. • The registered person shall 01/04/06 establish and maintain a system for reviewing, (with the service user and their representatives involvement) the service at appropriate intervals, and improving the quality of care provided at the care home. • The registered person shall supply the Commission a report in regard to quality assurance i.e. an annual development plan for the home. Previous timescale not met. There needs to be evidence that 01/04/06 fire drills take place more frequently (at least twice a year) to ensure that all staff, and so far as practicable, residents are aware of the fire procedure to be followed in case of fire. DS0000017560.V258204.R01.S.doc Version 5.1 Stanmore Residential Home Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The statement of purpose should be dated following review. • The service user guide should record evidence of having been reviewed. • The registered person should ensure that all relatives/significant others are aware of how to access a copy of inspection reports. The registered person should further develop the staff guidance in the care plans to ensure that there is clarity and consistency in regard to meeting resident’s varied needs. • It is recommended that if residents require support in regard to opening mail, that this is agreed by the resident and recorded in their care plan. The resident’s preferred name should be recorded in the care plans. It should be recorded on the menu that meals are sometimes chosen on a daily basis. The registered person should obtain the comprehensive Harrow Protection of Vulnerable Adults documentation. An annual development plan in regard to the service should be actioned by the registered person. The registered person should ensure that she regularly reviews the issue of doors possibly being ‘propped’ open within the care home. • • 2. OP7 3. OP10 4 5 6 7 OP15 OP23 OP33 OP38 Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Stanmore Residential Home DS0000017560.V258204.R01.S.doc Version 5.1 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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