CARE HOMES FOR OLDER PEOPLE
Tower House 10 Tower Road Willesden London NW10 2HP Lead Inspector
Julie Schofield Unannounced Inspection 18th November 2005 11:50 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 Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Tower House Address 10 Tower Road Willesden London NW10 2HP 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 8933 7203 020 8930 3681 Mrs Mary Mundy Mrs Mary Mundy Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Registration is increased to 7 older people requiring personal care. You may only accommodate service users in the bedrooms on the first floor when they have been subject to an assessment by acompetant person representing the service user and nominated by the placing agency. In the case of a service user who is self funding, the assessment must be undertaken by a competent person who is independent of the home, such as an Occupational Therapist, CPN or Care Manager. This assessment must clearly state that the service user is able to ascend and descend the stairs to the ground floor without the assistance of staff. A copy of this assessment must be retained in the home and be available for inspection. Any such assessments held at the home must be subject to regular external review in accordance with the changing needs, abilities or condition of the service user. 4th April 2005 Date of last inspection Brief Description of the Service: Tower House is a care home providing personal care for 7 elderly residents and at the time of the inspection there were no vacancies. The home is situated in a quiet turning behind Willesden Lane and is close to bus routes, Willesden High Road and local underground stations, Dollis Hill and Willesden Green. The proprietor of the home is also the registered manager. The home consists of 2 houses, which have been converted into one property and there is an open plan lounge and dining area on the ground floor with access from both houses. The first floor areas are still separate and each has its own staircase. There are 2 bedrooms on the ground floor and 5 bedrooms on the first floor areas. There is a garden at the front and at the rear of the property. There is off street parking space available for 2 cars. Parking in the street outside the home is restricted to permit holders (and their visitors) or pay and display parking. There is level access, via a portable ramp, to the front of the house. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on a Friday morning in November 2005. It started at 11.50am and finished at 2.50pm. The purpose of the unannounced inspection was to check compliance with the statutory requirements identified during the inspection in April 2005. The manager and deputy manager were on duty during the inspection. The inspector would like to thank the managers, staff and residents who took part in the inspection. Additional visits to the home took place on the 5th and the 14th July 2005. The visit on the 5th July was to check compliance with certain statutory requirements identified during the inspection in April 2005. A letter of serious concerns was sent to the home after this visit in respect of staffing issues. The visit on the 14th July confirmed that the home’s action plan had resolved these issues. What the service does well: What has improved since the last inspection?
Twenty three statutory requirements were identified during the inspection in April 2005. The home has complied with 18 of these. Compliance has included obtaining a copy of the assessment carried out by the placing
Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 6 authority prior to the admission of a resident to the home, having accurate and up to date medication records, offering residents a choice of dish at mealtimes, amending the complaints procedure so that it includes contact details of the CSCI, meeting the requirements made by the LFEPA and the environmental health officer and food hygiene training for staff that prepare and serve food. 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. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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 Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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): 1, 3 Prospective residents and their relatives or carers are able to use the information provided by the home to help them choose a care home which will meet the needs of the resident. Without documentation the home is unable to demonstrate that the manager can give an assurance, before admission, that the home is able to meet the needs of the prospective service user. EVIDENCE: During the last inspection a statutory requirement was identified that the statement of purpose includes the qualifications and experience of the provider/manager and of the staff and that the service users’ guide contains a copy of the most recent inspection report. The statement of purpose has now been amended and the service users’ guide contains a statement that a copy of the most recent inspection report is available on request. A notice to this effect is on display in the entrance hall, adjacent to the visitors’ book. The recommendation that these documents are available in large print has been implemented. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 9 During the last inspection a statutory requirement was identified that during the pre-admission process the manager obtains a copy of the assessment by the placing authority. A statutory requirement was also identified that the manager conducts a pre-admission assessment of the resident to enable them to confirm in writing to the resident that the home is able to meet their needs. A resident had been admitted since the last inspection and the case file was inspected. It contained a copy of the assessment completed by the placing authority. The assessment carried out by the manager had been completed on the day of admission and not prior to the admission to the home. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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): 7, 9 The changing needs of residents are identified and addressed by regular reviews of the care plans and the home must ensure that review meetings take place. Residents are supported by staff to take their medication, at the times directed and in the doses prescribed by their GP, in order to promote their general health and the medication records demonstrate this. EVIDENCE: During the last inspection a statutory requirement was identified that six monthly reviews of the care plan take place and that the resident, their representative(s) and placing authority are invited to attend. The minutes of these meetings are to be kept on file. Three case files were inspected and it was noted that six monthly reviews had not taken place. During the last inspection a statutory requirement was identified that the record of administration of medication to residents is accurate and that the code for “in hospital” is used, when needed. Medication records were inspected and were up to date and complete. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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 the following standard(s): 12, 15 Providing activities both inside and outside the home gives residents the opportunity to enjoy a stimulating and enjoyable lifestyle and the range of activities needs to be increased. Residents are offered a balanced and varied diet and a resident is responsible for recording the daily choices made by each of the residents. EVIDENCE: During the last inspection a statutory requirement was identified that the manager asks residents what activities they would like to take part in and uses this information to draw up a weekly activities programme, which is then implemented. A list of activities was on display on the board. The range of activities is limited and could be expanded. An activities book is used to record these. The book only lists the weekly visits to the day centre. A resident said that they went out shopping and to the bank and that a member of staff accompanied them. During the inspection another resident, who is blind, had asked for someone to read the Bible to them and this was done. All activities taking place inside and outside the home should be recorded in the activities book and the names of residents taking part should also be entered. The home had been decorated for Christmas and looked festive. There were decorations and a Christmas tree. Residents said that it looked very nice and
Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 12 one resident said that they had provided some tapes of carols for the music centre. During the last inspection a statutory requirement was identified that the meal on the menu, which is on display, matches the meal that is being prepared. During the inspection the midday meal was prepared and served. It consisted of corned beef, brown rice and vegetables. There was yoghurt or peaches for dessert. It was not the meal listed on the menu. It is recommended that the manager discuss the content of the menus with residents. During the last inspection a statutory requirement was identified that food is freshly prepared and served immediately. This was complied with. During the last inspection a statutory requirement was identified that residents are offered a choice of dish at lunchtime and are encouraged to exercise choice. One of the residents said that they take a book with them each day and talk to the other residents and record their choice of breakfast and lunch. Each morning the resident attends the morning handover session, at the end, and gives the manager information about the menu choices. During the last inspection a statutory requirement was identified that suitable crockery is provided for residents who have a disability. This has not been complied with. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 13 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): 16 Residents’ rights are promoted and protected by a complaints procedure that informs them of how to contact other agencies, if they are dissatisfied with the home’s response to their concerns. EVIDENCE: During the last inspection a statutory requirement was identified that the complaints procedure refers to the CSCI as the regulatory authority. It was noted that the procedure on display had been amended to incorporate this detail. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 14 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): 19, 25, 26 Residents were satisfied that Tower House is comfortable and “homely” in appearance. Residents had the choice of whether they wished to sit and talk with someone in the lounge or whether they wished to sit quietly on their own. Residents’ safety when using the hot water is protected by systems to prevent the risk of scalding. Residents are able to maintain a smart appearance by their personal clothing being laundered and returned to them promptly. EVIDENCE: The communal areas are decorated and furnished in a “homely” manner and since the last inspection new comfortable seating has been purchased for the lounge. Residents said that the lounge was comfortable and well furnished. There are matching individual chairs and 2 seater settees, giving residents the opportunity to sit and talk with each other, if they wish. There are more seats than residents so the residents can choose to sit in any part of the open plan lounge/conservatory area. A resident said that it could be cold in the early hours of the morning.
Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 15 During the last inspection a statutory requirement was identified that the manager forwards confirmation that pre-set valves have been fitted to prevent the risk of scalding. This related to rooms 5, 7 and 10. A copy of the plumber’s bill for carrying out the work was available. During the last inspection a statutory requirement was identified that the time taken in collecting, washing and returning the clothes of residents is reduced. The manager said that alternatives arrangements have been made that have now produced a quicker turn around time. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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): 27, 29 The rota is an accurate record of all staff caring for the residents. The welfare and safety of residents is promoted and protected through the possession of a CRB disclosure by students on placement in the home. EVIDENCE: During the last inspection a statutory requirement was identified that the names of all staff working in the home and all students on placement are recorded on the rota. The rota was inspected and the names of all staff working in the home were recorded. There were no students on placement in the home. During the last inspection a statutory requirement was identified that confirmation of satisfactory CRB disclosures is obtained from the college for students before their placement commences. Details of satisfactory CRB disclosures for the students on placement in the home at the time of the last inspection were forwarded to the CSCI. There were no students on placement in the home during this inspection. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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): 36, 38 Individual supervision sessions enhance the overall support available to staff and is an opportunity to encourage personal development. Health and safety practices in the home promote a safe environment for both residents and staff although a qualified first aider must be on duty in the home at night. EVIDENCE: During the last inspection a statutory requirement was identified that individual supervision sessions take place with members of staff, at least 6 times per year, and that these are recorded. The manager said that a system of supervision had been put into practice and supervision records were inspected. The first sessions had taken place in September 2005. During the last inspection a statutory requirement was identified that the home has a health and safety policy. This was available for inspection. During the
Tower House DS0000035842.V258338.R01.S.doc Version 5.0 Page 18 last inspection a statutory requirement was identified that a copy of the Landlords Gas Safety Record is available for inspection. It was dated 6th June 2005. During the last inspection a statutory requirement was identified that the manager complies with the requirements identified by the environmental health officer and the LFEPA in their reports. There was a letter from the LFEPA dated 22nd June 2005, which confirmed that arrangements in the home were now satisfactory. It was noted that the home had implemented the recommendations made by the environmental health officer. During the last inspection a statutory requirement was identified that there is a qualified first aider on duty in the home at all times. Although this issue has been addressed during the day the night staff have not undertaken the training. During the last inspection a statutory requirement was identified that all staff involved in the preparation and serving of food to residents have undertaken food hygiene training. This has been addressed. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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 3 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X 3 X 2 Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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 OP3 Regulation 14.1 Requirement That the manager conducts a pre-admission assessment of the service user to enable them to confirm in writing to the prospective service user that the home is able to meet their needs. (Previous timescale of 01 June 2005 has not been met). That six monthly reviews of the care plan take place and that the service user, their representative(s) and placing authority are invited to attend. That the minutes of the review meeting are kept on the case file. (Previous timescale of 01 July 2005 has not been met). That the range of activities provided for residents, both inside and outside the home, is increased. That the menu on display matches the meals that are prepared. (Previous timescale of 01 June 2005 has not been met). That suitable crockery is provided for residents who have a disability. (Previous timescale of 01 June 2005 has not been
DS0000035842.V258338.R01.S.doc Timescale for action 01/01/06 2 OP7 15.2 01/01/06 3 OP12 16.2 01/01/06 4 OP15 12.4 01/01/06 5 OP15 23.2 01/01/06 Tower House Version 5.0 Page 21 6 OP19 23.2 7 OP38 13.4 met). That the temperature of the home in the early hours of the morning is monitored to ensure that heating levels do not fall below a safe level. That there is a qualified first aider on duty in the home at all times. (Previous timescale of 01 August 2005 has not been met). 06/12/05 01/08/05 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 OP12 OP15 Good Practice Recommendations That the activities record book records all activities taking place inside and outside the home and lists the names of residents taking part. That the manager discusses the content of menus with residents and amends the rotas accordingly. Tower House DS0000035842.V258338.R01.S.doc Version 5.0 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
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