Inspection on 28/08/07 for Tower House

This inspection was carried out on 28th August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tower House 28/07/08

Tower House 22/06/06

Tower House 18/11/05

Tower House 04/04/05

Tower House 10/11/04

Tower House 19/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Tower House 9-10 Tower Road Willesden London NW10 2HP Lead Inspector Judith Brindle Key Unannounced Inspection 28th August 2007 09:20 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.V342945.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 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.V342945.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House Address 9-10 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.V342945.R01.S.doc Version 5.2 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 a competent 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. 22nd June 2006 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 was one vacancy. The home is situated in a quiet residential area close to the varied amenities of Willesden Green, and to transport facilities, which include bus services, and the local underground stations of Dollis Hill and Willesden Green. The proprietor of the home is also the registered manager. The home consists of two houses, which have been converted into one property. 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 two bedrooms on the ground floor and five bedrooms on the first floor areas. Four bedrooms have ensuite facilities. 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. Information about the service is recorded within the statement of purpose and the service user guide documentation, which is accessible in the care home. Information about the range of fees can be obtained from the provider/registered manager, and is recorded in the service user guide documentation, and in the contract/terms and conditions of people using the service. Tower House DS0000035842.V342945.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 August 2007. There was one vacancy at the time of the inspection. The inspector was pleased to meet and talk with the people living in the home, and with staff on duty. Staff were very helpful during the inspection, and supplied all documentation, and information requested by the inspector. The inspector also spoke with a visitor during the inspection. The registered manager/provider was present during the inspection. The inspection focussed on spending time talking with people living in the care home, and observing interaction between residents and staff. Documentation inspected included, resident’s care plans, risk assessments, staff training records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements from the previous random inspection that took place in January 2007 had been met also took place during the inspection. 26 National Minimum Standards for adults, including Key Standards, were inspected during this inspection. The registered manager/provider gave me a completed Annual Quality Assurance Assessment (AQAA) document during the inspection, which includes required information from the owner about the quality of the care home and the plans to improve the service. Reference to some aspects of this AQAA record will be documented in this report. The inspector thanks all the people living in the care home, visitors and the staff for their assistance in the inspection process. What the service does well: The care home has a very welcoming atmosphere. Residents live in a homely environment. People using the service were positive about the care home and staff, and confirmed that they were happy living in the home. It is evident that the manager works hard to provide a quality service to people living in the care home, and has plans to continue to improve and develop this service. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 6 Staff spoke of there being good team work carried out in the home, and that it is a ‘happy’ place to work in. Residents’ contact with relatives and others (as agreed by the residents) is fully supported and enabled by the care home. A caring, and supportive staff team demonstrate knowledge, and understanding of the varied needs of people living in the care home. The home has a large well maintained garden. Residents spoke of enjoying this facility. Meals are varied and wholesome, and meet the cultural needs of people using the service. What has improved since the last inspection? What they could do better: There could be improvement in the format of documentation within the care home to improve its accessibility to people using the service. It could be more evident that people using the service are fully involved in the development, and review of their care plans, and that these care plans are ‘person centred’ working documents. Activities for people using the service could be further developed and improved. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 7 Staff need to have 1-1 supervision at least every two months as a minimum, and staff training including ‘refresher’ statutory training could be further developed. Risk assessments could be more comprehensive and record evidence of being regularly reviewed. 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. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 8 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.V342945.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,2 and 3 (6 is not applicable) 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 prospective service users to have the information that they need to make an informed choice about where to live, but some documentation needs to be further developed. People using the service have a written contract/statement of terms of conditions, which could be signed by them. Arrangements are in place to ensure that residents have their needs assessed prior to moving into the care home. EVIDENCE: The statement of purpose, and service user guide documentation includes information about the service provided by the care home. The service user guide is dated 2005, and the statement of purpose (a copy was included in each care plan inspected) was not dated. Both should show evidence of recent Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 10 review. The format of the service user guide could be developed to improve its accessibility to those residents who have difficulty (due to their varied needs) in reading. The format of the service user guide could include pictures, but there should also be a format that makes the information accessible to people using the service who have visual sensory needs. Copies of the service user guide documentation were observed to be located in residents, bedrooms. At the time of the inspection a person was receiving temporary day care. The statement of purpose needs to be updated to include information in regard to the provision of a respite day care service. Contracts/terms and conditions were recorded in the care plans inspected and included the fees charged, and costs not covered by the fees. These documents were not signed by the resident (or significant other, if applicable). Placement agreements from the Local Authority were located in care plans inspected. The care home has an admission policy/procedure, which is documented in the statement of purpose. The manager confirmed that she carries out an initial assessment of the needs of prospective residents. Records confirmed that this includes assessment of physical needs, personal care needs, health needs and social needs. There could be more evidence of initial assessment of cultural and religious needs. There was some indication of the residents having been involved in the assessment process, but this assessment information should include a record of their signature (if able to sign) and/or their relative/significant others signature. Staff confirmed that visits to the home by prospective residents is encouraged, and that there is a one month ‘trial’/settling in period. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 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. Each person using the service has a plan of care, but these could be further developed to improve their accessibility, and to indicate residents’ full involvement in their care plans. Arrangements are in place to ensure that resident’s individual personal and healthcare needs are met, but there could be further development in staff guidance to meet some specialist health needs. Arrangements are in place to ensure that the residents are respected and their right to privacy upheld. Medication is stored and administered safely. EVIDENCE: All the people using the service have a plan of care, which is kept in their bedroom. This is positive. Staff who spoke with me were aware of the care plans and confirmed that they have read them. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 12 Three care plans were inspected, including a care plan of a resident who had been recently admitted to the care home. These care plans all included recorded evidence of assessment of residents’ needs, including preferred name, personal care needs, health needs, and physical care needs. Information about each assessed need, and staff guidance to meet these needs was documented. This was required from the previous random inspection of the care home, which took place in January 2007. The care plans are generally more focused on physical needs, than social, and diversity needs (including sexuality needs, cultural and spiritual/religious needs). The AQAA information supplied to the Commission recorded some plans for promoting equality and diversity, and for developing and improving activities for residents within the service. A significant number of the ‘headings’ of documentation used in the home recorded ‘nursing’, such as ‘nursing assessment form’. The care home is a residential care home, and references to nursing (apart from documentation completed by a community nurse or other) should be removed from the care plans. 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 (as recommended Standard 3). Though there was some evidence that care plans are reviewed on a monthly basis, the care plans could show more evidence of having the content of the individual recorded identified care and support needs of each resident reviewed and updated more comprehensively. For example it was recorded in a resident’s care plan that they had a ‘normal’ sleep pattern, but the daily records indicated that this person was not presently sleeping well. Records confirmed that a resident recently admitted to the home had participated in a comprehensive review of his/her needs and had confirmed that he/she was very happy living in the care home. A Care Manager and the resident’s family member also were involved in this process of review. Daily records of resident’s progress were generally documented though there were some gaps in recording, and the content of these records could be improved. There was not always evidence that changes in resident’s needs that were recorded in the daily records then led to the care relevant plan being updated and reviewed. An example of this was a resident’s episodes of ‘challenging’ behaviour though recorded in the daily records had not been updated in the care plan assessment/needs documentation. This was discussed with the manager. Records confirmed that a resident had had advice from a tissue viability nurse, and community nurse and the care plan had been updated in regards to ensuring that this resident had her position changed two hourly, but it was not evident that the date, time and position change was being recorded. This was discussed with a senior staff member, who reported that a record chart would Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 13 be put in place promptly, and that a comprehensive review of this resident’s needs was planned, with participation from health and social care professionals and relatives. There was some evidence of risk assessment, with recorded staff guidance to ensure that these assessed needs are met, but the content of these and the review of them were varied. Some residents had risk assessment, which included risk of falls, risk of wandering and nutrition risk assessment, but not all. The registered person needs to ensure each person using the service has a comprehensive risk assessment (which includes procedures to minimise the development of pressure sores, and nutritional assessment, management of challenging behaviour, road safety, and bathing risk assessment and other activities such as gardening which residents might choose to participate in), and in which any limitations on freedom are understood and agreed by each person using the service. That these be regularly reviewed, to ensure that risks are managed positively to help residents lead the life that they want. All risk assessments that are already in place need to record evidence of having been reviewed regularly. From speaking to residents, staff, and inspection of records it was evident that people living in the home are having the support and care they need to meet their personal care needs. Health needs are monitored and appropriate intervention taken. Records confirmed that residents have access to care and treatment from a variety of healthcare professionals. These include GP appointments, optician, dentist, chiropody care and treatment. Residents as needed, access additional specialist support and advice (a resident, at the time of the inspection was receiving care from a community nurse). Records and residents confirmed that they attend hospital appointments. Residents’ weight is monitored. People using the service spoke of making choices, one person spoke of having choice in what they wanted to wear, and of what time they wished to go to bed. Another resident said that she could choose the television programme that she wished to watch. Staff spoke of being a key worker to certain residents, and informed me of this particular role. The care home has a medication policy/procedure. The medication storage and administration systems were inspected. Medication is stored securely. Photographs of each resident are attached to the medication administration recording charts. The registered manager reported that staff receive training, and assessment to ensure their competency prior to them administrating medication to people using the service. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 12,13 14 and 15 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 to ensure that residents have the opportunity to participate in some activities, but there needs to be further development in the provision of daytime activities. The visiting arrangements are flexible and meet the needs of visitors and residents, so that residents have the opportunity to develop and maintain important relationships. Residents are supported to make choices. Meals provided are varied and nutritious. The menu could be more accessible to people using the service. EVIDENCE: The care plans briefly documented some residents preferences in regard to leisure pursuits, for example he/she ‘loves singing’, but there was not a record of how this need and the social needs of others were to be met. The daily life, social, religious, cultural needs need to be comprehensively assessed (with full involvement of the people using the service), and guidance recorded to ensure that individual goals and identified individual needs are reviewed and met. The Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 15 registered person should develop and improve the opportunities for residents to participate in a variety of preferred activities. Records confirmed that people living in the home participated in some activities. A resident spoke of enjoying reading the newspaper, another spoke of enjoying some programmes on television, and of participating in the community on occasions. A person using the service spoke of enjoying the garden facility and of sometimes helping with the garden. The garden facility is shared with another care home, which has the same owner. I was shown the variety of different vegetables and flowers, which have been grown by residents and staff. Apart from watching television and spending some periods of time in the garden there were not many activities taking place during the inspection. A person using the service informed me that she/he would like to do some puzzles. The manager was informed of this request and confirmed that she would take action to make sure that this was arranged. The AQAA information recorded that there were plans to approach the local library to regularly bring books for people using the service to borrow, and to appoint an activities co-ordinator. This could be positive for the people using the service. The registered manager/owner reported that people who live in the home are free to practice their faith. I was informed that the representatives from the Roman Catholic Church and the Pentecostal Church visit the care home regularly. The manager reported that a resident attends a place of worship several times a month. The service user guide record includes information in regard to how the care home staff will support people using the service to practise their religion, which includes all faiths. The visitor’s record book indicated that people regularly visited the home. People who use the service have the opportunity to develop and maintain personal and family relationships. The service user guide indicates that visitors are made welcome in the home. A visitor confirmed this, and spoke positively about the care received by her relative. Information recorded in the service user guide records that friends and family can join the person using the service for a meal in the home if they so wish. The registered person does not impose restrictions on visits (unless requested by the resident concerned). A resident spoke of the visitors that he/she had had. People using the service were observed to interact positively with each other during the inspection. Information about resident’s family/friends contacts and personal profiles could be developed and recorded in the individual plan of care. The home has a pay phone, which people using the service can use. I was informed that a cook was employed on a part time basis and that staff, including the manager cook meals on days when the cook is not on duty. The manager confirmed that all staff that carry out cooking duties have an appropriate food and hygiene qualification. The home has a menu, but this was not displayed, and one resident who kindly spoke with me said that she/he Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 16 was not aware of what was for lunch. The menu recorded varied and wholesome meals. The registered person could improve the format of the menu to ensure that it is more accessible to people using the service. This was agreed by the manager. I was informed that residents choose meals often on a daily basis. Residents spoke of enjoying the meals provided. This included the lunch provided during the inspection. Condiments were provided during the meal to residents, and lunch was unhurried. Food eaten is generally documented, but there were some gaps in this recording. Drinks were regularly provided to residents during the inspection. A resident reported that the food provided in the care home meets his cultural needs, and that he particularly enjoyed chicken with rice and peas. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 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 ensuring that complaints are taken seriously and handled objectively. The format of the complaints procedure could be developed to improve its accessibility to people using the service. Arrangements are in place to ensure that service users are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints policy. This is in written format, displayed in the home, and recorded in the service user guide documentation. The registered person could develop the format (such as pictorial, and/or in a verbal recording and also in Braille) of the complaints procedure to ensure that it is accessible as possible to all the people using the service, including those who have difficulty in reading, and those who have a visual disability. Residents who kindly spoke to me were aware of how to make a complaint, and said that they would talk to the manager if they had a concern or complaint. No complaints had been recorded since 2005. The manager said that she regularly asks the people using the service if they have any concerns/complaints. There is also a suggestion box located in the communal area. The AQAA information supplied to the Commission, informed me that staff would be receiving training in regard to understanding the complaints procedure and in responding and recording complaints. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 18 The home has a protection of vulnerable adults policy, and a counter bullying policy. There is also an accessible recorded Local Authority protocol in regard to safeguarding adults. Staff who spoke with the inspector were knowledgeable of the reporting and recording procedures in regard to an allegation or suspicion of abuse. Records confirmed that some staff had received protection of vulnerable adults training, but not all. The manager reported that this training was planned to be carried out within a few days following the inspection. This is positive. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 19, 23 and 26 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, homely, clean and comfortable. The premises are suitable for the care home’s stated purpose. Residents bedrooms are individually personalised, meet their individual needs. The care home is clean, and odour free. EVIDENCE: The home is located in a quiet residential road in Willesden Green, within a few minutes walk from public bus and train services. There is off street parking for two cars at the front of the care home. The living environment is very clean, homely and generally well maintained. Pictures of people using the service are displayed. People living in the home, who kindly spoke to me, confirmed that the environment is agreeable, and meets their needs. Handrails are located in communal areas. The home has Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 20 been redecorated in several areas since the last inspection. This has significantly improved the environment in making it seem brighter, cleaner and more attractive. The manager spoke of further plans for redecoration of other areas of the care home. This is positive, and commendable. Bedroom doors have been painted in a different colour from the walls, and have had pictures, and the resident’s names on them to aid orientation for people using the service. This is positive. There are several communal areas in the home where people using the service can sit if they wish to have ‘quiet time’ away from the main communal areas and bedrooms of the care home. The garden is a very attractive, and a well developed facility. It was evident that staff and residents have worked hard to develop and improve it. Bedrooms are personalised. Pictures, photographs and ornaments were among the items located in resident’s rooms. The manager spoke of residents being able to bring to the care home their own furniture if they wish. People using the service spoke of liking their bedrooms. The care home has an infection control policy/procedure. The home is clean and odour free. Soap and hand towels were located in the bathrooms/toilets inspected. A part time domestic member of staff is employed in the care home. A senior staff member reported that most of the laundering of clothes, including bed linen and residents clothes is done by an outside company, but that there is an accessible washing machine that is used for the laundering of some items of clothing. Staff were observed to wear protective clothing, such as disposable gloves as and when needed. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27,28 29 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. Staff receive some training to ensure that they are competent and skilled in regard to carrying out their roles and responsibilities, but staff training could be further developed. Sufficient numbers and skill mix of staff are employed to meet 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 procedure. EVIDENCE: The staff rota was available. There are generally three to four staff on duty during the day, and two at night. There were judged to be sufficient staff on duty during the inspection. The manager and three care staff were on duty. Records confirmed that staff work ‘long days’ but the number of these shifts were not more than four a week. The rota should record a ‘key’ in regard to the hours that the shifts consist of. This was a previous recommendation. Some staff work in both care homes owned by the manager/provider. Comments from residents were positive about the staff that were described as caring and supportive. Staff were observed to interact with residents in a respectful, and sensitive manner during the inspection. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 22 Records confirmed that a staff meeting about the care home had recently taken place. Staff who spoke with me confirmed that they were pleased to be working in the home, and that the staff team was a were a ‘happy team’. The home has a recruitment and selection policy/procedure. Five staff personnel files were inspected. This documentation included evidence that required and appropriate recruitment procedures had been carried out. The AQAA information supplied to the Commission recorded that the care home involves people using the service in the recruitment and selection process by listening to their views of prospective staff. Records and staff confirmed that two staff have achieved an NVQ level 2 care qualification. The manager reported that a staff member was planning to be enrolled for this NVQ level 2 course. The registered manager/person should ensure that all care staff have the opportunity to achieve this NVQ level 2 care qualification. The manager reported that two staff were in the process of completing the Registered Manager’s Award qualification. The manager, and staff confirmed that they received an induction programme, which is linked to the Skills for Care (training organisation for staff working in the care sector) induction standards. A completed induction record and Foundation in Care qualification certificates were available for inspection. The staff induction programme includes code of conduct, confidentiality, the rights of Service Users, health and safety, food and hygiene safety, support workers responsibilities, complaints and whistle blowing, and ‘abuse’ policies and procedures. Records and staff confirmed that some staff training takes place, but the amount and frequency of ‘refresher’ training is variable. This training includes some statutory training such as fire training, manual handling training, basic 1st Aid training and food and hygiene training. A staff member reported that she had received all appropriate statutory during her NVQ care course. This training, including manual handling training, protection of vulnerable adults training, food and hygiene training, fire training, health and safety training and 1st Aid training, another staff member spoke of having received suitable statutory training. The manager said that ‘refresher’ staff training was planned for all staff to take place in September 2007. There needs to be evidence that all staff have up to date training (including training to meet particular needs of people using the service such as dementia care needs and behavioural needs) to ensure that staff have a balance of all the skills, knowledge and experience to meet the needs of people using the service. The AQAA information supplied to the Commission included a record of plans to ensure that each staff member has an individual training record. This should be actioned by the registered person. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31,33,35, 36, 37 and 38 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 registered manager/provider is qualified, competent and experienced to run 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/provider has managed the care home for four years. She has completed an NVQ level 4 management course. She is a registered Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 24 nurse. She has completed a ‘mentoring’ course, and is currently in the process of completing an assessors training course. She confirmed that she ensures that she updates her knowledge and skills. The staff who spoke with the inspector and records inspected confirmed that there are clear lines of accountability within the home. The manager has a ‘hands on’ approach, and works a variety of shifts in the care home. It was evident that the manager has a good understanding of the needs of the residents and that they know her well. Residents and a visitor who kindly spoke with me were positive of the manager. Staff confirmed that the manager was very approachable and supportive. The care home has a quality audit policy. In June 2007, the registered manager/owner supplied the Commission for Social Care Inspection with a copy of an Annual Performance plan in regard to the quality of the service provided by the care home (and for No 11 Tower House), and plans for improving the service. Records confirmed that records were generally reviewed regularly, and that maintenance safety checks are carried out. Completed questionnaires from residents about their views of the service were available for inspection but these were not dated. A copy of the residents’ and the relatives/significant others, questionnaires were accessible amongst the service user guide documentation. I was informed that this year further views of the service would be obtained from other stakeholders. This should be actioned. AQAA information supplied to the Commission recorded that residents meetings take place, and that there were several plans to improve and develop the service in response to listening to the views of those who use the service. One of these planned changes is to provide a newsletter for residents and other stakeholders. The home has accessible and appropriate policies and procedures. A senior staff member confirmed that there is monitoring to ensure that staff follow procedures. The Commission for Social Care Inspection report is accessible in the home and a sign was displayed, which informed visitors of how to access this report. The manager reported that she did not manage resident’s finances and that relatives or significant others or the residents themselves managed their financial affairs. 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 11 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 manager. Record keeping has generally improved but there could be further improvement. Policies and procedures should be numbered so that they are easily accessible. A record could be maintained of the staff names when they have read and/or been informed of the content of a policy/procedure. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 25 Documentation should always be dated and signed by the person completing those records. The care home has appropriate accessible health and safety policies/procedures. The required health and safety poster was displayed. A record of a health and safety audit was available for inspection but was not dated. Daily safety checks are carried out by staff. Recent gas safety checks had been carried out. There was not an available record of an electrical installation check available for inspection, but records confirmed that this was up to date at the time of the previous random inspection. A fire risk assessment was up to date. Monthly fire drills are carried out which exceeds requirements and is commendable. Fire appliances have been recently serviced; a recent check of the fire alarm system and emergency lighting had been carried out. Accidents/incidents are recorded as required. An assessment of cleaning products and other chemical items used in the home had been recently carried out. The home has a displayed an up to date employers liability insurance certificate. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 26 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 2 3 Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 4(1)(b) Requirement Timescale for action 01/11/07 2 OP7 14(1) 15(1)(2) 3 OP7 13(4) 14 (1)(a) (c) The statement of purpose needs to be updated to include information in regard to providing a respite day care service. Care plans must be updated and 01/11/07 reviewed particularly when the needs of people using the service change. So as to ensure that their needs are met at all times. • The registered person 01/11/07 needs to ensure each person using the service has a comprehensive risk assessment (which includes procedures to minimise the development of pressure sores, and nutritional assessment), which is agreed by them and is regularly reviewed, to ensure that risks are managed positively to help residents lead the life that they want. • All risk assessments that are already in place need to record evidence of having been regularly reviewed. DS0000035842.V342945.R01.S.doc Version 5.2 Tower House Page 28 4 OP12 14 (1)(a) 16(2)(m) 5 OP16 22 (6) 6 OP30 18(1)(c) The daily life, social, religious, 01/11/07 cultural needs need to be comprehensively assessed and guidance recorded to ensure that individual goals and identified individual needs are met. The registered person needs to 01/01/08 develop the complaints procedure format (such as pictorial, and/or in a verbal recording and also in Braille) to ensure that it is as accessible as possible to all the people using the service, including those who have difficulty in reading, and those who have a visual disability. There needs to be evidence that 01/01/08 all staff have up to date training (including training to meet particular needs such as dementia care needs and behavioural needs) that ensures that staff have a balance of all the skills, knowledge and experience to meet the needs of people using the service. 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 and the service user guide documents should show evidence of having been recently reviewed. • The format of the service user guide could include pictures, but there should also be a format that makes the information accessible to people using the service who have visual sensory needs. The statement of terms and conditions between the resident and the owner of the care home should be signed DS0000035842.V342945.R01.S.doc Version 5.2 Page 29 • 2 OP2 Tower House 3 OP3 4 OP7 5 6 7 OP12 OP13 OP14 8 9 10 11 OP27 OP28 OP30 OP37 by the person using the service (or significant other if applicable) • There could be more evidence of initial assessment of cultural and religious needs. • The resident should be given the opportunity to sign the assessment information. • Titles of documentation that includes reference to nursing (except when completed by community nurse or other) should be removed. • The registered manager should ensure that the persons involved in the initial assessment are always documented on the assessment record. • All staff should have knowledge and understanding of the procedures to ensure that resident’s care plans are immediately updated when the resident’s needs change. • 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 review) and include more information in regard to individual cultural and religious needs The registered person should develop and improve the opportunities for residents to participate in preferred activities. Information about resident’s family/friends contacts and personal profiles could be developed and recorded in the individual plan of cares. The registered person could improve the format of the menu to ensure that it is more accessible to people using the service, so that all residents are aware of what meals are to be provided on each day. The rota should record a ‘key’ in regard to the number of hours that each shift consists of. The registered manager/person should ensure that all care staff have the opportunity to achieve this NVQ level 2 care qualification. The registered person should ensure that each staff member had an individual training record. • Records should always be dated and signed by the person completing those records. • A record could be maintained of staff names of when they have read and/or been informed of the content of a policy/procedure. Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 30 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 Tower House DS0000035842.V342945.R01.S.doc Version 5.2 Page 31 - 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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