Inspection on 28/07/08 for Tower House

This inspection was carried out on 28th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Tower House 28/08/07

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 09/11/2008.

CARE HOMES FOR OLDER PEOPLE Tower House 10 Tower Road Willesden London NW10 2HP Lead Inspector Judith Brindle Key Unannounced Inspection 28th July 2008 10:00 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 Tower House DS0000035842.V367075.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.V367075.R01.S.doc Version 5.2 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 Mary Christabell Chongo Mundy Mary Christabell Chongo Mundy Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (7) of places Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 39 28th August 2007 Date of last inspection Brief Description of the Service: Tower House is a care home providing personal care for 7 elderly residents. The home is situated in a quiet residential area close to the varied amenities of Willesden Green, and 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. The first floor areas are 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 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. Fees are approximately£500 per week; details can be obtained from the provider/registered manager. Fees are recorded in the service user guide documentation, and in the contract/terms and conditions of people using the service. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 Star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection took place throughout 7 hours during a day in July 2008. There were no vacancies at the time of the inspection. We visited the home in February 2008 to carry out a random inspection of the service following an anonymous complaint. The findings of that inspection are in a report that is available upon request, from the Commission for Social Care Inspection. The inspection took place at the same time as the inspection for another care home, owned by the manager/owner. Both care homes are run in a very similar manner. Some of our findings for both services were shared, as many of the arrangements, systems, and services, of the care homes are the same, and/or similar. We were pleased to meet, all the people living in the home. The registered manager/owner was present during the inspection. Prior to this unannounced key inspection the manager was supplied by the Commission for Social Care Inspection (CSCI) with an Annual Quality Assurance Assessment (AQAA) document to complete. The AQAA is a selfassessment of the service provided by the care home, and is carried out by the owner and/or manager. It focuses on the quality of the service, and how well outcomes for people using the service are being met by the care home. It also includes information about plans for improvement, and it gives us some numerical information about the service. The manager completed this Annual Quality Assurance Assessment (AQAA), within the timescale requested by the Commission. The AQAA was generally appropriately completed. Reference to some aspects of this AQAA record will be documented in this report. A number of surveys were supplied to the care home prior to this inspection. These requested feedback from people using the service, health and social care professionals, and staff. At the time of writing this report, we had received 7 completed surveys from people using the service, and 5 from staff, and 1 from a health professional. We have included some comments and details of this feedback in this report. Other information received by the Commission for Social Care Inspection (CSCI) about the service since the previous key inspection was also looked at. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 6 This included what the service has told us about things that have happened in the service, these are called notifications and are a legal requirement. Also relevant information from other organisations, and from what other people might have told us about the service, was assessed. We spoke with all of the people using the service, some of whom have various communication needs, and sometimes some difficulty in responding to questions, so observation was a useful and significant tool used during this inspection. Care staff, were also spoken with, during the inspection. Between the two inspectors, a variety of documentation was looked at. These records included care plans of people using the service, risk assessments, staff training, the menu, staff personnel records, health and safety records, and some policies and procedures. The inspection included a tour of the premises. Assessment as to whether the requirements and recommendations from that inspection had been met also took place during this inspection. 27 National Minimum Standards for Adults, including Key Standards, were inspected during this inspection. The inspector thanks the people living in the care home, staff, the manager/ owner, and all those who supplied us with completed feedback survey forms, for their assistance in the inspection process. What the service does well: The home has a welcoming homely atmosphere. People using the service confirmed that they were happy living in the home. Feedback from surveys from residents told us that they were satisfied with the care and support that they received from the care home. The home provides a good standard of accommodation, which is free from odours. Some areas of the home have recently been redecorated. 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. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: There were two requirements from the previous inspection that have not been met. Medicines management was not always carried out safely. Some medicines were administered at too short an interval. This may be putting residents at risk. The actual amount of medicines that is administered in cases when a variable dose of medicine is prescribed must be recorded. Some areas of healthcare could be better. This includes better access to chiropody care and treatment for residents, and improved communication with the community health care team. The home must keep a record of the care that is given to residents on a daily basis and on every shift. There could be better monitoring of the quality of the service provided to people living in the care home. Staff training could be better, and it could be more evident that staff receive regular 1-1 staff supervision to ensure that they receive appropriate support and guidance to be able to provide a quality service to residents. Although the care records are kept in residents’ room, staff could be more proactive by discussing the content of the care records with residents and recording their discussion. The provision of meals in the home could also be improved to make sure that this reflects the choices of residents. Appropriate records must also be kept to evidence this. Whilst there is little input of the home in the management of the personal money of residents, more could be done to safeguard the possessions and Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 8 valuables of residents by keeping good records about all the possessions that are brought into the home by residents. 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.V367075.R01.S.doc Version 5.2 Page 9 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.V367075.R01.S.doc Version 5.2 Page 10 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, 3 and 6 (not applicable) 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. Prospective residents have the information needed to choose a home that will meet their needs. People using the service have their needs assessed prior to moving into the care home, which makes certain that the home knows about the person, and the support that they need. Some equality and diversity aspects of this assessment could be further developed. People using the service have a contract, statement of terms and conditions, with the home. EVIDENCE: The care home has a statement of purpose, and a service user guide. These documents provide information about the service provided by the care home, and set out the objectives and philosophy of the service. It was evident that people using the service had a copy of the service user guide. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 11 The manager/owner should ensure that residents have an up to date copy of this document. There should be development of the format of the service user guide (i.e. pictorial and/or audio) so that the information is more accessible to people who have difficulty reading, and /or significant sensory needs. Care plans inspected all included assessment of the person’s needs. It was evident that an initial assessment is carried out (with the person’s involvement) prior to the person moving into the care home. These assessments covered areas including health, emotional, some aspects of religious needs, social and personal care needs. There could be more evidence of initial assessment of equality and diversity needs (including race, gender identity, disability, sexual orientation, age, religion and belief) of people using the service, to ensure that all their needs are assessed and met. This was discussed with the manager/owner. A resident told us that the manager had been to ‘see’ them in hospital before they moved into the care home. Some resident had signed the assessment information. Titles of documentation in the care plan files that includes reference to nursing (except when completed by community nurse or other) should be removed, as the home is a registered care home not providing nursing care. Records informed us that residents had a statement of terms and conditions, which included a record of the fees. The person using the service had generally signed this document. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 12 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 adequate 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, in which residents’ health, personal, and social needs are set out. People using the service are respected and their right to privacy upheld, and they are generally supported and encouraged to make decisions and choices, and to take risks as part of an independent lifestyle. People using the service could be better protected by the home’s policies and procedures for managing and administrating medication to residents. EVIDENCE: All the people using the service have a plan of care. Three resident’s care plans were inspected. The care plans looked at included information about resident’s preferences, including activities, emotional needs, sensory needs and behaviour needs, day and night preferred routines, and dietary needs. Records confirmed that there was some staff guidance to support residents in meeting those needs. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 13 There was some information about residents religious needs documented in the care plans, but little information about other equality and diversity needs (see previous section). The care plans could indicate more understanding, and assessment of the strands of diversity. The format of the care plans could continue to be reviewed to improve and develop the accessibility of the information to residents who have difficulty reading and/or understanding the written word. Although the care records are kept in residents’ room, staff could be more proactive by discussing the content of the care records with residents and recording their discussion. Some care plans were not dated. There was evidence that care plan goals had been reviewed, but there were often several months between each record of review, for example, the communication needs of a resident was last reviewed 14/1/07. There was some evidence that Local Authority Care Managers had attended review meetings where the resident, their relatives, and staff also attend. Recent daily individual progress notes about each person using the service were not evident (the most recent record for one person was 21/7/08, and prior to that there was a large gaps in recording from 11th May 2008, the last daily record available for another resident was the 28 /1/08). There were also no evidence nighttime progress records in the care plans inspected. The poor standard of daily notes about residents’ condition is a major shortfall for the home. The manager stated that this would be addressed immediately. 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 be ‘working’ tools, so updated frequently (sometimes on a daily basis as their needs change. 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. There was evidence that residents have received some risk assessment, such as risk of ‘wandering’, mobility, falls, bathing, and nutrition risk assessment. These had not been reviewed recently (examples of this was a bathing assessment dated 01/10/05 and a falls risk assessment 20/12/04). All risk assessments need evidence of having been regularly reviewed, (with the resident if able, and/or relative) to ensure that there is evidence of up to date risk assessment of the person using the service. Residents were observed to have signs of ‘well being’, and wore clothes appropriate to their age and culture. A resident who had her hair styled in cane rows, told me that her hair had been ‘done’ by staff. We were told that each resident has a key worker. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 14 Staff provided assistance and support to residents in a sensitive and respectful manner, and have an understanding of the importance of upholding their right to privacy. A resident spoke of it being ‘quite good here’, and that staff were ‘nice’. The manager informed us that no residents have a pressure sore. AQAA information told us that residents in response to their pressure care needs, are provided with pressure relieving equipment. Records confirmed that residents generally have their healthcare needs met. But feedback from a health professional survey told us that the home could improve by better ‘communication’, with ‘members of the community team, in order to give residents, better management of their health and well being’. Records told us that people using the service have access to care, and treatment from a variety of healthcare professionals including, GP, dentist, optician, psychiatrist. AQAA information told us that there were plans for a dentist and an optician to visit the care home to see residents for check ups. This document also told us that referrals are made to a continence advisor as and when needed by people using the service. The manager clarified that staff cut the toenails of some residents. However for staff to cut the toes nails of residents it is important that they receive training for that, particularly when residents may have vascular or neurological problems or when they are diabetics. AQAA information told us that there were plans to ensure that a chiropodist visits the home to provide care and treatment to residents every six months. The home has a medication policy. We inspected the medication administration and storage systems. Medication is stored securely. Medications administration records were inspected. There were no gaps in recording of the medication administered by staff, but we found that some medications including paracetamol were given at 08:00, 14:00, 16:00 and 22:00. There was only a gap of two hours between 14:00 and 16:00. Some medicines including paracetamol must be given after four hours or more. If these are given earlier then this could cause an overdose of the medicine in the blood serum and could adversely affect residents. We also noted that the actual number of tablets of paracetamol given when one or two is prescribed to be given was not always recorded. A senior member of staff told us following the inspection that steps had been taken to ensure that these issues had been resolved and that medication was being administered safely. We asked about the training of staff in the administration of medicines. A senior member of staff told us that the manager, during the staff induction programme, carries out ‘in house’ medication training, which includes reading Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 15 the medication procedure, and ‘shadowing’ the manager, and answering verbal questions about the medication policy/procedure. Records of this ‘in house’ training were not available. The manager told us that there are only two persons who administer medicines. She added that she had trained the other person to administer medicines, but we could not find any records where the competency of the member of staff was tested with regards to the management of medicines. The member of staff has also been in the home for a number of years and should have been offered certified training for the administration of medicines. She added that there is another person who works in another care home who comes to the home to administer medication. That person is not a member of staff and is not from the agency and therefore the accountability of that person and the liability of the home with regards to medicines administration and the action of that person are not clear. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 16 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. People have the opportunity to take part in activities, but there could be further development in the provision of daytime activities, including community based leisure pursuits. There is insufficient evidence to show whether the meals that are provided are according to the choices of residents and whether these are sufficiently varied and nutritious. EVIDENCE: The care home has an activity programme. This was displayed in the dining area. Activities recorded on this, included exercise sessions, shopping, games and gardening. It was not evident due to lack of ‘daily’ records, what activities actually took place. Records of activities that residents participate need to be maintained. These need to show that residents are consulted about the programme of activities, and that facilities are provided to meet their leisure needs, and preferences. AQAA information told us that the home planned to hold a garden party in September. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 17 Some residents sat in the garden, and/or walked around the premises with staff during the inspection. Others watched television. A resident spoke of not having much to do. We were told the residents have the opportunity to participate in household duties, such as helping in the kitchen. AQAA information told us that a priest visits the care home, and that residents have joined the local library. Several residents attend a day centre for one day a week. A person using the service spoke of enjoying the time that they spent there. We were told by staff and the AQAA that some staff participate in gardening by growing a variety of vegetables. The registered person should develop and improve the opportunities for residents to participate in preferred activities. A resident told me that he had a radio, but would like a television in his bedroom. This was discussed with the manager and senior staff member, who told us that this would be ‘looked into’, with this person’s relative. The home has a payphone, which residents can use. We were informed by AQAA information that the home planned to provide a computer for people using the service, and to employ an activity co-ordinator. The visitor’s record book confirmed that there were regular visitors to the care home. The manager confirmed that several people using the service have close contact with family/friends. A resident spoke of having recently seen a family member. The home has a menu. This was in pictorial and written format and included a record of varied, wholesome meals. The menu was displayed upon the dining room table. A senior staff member told us that this menu was not generally followed, and meals were decided upon usually on a daily basis, following consultation with people using the service. If the menu is not correctly identifying the meals being provided or planned in the home it should be removed as it could cause confusion to residents and could be providing misleading information. There needs to be a menu that is current and gives correct information about the meals provided to people using the service. There were no up to date records (the last record seen was 22/5/08) of food eaten by residents, nor evidence that people had choice with regard to their meals. Two residents informed us that they generally did not have choice about their meals and receive what they are ‘given’. Another resident when asked if he received meals that met his cultural needs, (such as rice and peas, and jerk chicken) replied ‘no’ to the question. It needs to be evident that residents have the opportunity to choose what to eat. Food eaten by residents must be recorded to ensure that it is evident that they are provided with wholesome, nutritious food, which meets their dietary needs, cultural needs and their choice. Records of food eaten by people using the service is also important to be able to track the source of a possible food safety issue, such as following an outbreak of illness. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 18 There were items of tinned, dried and frozen food products. There were some fresh vegetables, some frozen chicken, fish and bacon. The food was generally supermarket basic brands, and there was not a significant mount stored. The home should review the quality and quantity of food products of food bought for the home. To ensure that varied, nutritious and quality food is provided at all times to people using the service. On the day of the inspection, the meals on the menu were not prepared but the proprietor got residents a ‘take-away’, which they were able to choose from a list. A resident was observed to be offered a choice of meat for lunch. The proprietor stated that they plan to prepare the meal that they had planned for lunch, for supper. We saw some fish defrosting in the sink. We were told that the home regularly defrosts food items in cold water in the sink. This could be of risk. The home needs to ensure that food is always defrosted by following safe procedures, in accordance to the Food Standards Agency and should consult appropriate agencies (i.e. Environmental Health Dept) for advice if needed. There is bottled drinking water accessible to residents in the sitting room. There has been another water cooler provided since the previous inspection. Drinks were offered frequently during the inspection. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 19 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. People using the service and others are confident that their complaints will be listened to, looked into and action taken to put things right, but there could be development in the recording of ‘comments/concerns’. Residents are protected from abuse, neglect and self-harm. EVIDENCE: The care home has a complaints procedure, a summary of which is recorded in the service user guide. The complaints procedure includes timescales with regard to responding to a complaint. There are no recorded complaints The issue of recording ‘concerns’ was discussed with the manager, who reported that she would examine ways of supporting residents to communicate concerns, and would record them. This was confirmed in the AQAA. AQAA documentation informed us that the home has a suggestion box in which residents and visitors can provide feedback about the service. This document also indicated that the care home knew the importance of listening to complaints and taking them seriously. There have not been allegations of abuse about the service. There was evidence that some members of staff were given training on abuse. The proprietor uses a training agency and the local borough for this purpose. All new members of staff also receive induction as per skills for care with the Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 20 training agency and we were informed that the staff receive an awareness of safeguarding adult during this process. Staff who spoke with us had an awareness and understanding of the reporting, and recording procedures with regard to responding to ‘concerns’/complaints, and/or any suspicion or allegation of abuse. There are systems in place for recording accidents and/or incidents. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 21 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 adequate 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, warm, clean and comfortable. The premises are suitable for the care home’s stated purpose, but there could be some environmental improvements. Resident’s bedrooms are individually personalised and meet their individual needs. EVIDENCE: The care home is in keeping with other houses in the residential street. The front of the care home is attractive with potted plants, trees and seating facilities. The care home is located in Willesden Green within a few minutes walk from a variety of local shops, restaurants and banks. Public bus facilities are accessible close to the care home, and underground train services are located, a short drive from the home. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 22 The inspection included a tour of the premises. 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. Feedback surveys from people using the service confirmed that they thought that the home was fresh and clean. . The living environment is appropriate for the particular lifestyle, and needs of people living in the home, and contains homely features, such as pictures, and large television. AQAA information told us that the dining room has been redecorated and another table added to provide a choice of seating for people using the service. We were told that further improvements to the environment, including redecoration were planned. This is positive. Restrainers have been fitted to windows to make sure that they do not open wide enough so that a person would be able to fall through. We however found that the restrainers could very easily be disabled, so widening the opening distance of the windows. There needs to be risk assessment of these windows, including bedroom windows, linked to the person whose bedroom its (taking into account of the person’s behaviour needs and other needs), and new restrainers fitted if necessary. A rug located in a bathroom was ruffled and could be a trip hazard. This needs to be risked assessed and if it is not of minimal risk it needs to be removed or secured to the floor. There were tiles that were chipped in a bathroom. Ensure that the bath hoist is serviced as per a maintenance schedule. Residents told us that they liked their bedrooms. Bedrooms are individually personalised, though most had minimal personal possessions. Each bedroom has a fridge, but those seen were observed to be empty. Two ensuite facilities of two bedrooms did not have a light that was working. A senior staff member contacted a maintenance person to replace the light bulb during the inspection. Though all bedrooms have call bells. Some bedrooms did not have call bell leads, so this could be difficult for residents to call staff. All residents need to have a call bell that they can reach, unless it has been assessed that this could be of risk to their safety. The care home has an infection control policy/procedure. Alcohol hand cleansing gel was accessible in the care home. Several of the ensuite bathroom facilities and bathrooms did not have hand towels. Staff refilled hand towel containers during the inspection. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 23 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 adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Records kept in the home about staff that have worked in the home were not comprehensive enough to make a judgement about whether the staffing levels were adequate to meet the needs of residents who live in the home. The recruitment procedure was not robustly applied to ensure the safety of people who use the service. There were no records about the induction of new staff in the home. Staff must receive training in a number of areas to make sure that they are competent in these areas. EVIDENCE: The present staff rota was available for inspection. This told us that two staff are generally on duty during the day and one ‘wake staff’ staff member is on duty at night. Two care staff were on duty with the manager at the time of the inspection. On the day of the inspection, a member of staff who should have been on duty was not on duty and instead an agency carer had been booked to cover the shift. Another agency staff member was also working on the day of the inspection and her name was not recorded on the staff rota. We found that the duty rota had also not been updated to reflect this. The registered manager told us that this staff member had worked several shifts. This was not evident from the rota. As a result we concluded that the duty roster has not been updated to reflect changes in the staffing team and the actual people Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 24 who worked in the home. It is a statutory duty for the person who runs a care home to keep a record of whether the duty roster was actually worked. Staff were observed to interact with residents in a respectful, and sensitive manner during the inspection. The manager told us that she was in the process of recruiting care staff. She informed us that agency staff work shifts when permanent staff are not available. The manager told us that she employs agency staff that have worked in the care home previously, to ensure that residents know the care staff, and that consistency of care is provided to people using the service. We looked at the personnel files of four members of staff. One was recruited prior to 2008 and the other three were recruited in 2008. Each had an application form that was generally well completed, except for one where the work history in the application form and in the attached CV was not given close to the month. As a result it was not possible to say whether there were gaps in the employment/education history and whether these were explored during the recruitment process. One member of staff did not have two references and another did not have a copy of the passport and the visa to show that he/she was eligible to work in the UK. However they all have had appropriate Criminal Records Bureau checks. It was evident from information received following the inspection that staff files of care staff that are no longer working in the care home are not always archived. This should be carried out to ensure that it is evident which staff are presently working in the care home. The proprietor informed us that all new applicants receive induction about the home when they first start work. They also complete the common induction standards as per Skills for Care, through a training agency. Whilst the records were available to show that new members of staff were in the process of completing the Common Induction Standards, we noted that there were no records to show that they have had an induction about the home to cover areas such as its philosophy of care, its policies and procedures, introduction to the environment and action to take in an emergency. One member of staff started work at the end of March and had still not completed the common induction standards at the time of the inspection (end of July) when this induction should be completed within six weeks. It was noted that the member of staff who was recruited prior to 2008 was up to date with most of the statutory training except for medication training. The other members of staff have had training that has been organised by the training agency and covered food hygiene, manual handling and infection control, but not fire training, medication training and abuse training. We were informed that the abuse training is addressed during induction and will be provided when this is organised by the local Borough. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 25 According to the AQAA the home has 2 staff working towards a national Vocational Qualification level 2 in care and that out of 11 care members of staff, 2 have NVQ level 2. We were told that there were plans to develop the numbers of staff completing a NVQ qualification. The registered manager/person should ensure that all care staff have the opportunity to achieve this NVQ level 2 care qualification. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 26 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, and 38 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The registered manager/owner is qualified, competent and experienced to run the care home appropriately. The home has yet to apply quality control measures to make sure that it has a fully working self-assessment tool. The management of residents’ possessions could be made more robust to ensure the safety of these. There are some the health, safety issues that need resolving to ensure that the health, safety, and welfare of people using the service is promoted and protected. EVIDENCE: Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 27 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 nurse. She has completed a ‘mentoring’ course, and is currently in the process of completing an assessor’s training course. The manager told us that she ensures that she updates her knowledge and skills. The staff that spoke with the inspector 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. AQAA information told us that the care home acknowledges that keeping up with ‘paperwork’ has been a barrier to improvement during the last twelve months. It is evident that record keeping in the care home needs to be better. The home has a quality assurance procedure. We were told by staff and AQAA information that residents have the opportunity to complete feedback questionnaires, and that policies and procedures have been recently reviewed. It was not clear what action had been taken in response to this feedback. There was evidence that it had the self-assessment format to carry out an audit of the standard of service that it provides. We however noted that the home has not yet used the audit format to carry out a self-assessment. The home had completed the AQAA document to a satisfactory standard. Minutes of staff meetings and residents’ meetings were available for inspection. There has been a staff meeting in May 08 and the one prior to that was held in September 07. Similarly the last residents’ meeting was held in May 08 and the one prior to that was held in August 07. The proprietor said that the policy of arranging meetings state that the meetings should be arranged monthly. We noted that there were records of the property and possessions that have brought into the home when residents were admitted. We checked that these inventories, and noted that these have not always been kept up to date when residents bought more things or when things were brought after admission, into the home for them. The records must be kept up to date as far as possible to ensure the safety of residents’ possessions. 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. We were told that staff were not the agent for any of the resident. These were managed either by residents themselves, their relatives or by the local authorities, which placed them into the home. The care home has appropriate accessible health and safety policies/procedures. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 28 A PAT certificate test certificate and an electrical wiring test certificate were available for inspection. There was also an up to date gas safety certificate. The care home has a fire risk assessment. This was dated 2006, and should show evidence of having been reviewed annually. The manager told us that she would review the document. The care home has an up to date employer’s liability insurance displayed in the home. Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 29 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 3 X X 3 STAFFING Standard No Score 27 2 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 3 Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 30 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 OP7 Regulatio n 17 Requirement That a record is kept about the day to day implementation of the care plans and of the care that residents receive on each shift (including night time) that staff do. All risk assessments need evidence of having been regularly reviewed, (with the resident if able, and/or relative) to ensure that there is evidence of up to date risk assessment of the person using the service. Staff who cut the toenails of residents must have the appropriate training to do so, particularly when residents have poor circulation, diabetes or vascular diseases. All members of staff that administer medicine must receive certificated training in this area. There must be more than two members of staff (for both homes) to make sure that the home has sufficient number of competent people to administer medicines. The administration of medicines by people who are not DS0000035842.V367075.R01.S.doc Timescale for action 01/10/08 2 OP7 15(2) 01/10/08 3 OP8 18(1)(c) 01/10/08 4 OP9 13(2) 01/10/08 Tower House Version 5.2 Page 31 5 OP9 13(2) I 6 OP9 13(2) 7 OP12 16(2)(m) 8 OP15 16(2)(i) members of staff and who are not from an agency must be explored to make sure that accountability and insurance liability issues are addressed. The amount of medicines that is administered in cases of variable dose must be recorded to ensure appropriate monitoring of the effect of the medicine. That the time that is lapsed between each dose of medicines when these are prescribed to be given a number of times daily, be of equal intervals as far as possible and when this is indicated, to make sure that residents receive the full therapeutic effect of the medicine. The interval must be not be shorter than what is recommended as this could have detrimental side effects on the health of residents. Records of activities that residents participate need to be maintained. These need to show that residents are consulted about the programme of activities, and that facilities are provided to meet their leisure needs, and preferences. The menu needs to reflect the actual meals provided in the care home. Previous timescales 01/04/08 not met. 01/10/08 01/10/08 01/10/08 01/10/08 9 OP15 17 The menu must be reviewed to reflect the choices (including cultural dietary needs) of residents and once the menu has been agreed this must be adhered to as much as possible There must be a record of all food 01/10/08 eaten by residents to enable a person inspecting the records make a judgment about the DS0000035842.V367075.R01.S.doc Version 5.2 Page 32 Tower House 10 OP15 13(4) 11 OP19 23(2) 13 (4) 12 OP19 13 23(2) 13 (4) meals that are provided to residents with regards to variety and nutritional content and whether the meals meet residents’ dietary and cultural needs. Food must always be defrosted 01/10/08 by following safe procedures, and should consult appropriate agencies (i.e. Environmental Health Department of the local Borough) for advice if needed. Window restrainers that are fitted 01/10/08 must be of a type that can only be disabled by a special key/device so that residents are not able to disable the restrainers themselves, unless there has been a risk assessment. 01/10/08 A rug located in a bathroom was ruffled and could be a trip hazard. This needs to be risk assessed and remove if not of minimal risk to residents. Two ensuite facilities of two bedrooms, which do not have a light that is working, need the lights repaired to ensure that residents are safe. There needs to be evidence that the bath hoist is serviced as per a maintenance schedule All residents need to have a call bell that they can reach, unless it has been assessed that this could be of risk to their safety. The registered person needs to ensure that all hours worked by staff in the care home are recorded on the staff rota. To ensure that it is evident that there are sufficient numbers of skilled and competent staff at all times to meet the needs of people using the service. DS0000035842.V367075.R01.S.doc 13 OP27 17(2) Sched 4 01/10/08 Tower House Version 5.2 Page 33 14 OP29 19 15 OP30 17,19 16 OP30 18(1)(c) 17 OP33 24(1)(2) (3) 18 19 OP36 OP37 18(2) 17 Previous timescales 01/04/08 not met The recruitment procedure must be followed robustly to make sure that all the checks are carried out before an applicant is offered a job to ensure the safety of people who use the service. The checks should include a full work history (with dates as close to the month as possible), two references and proof of eligibility to work in the UK. There must a record of the induction that staff go through when they start work in the home, to make sure that they receive enough information about the service to work safely with residents Staff must receive training in the management of medication and in fire training to make sure that that staff are competent in these areas. It needs to evident that there are systems (such as an annual development plan) in place to monitor the quality of the service provided to people using the service Care staff must be supervised at a minimum of six times a year or once every two months The inventory records of people using the service must be kept up to date as far as possible to ensure the safety of residents’ possessions. 01/10/08 01/11/08 01/11/08 01/12/08 01/11/08 01/10/08 Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 34 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 manager/owner should ensure that residents have an up to date copy of this document. There should be development of the format of the service user guide (i.e. pictorial and/or audio) so that the information is more accessible to people who have difficulty reading, and /or significant sensory needs. There could be more evidence of initial assessment of equality and diversity needs of people using the service, to ensure that all their needs are assessed. Titles of documentation in the care plan files that includes reference to nursing (except when completed by community nurse or other) should be removed, as the home is a registered care home not providing nursing care. The care plans could indicate more understanding, and assessment of the strands of diversity. All resident’s care plans should be clearly dated, to ensure that staff and resident’s have knowledge of up to date information about the person. 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 be ‘working’ tools, so updated frequently (sometimes on a daily basis as their needs change. The home could seek ways to improve communication, with the community health care team, in order to give residents, better management of their health and well being’. The registered person should develop and improve the opportunities for residents to participate in preferred activities. DS0000035842.V367075.R01.S.doc Version 5.2 Page 35 2. OP3 4. OP7 5 OP8 6. OP12 Tower House 7 OP15 Staff should support a resident to have access to a television in his/her bedroom. If the menu is not correctly identifying the meals being provided or planned in the home it should be removed as it could cause confusion to residents and could be providing misleading information. The home should review the quality and quantity of food products of food bought for the home. To ensure that varied, nutritious and quality food is provided at all times to people using the service. 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 manager should examine ways of supporting residents to communicate concerns, and ensure that they are recorded and that action is taken to resolve them. The personnel files of care staff that are no longer working in the care home should be archived. To ensure that it is evident which staff are presently working in the care home. The registered manager/person should ensure that all care staff have the opportunity to achieve this NVQ level 2 care qualification. Staff and resident meetings should be arranged monthly. 8 9 OP16 OP29 10. 11 OP28 OP33 Tower House DS0000035842.V367075.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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.V367075.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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