Inspection on 03/06/09 for Tower House II Residential Home

This inspection was carried out on 3rd June 2009.

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

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

Other inspections for this house

Tower House II Residential Home 06/11/09

Tower House II Residential Home 28/07/08

Tower House II Residential Home 24/05/07

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 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Tower House II Residential Home 11 Tower Road Willesden London NW10 2HP Lead Inspector Mr Ram Sooriah Key Unannounced Inspection 3rd June 2009 10:15 DS0000068639.V375721.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tower House II Residential Home Address 11 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 8621 0399 Mary Christabell Chongo Mundy Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category 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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 3 28th July 2008 Date of last inspection Brief Description of the Service: Tower House II is located in Tower Road off Pound Lane in Willesden. It is easily accessible by cars and public transport. The home is about five minutes walk from Pound Lane, which is served by buses. There is a small parking area in front of the home for about 2 cars. Additional parking is available on the road, but this is paid parking or for residents only. The home was registered on the 11th January 2007 for three elderly residents of mixed gender who require personal care. It consists of a semi-detached House. There is a kitchen, lounge/dining area and a bedroom on the ground floor and two bedrooms and a bathroom on the first floor. The home does not have a lift. All bedrooms are en-suite with a toilet and washbasin. There are pleasant and maintained garden/patio areas in front of the home and at the back. Tower House II is own by Ms Mary Mundy. She has another care home next to Tower House II at number 9 and 10. There are a lot of interactions between the two homes and many activities are shared as, they are next to each. The home charges £580 weekly and also accommodates residents who are publicly funded. They do not have to pay a top-up. There were 3 residents in the home at the time of the inspection. Tower House II Residential Home DS0000068639.V375721.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 one star – adequate service. This means that people who use this service experience adequate quality outcomes. The key unannounced inspection started on the 3rd June 2009 at 10:15 and finished at 16:00. This is the first key inspection for the period 2009-2010. The last key inspection took place on the 28th July 2008 and during that inspection the home was rated as an adequate (1 star) service. At the time the home did not have a registered manager in place and the provider was running the home with a team of staff. The Commission has also received an application from the provider to vary the number of residents in Tower House II from 3 to 9 as the provider has plans to extend the home (number 11), to include number 12 and 13 Tower Road. During the inspection we spoke to three residents in the home and to the provider and the acting manager of the home. We toured some of the premises and looked at a sample of records that the home keeps. The provider has sent us an Annual Quality Assurance Assessment (AQAA) that we have used where possible in this report. We would like to thank all the residents and Mrs Mundy and all her staff for their assistance and kind support during the inspection. What the service does well: The home has the necessary information to give to prospective residents for them to be able to make a decision about moving in the home. Prospective residents’ needs are assessed before they are offered a place in the home, to make sure that the home will be able to their needs. Residents in the home generally appeared well cared for and receive a good standard of personal hygiene. They have the opportunity to engage in the local community by going to the day centre, taking part in shopping activities, and visiting healthcare professionals who provide their services locally. The home is well maintained and has beautiful grounds that residents can enjoy. Bedrooms of residents are personalised and offer comfortable accommodation. It is clean and free from odours. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home has not made enough progress since the last inspection in terms of improving the quality of the service that it provides. 25 requirements were imposed on the home during the last inspection, 15 of these were met but a significant number (10) were not met and are repeated in this report. 4 of these requirements are repeated twice. Requirements must be met within the appropriate timescales as they address breaches of regulations. Enforcement action may be taken if these are not met within the appropriate timescales. To evidence the care that is provided to residents, care plans must appropriately address all the needs of residents including, their changing needs and these must be reviewed at least monthly. Risk assessments must be in place to address the risks that residents may face in their daily life and while Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 7 carrying out the activities of daily living and these must also be kept under regular review. Most of the residents’ accommodation is found on the first floor. They would therefore benefit from an assessment about their ability to manage the stairs and this must be kept under review with their changing needs. Any assistance and support that is required must be recorded in the care plan. Residents must be weighed at least monthly and the nutritional risk assessment must also be reviewed monthly to ensure appropriate monitoring of residents’ nutritional status. Some issues about the management of medicines must be addressed to ensure the safety of people who use the premises. The amount of all medicines that are received in the home must be recorded. We were unable to explain a discrepancy between the amount of tablets received for a resident with the amount that were administered (according to the number of signatures) and the amount of the tablets that remained. The home did not have a working menu at the time of the inspection and the records of the meals provided to residents were not comprehensive. As a result we were unable to make an informed decision about the variety and choices of meals that are offered to residents. The recruitment procedures are not robustly adhered to, to ensure the safety of residents. Staff did not always have all the records as required by legislation, such as appropriate references. We were not sure whether all members of staff receive a contract of employment. A form to document the local induction of staff was not available for inspection. The home did not keep appropriate records about the names of the members of staff who work in the home. The duty roster is a legal record and must be kept. This also enables us make an informed decision about the staffing levels that are provided. The home did not have enough records about the training of staff to enable us make an informed decision about the standard of training that is provided in the home. Records about the supervision of members of staff were also not available. During the last inspection we asked the home to make sure that appropriate window restrainers were in place in the home to make sure that these cannot be easily disabled. This requirement has yet to be addressed. Similarly the home did not have an up to date fire risk assessment and health and safety risk assessment, even though these were requested during the last inspection. A number of other records in relation to health and safety, including safety certificates, were not available for inspection on the day of our visit to the home. The home did not have a quality management system. This would have enabled the monitoring of the quality of the service that it provides and would Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 8 have given feedback about how well the service meets national minimum standards and requirements that have been imposed by the Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Tower House II Residential Home DS0000068639.V375721.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 II Residential Home DS0000068639.V375721.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 & 4 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has the necessary information to offer to residents and to their representatives for them to decide about using the service. To make sure that the home only accepts residents whose needs can be met in the home, the provider ensures that prospective residents’ needs are assessed appropriately before they are offered a place in the home. EVIDENCE: During the inspection the provider stated that she has updated the service users’ guide (SUG) and the statement of purpose (SoP) to include information about the extension to the home and to increase numbers of residents from 3 to 9. Copies of both documents were kindly provided to the inspector. We noted that these have been updated to include the proposed variation to the home. These Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 11 documents will be more fully assessed when the application for variation is processed. We were however not very clear about the proposed service that home plans to provide and whether it aims to provide long term care or respite care. The SUG says under the section Philosophy of Care that ‘the purpose of the home is to provide supportive rehabilitative care’. The SUG then mentioned respite emergency care, but in the front of the SUG it states that ‘residents care plans are evaluated monthly and also a daily report and 6 monthly report by social services’. A contract was in place between the home and the local authority that placed the resident in the home and another contract was in place between the home and the residents or with their representative. The homes contract was comprehensive and covered the key terms and conditions. The home has had a new admission since the last inspection. As the resident was admitted to the home at short notice, the resident or their representatives did not receive an opportunity to see the home, but the provider did visit the prospective resident to assess their needs. We were able to look at the preadmission assessment of the needs of the resident that was carried out by the provider. This was completed appropriately and described the needs of the resident. Tower House II Residential Home DS0000068639.V375721.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7-11 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are not always kept up to date and reviewed with the changing needs of residents. As a result there is no guarantee that the needs of residents would be met. Residents enjoy a good standard of personal care and their privacy and dignity are maintained. They are however, not always supported appropriately by staff to meet their healthcare needs. A few issues are noted with medicines management that need to be addressed. EVIDENCE: We looked at the care plans of two residents. The care plans were formulated after an assessment of the needs of residents and generally had information about the action to take to meet the needs of residents. The care plans and risk assessments were however, not kept up to date with the changing needs of residents. A resident who was recently in hospital and returned to the home with some changes in their needs did not have the care Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 13 plan altered to reflect the change in needs. The care plan for mobility and the manual handling risk assessment were not amended to reflect the changes in the needs of the resident. In addition to that, as the resident has to use the stairs, as their bedroom was on the first floor, an assessment about the ability of the resident to negotiate the stairs was not in place and neither was a care plan to describe the assistance and support that they required. We noted that the care plans of both residents had not been reviewed since March 2009. Risk assessments such as, pressure ulcer risk assessment, falls risk assessment, nutritional risk assessment and manual handling risk assessment were not reviewed monthly or when residents’ condition changed. The manager stated that the care plans were drawn up and reviewed with residents or their representatives and that any changes in residents condition are always discussed with residents or their representatives. We however saw little evidence of this in the care records. The care plans are kept in residents rooms but there was little evidence that staff had gone through the care plans with residents or their representatives to make sure that the residents were fully aware of the plan of care. We observed that residents generally presented with a good standard of personal care. They were also appropriately dressed, according to the weather and the wishes of the residents. We talked to one of the residents and we noted that the latter was in pain. We looked at the care records and noted that there was no care plan in place to address pain. We were therefore not sure how the home was monitoring and addressing the resident’s pain. The resident was given pain killers, when we mentioned this to staff. Residents are registered with a GP and are supported by members of staff with their healthcare needs. We were informed that residents are able to attend the dentist and optician in the local community. Records about the outcomes of the input of various healthcare professionals were kept. Staff in the home do not cut the toe nails of residents, as a chiropodist is now responsible for this. Residents have a nutritional risk assessment, but we noted that the nutritional risk assessment for one resident was last reviewed in June 2008 and for the other resident in November 2008, more than 6 months ago. We also noted that a resident had not been weighed for 2 months. We therefore conclude that the nutritional needs of residents are not being monitored appropriately. The provider stated that only staff who have had medication training administer medicines. The acting manager has not yet had medicines training and therefore does not administer medicines. So far three people have been trained to administer medicines and the provider stated that more staff will be trained to administer medicines. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 14 We checked the management of medicines and noted that the amount of medicines that were received in the home for 2 residents were not recorded. We counted the amount of a pain killer that was in stock in the home for a resident and compared this with what should be in stock (amount received minus the tablets that have been given and signed for). We noted that there were more tablets than what should have been in place indicating that the number of initials/signatures did not match the amount of tablets given to the resident. The home did not have a sample of initials at the front of the medicines folder. We recommend that a sample of signatures and initials be kept in the home to enable the quick identification of the person who has put their initials in the medicines charts. There were no specific care plans in the care records of residents addressing end of life care and the fears and aspirations of residents for the future, but there was some information about the wishes and instructions of residents with regard to end of life care in the life story of residents. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12-15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents in the home have the opportunity to take part in appropriate social and recreational activities. The records with regards to the provision of meals, including the menu and daily records were not very good to provide information about the variety and choices of meals that were provided for residents. EVIDENCE: There was some improvement with the records that were kept about the social and recreational needs of residents. The provider has been working on producing a life story for each resident and care plans were in place addressing the identified needs of residents. We recommended during the last inspection that these be produced in a user friendly format and placed in the front of the care records. This would have provided a person centred approach perspective to care planning as one would have been informed about the ‘person’ before the needs of the residents. These have yet to be met. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 16 There was an activities room with some resources for the provision of activities that staff could use to lead activities for residents. We were informed that some residents attend a day centre once a week. This provides an opportunity for residents to meet other people and to go out in the local community. Other opportunities are available for residents to go in the community when they go shopping or when they go to visit healthcare professionals who have shops in the local community. The provider said in the AQAA that some residents have been on holidays and some have gone to Brent Cross shopping centre. The provider informed us that residents are seen by representatives of the local churches on a weekly basis and that residents are able to attend the local churches if they wish to. Care plans tend to address the spiritual needs of residents. The provider stated in the AQAA that the home tends to celebrate all the big events and encourages residents to take part in these activities. The home did not yet have a menu in place and we were informed that a new menu will be implemented soon and that in the meantime the home was using the menu in Tower House I. There were some descriptions of meals on boards that were placed in the new dining area, but these were more for decoration purposes rather than showing the actual meals that would be provided. There were many different meals (about 10 or more) that were on the board and it is unlikely that the home will be able to provide that variety of meals on a daily basis to residents. On the day of the inspection we were informed that a take away would be provided for residents, as staff were busy with the inspection and were not able to prepare lunch. A main meal would be provided for supper. There were no records of meals that have been cooked for the week prior to the inspection. There were some records about the previous weeks and we thought that the meals were varied and nutritious, but we were unable to see whether the meals that were prepared reflected the menu that was in the home and were an account of what residents had for meals. Tower House II Residential Home DS0000068639.V375721.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16&18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider views complaints as an opportunity to improve the service and takes these seriously. Allegations and suspicions of abuse are taken seriously by the provider and staff. EVIDENCE: The home has not had any complaints since the last inspection. A complaints procedure is available in the home and in the SUG that is offered to all residents. The AQAA says that the provider listens carefully to complaints and ensures that these are investigated and documented. It adds that the client, family and staff will be involved as required and that complaints can be used as a learning opportunity to improve the service. The home has not had any referrals to the safeguarding adult team of the local borough. We discussed the management of allegations and suspicions of abuse with the provider and the acting manager. They were both clear of the action to take if they come across allegations and suspicions of abuse. Both persons have had training in this area. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 & 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The standard of accommodation that the home provides is suitable to meet the needs of the residents. EVIDENCE: The grounds of the home remain very well maintained and residents are able to benefit from this as, they are encouraged to sit outside or to walk in the grounds with members of staff. At the time of the inspection an application had been received to increase the number of residents in Tower House II from 3 to 9, as houses number 12 and 13 in Tower Road have been joined with number 11 to make a bigger care home. The application was being processed by the registration section of the Commission at the time of the inspection. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 19 We were able to see some of the work that has been carried out to join the houses together and some of the changes to the environment. The lounge area has been extended to accommodate the nine residents that the provider proposes to have in Tower House II, once the variation is approved. A new dining area has also been provided in an extension and a new kitchen has been created to cater for the bigger home. Generally the changes have been carried out to a good standard to provide a pleasant environment for residents. The current residents were accommodated in number 11 and they seemed to be quite comfortable with no significant changes in the quality of accommodation that was provided for them as, compared to what used to be in place previously. The bedrooms of residents were appropriately furnished to provide a homely and personalised environment for residents. All bedrooms were en-suite with a toilet and wash hand basin. We noted that window restrainers have not yet been replaced in the home despite a requirement during the last inspection to replace the current restrainers. These could easily be disabled by hand and therefore served no real purpose. The provider showed us new restrainers that she has purchased and that would be fixed to the windows. There was some evidence that the provider takes infection control seriously. There are alcoholic hand rub in the home and paper towels in the bathrooms/toilets. During the tour of the home we noted that a toilet has been provided on the ground floor of Number 11 Tower House II, in a small room that used to house the boiler. We noted that there was no wash hand basin in this toilet or close by, for hand washing. We did not see records to show that staff have had recent infection control training. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Although the home seems to provide adequate staffing levels, there was no reliable record of the actual numbers and the names of members of staff on duty, to fully evidence this. The home did not demonstrate that it adheres to robust recruitment procedures to ensure the safety of people who use the service. There were not enough records in the home to demonstrate that the home provides a good standard of training to its staff. EVIDENCE: We looked at the duty rosters that have been prepared for the home. According to the rosters there should be three members of staff on duty. We however noted that there were 2 persons on duty, the acting manager and the provider. The provider is also the registered manager for Tower House I. This number of staff seems to be appropriate for the number of residents that were in the home. Examination of the duty rosters showed that these contained names of staff that were not on duty in the home. They were not amended when staff whose names were on the rosters, did not work in the home and when different members of staff worked in the home. We therefore concluded that the duty Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 21 rosters did not reflect the actual numbers and names of staff that were on duty in the home. We looked at the personnel files of two members of staff. One had an application form and one reference and the other did not have an application form and no references. One member of staff started work in February 2008 and did not have a signed contract. The other member of staff started work the week of the inspection. There was evidence of proof of identity, CRB check and to show that the members of staff were eligible to work in the UK. We were informed that the new members of staff are offered induction according to Skills for Care. We however did not see a form to summarise the local induction of staff with regards to specific information about the home such as the layout of the home, the fire plan for the home, the philosophy of care and the policies and procedures. We found it difficult to check whether staff received training as part of their personal development and to ensure that they are competent and skilled to care and support residents. The new members of staff came from other care homes and we were informed that they have had the necessary statutory training in these establishments, but for the lack of comprehensive records we could not make a judgement about the standard of the provision of training in the home. We were informed that the current members of staff are NVQ trained or in the process of completing their NVQ training. Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 36 and 38 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a manager who is in the process of getting registered. The home does not yet have an effective quality management system for the provider to monitor the quality of the service that the home provides. Staff do not yet receive supervision six times a year or every two months. Health and safety issues are not always addressed appropriately. As a result people who use the premises may be put at risk. EVIDENCE: The home had an acting manager that has initiated a CRB check with the Commission. This is the first process to be registered. The latter has Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 23 experience in caring and supporting people to promote their independence. He has an NVQ level 2 in care and is in the process of studying for the registered manager’s award. He is closely supported by the provider who is also the registered manager of Tower House I. The provider is very much involved in the running of Tower House II as she was present throughout the inspection. Minutes of staff and residents meetings were not available during the inspection. The provider said that these were with the person who types the notes for the home. The minutes were later forwarded to us. The home sends customer surveys to residents. Copies of these were available in the care files of residents. While this is commended, the home does not prepare a report as per standard 33.4 to provide feedback about the outcome of the survey to residents, their representatives and other interested parties including CQC. The Quality Assurance Procedure of the home also says that the home should carry a formal annual audit. We noted that the home has not yet done that. Before doing that it must agree a quality assurance system to use to measure the quality of the service during annual audits as per standard 33.3. The provider informed us that she does not keep any personal money for residents. The personal money is either managed by relatives/friends of residents or by the local authority that placed the resident. The home had an up to date gas safety certificate. At the time of the inspection (3rd June 2009), the home did not have a portable appliance test certificate. It was due for renewal in March 2009. A copy dated 8th June was forwarded to the Commission. We did not also see a copy of the electrical wiring certificate for number 11 Tower Rd during the inspection. A copy dated the 10th June was provided after the inspection. All safety certificates must be renewed in a timely manner to ensure the safety of all people who use the premises. A format for a fire risk assessment was available in the home but this has not been fully completed yet. The fire emergency plan was not dated and signed. We were therefore not sure whether this had been reviewed. The home did not have a health and safety risk assessment available for inspection. Fire drills were conducted but the records showed that not all staff have had a fire drill. This is particularly relevant for members of staff who work night duty. Fire emergency light tests were conducted but we did not see a record of weekly fire detector tests and of regular hot water temperature monitoring at outlets to which residents have access. A copy of the record of the weekly fire detector tests was later forwarded to the inspector. However, these records, Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 24 must be made available for viewing during the inspection and not produced retrospectively Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X x 2 X 2 Tower House II Residential Home DS0000068639.V375721.R01.S.doc Version 5.2 Page 26 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 Regulation 15(2)(b) Requirement That risk assessments and care plans are updated as and when the condition of residents changes to make sure that these reflect the needs of the residents. (Repeated requirement-timescale 31/03/08 and 30/09/08 not met). Care plans must be reviewed at least monthly. All residents must have an assessment about their ability to negotiate stairs if they are accommodated on the first floor. Any assistance and support that residents may require must be addressed in their care plan. That evidence be kept about the involvement of residents/representatives in drawing and reviewing the care plans and risk assessments. There must be a care plan to address the needs of residents when they develop new needs, such as when they have pain. Residents must be weighed monthly and their nutritional risk assessment must also be DS0000068639.V375721.R01.S.doc Timescale for action 31/08/09 2 OP7 13(5) 31/08/09 3 OP7 15(2) 31/08/09 4 OP8 12(1) 31/07/09 5 OP8 12 31/07/09 Tower House II Residential Home Version 5.2 Page 27 6 OP9 13(2) 7 OP9 13(2) 8 OP15 16(2)(i) 9 OP15 17 10 OP19 13(4) 11 12 OP26 OP27 23(2) 18(1)(a) reviewed monthly. The amount of medicines that is received for each individual resident must be recorded appropriately. Medicines must be administered as prescribed. Audits that are carried out must be able to show that medicines are being managed safely. The menu must be reviewed to reflect the choices of residents and once the menu has been agreed this must be adhered to as much as possible (Repeated requirement-timescale 31/03/08 and 31/08/08 not met). There must be a record of all food eaten by residents to enable a person inspecting the records make a judgment about the meals that are provided to residents with regards to variety and nutritional content and whether the meals meet residents’ dietary and cultural needs. (Repeated requirementtimescale 31/08/08 not met). Window restrainers that are fitted 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 (Repeated requirement-timescale 30/09/08 not met). There must be hand washing facilities in the new toilet on the ground floor in 11 Tower Rd. The duty roster must be kept updated with the names of staff that actually work in the home including, the names of agency staff to enable a person looking at the records make a judgment about the staffing levels that the DS0000068639.V375721.R01.S.doc 31/07/09 31/07/09 31/07/09 31/08/09 31/08/09 31/08/09 31/07/09 Tower House II Residential Home Version 5.2 Page 28 13 OP29 19 14 OP30 18(1)(c) 15 OP33 24 home provides (Repeated requirement-timescale and 31/08/08 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. (Repeated requirementtimescale 30/09/08 not met). The home must keep all the relevant records to demonstrate that it provides a high standard of training for its staff. The home must have in place a fully working quality management system. (Repeated requirement-timescale 31/03/08 and 31/10/08 not met). Care staff must be supervised at a minimum of six times a year or once every two months (Repeated requirementtimescale 31/03/08 and 31/10/08 not met). The provider must consider carrying out monthly water temperature checks to make sure that the thermostatic valves are working appropriately and that water is kept at a constant temperature to prevent scalding. There must be an up to date fire risk assessment to make sure that the risk of a fire developing is reduced to the minimum level (Repeated requirementtimescale 30/09/08 not met). The fire emergency plan must be dated and signed to show the date when it was carried out and DS0000068639.V375721.R01.S.doc 31/08/09 31/08/09 30/09/09 16 OP36 18(2) 31/08/09 17 OP38 13(4) 31/07/09 18 OP38 23(4) 31/08/09 Tower House II Residential Home Version 5.2 Page 29 19 OP38 13(4) 20 OP38 13(4) by whom. There must be a comprehensive health and safety risk assessment to address the identifiable risks that people who use the service may face (Repeated requirementtimescale 30/09/08 not met). All safety certificates must be renewed in a timely manner to ensure the safety of all people who use the premises. All records, such as the record for the weekly fire detector tests, must be made available for viewing during the inspection 31/08/09 31/08/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard OP1 OP7 OP9 OP11 OP12 Good Practice Recommendations The service that the home wishes to provide must be made clear in the service users’ guide. This document seems to refer to respite care and long term care. Records should be kept about the involvement of residents or of their representatives in drawing up and reviewing care plans and risk assessments. A list of sample signatures and initials of staff who administer medicines, should be made available in the medicines folder. There must be a care plan in place addressing the fears for the future and aspirations of residents, including the end of life care. That the life history that is completed for residents is presented in an easier to read format with the use of icons where possible, and is placed at the front of the care plan to bring a real person centred approach to the care plan. That a format to summarise the local induction of new members of staff to the home be put in place. DS0000068639.V375721.R01.S.doc Version 5.2 Page 30 6 OP30 Tower House II Residential Home Care Quality Commission London Region Citygate Gallowgate Tyne And Wear NE2 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.london@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Tower House II Residential Home DS0000068639.V375721.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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!